Expanding Post-Mortem Toxicology (PMT) Testing

According to the National Center for Health Statistics (NCHS), in 2015 Kentucky had the 4th highest drug overdose mortality rate in the U.S., with 1,144 Kentucky-resident drug overdose deaths in (27.0 drug overdose deaths per 100,000 population). In recent years, drug overdose-related mortality in Kentucky has shifted from prescription opioids to heroin and synthetic opioids, including fentanyl and its analogs. Synthetic opioids and fentanyl derivatives are not currently part of the standard laboratory testing protocol in Kentucky. Because fentanyl derivatives have different chemical structures than pharmaceutical fentanyl, the presence of a fentanyl derivative in a sample will not be detected by the standard drugs of abuse panel, which includes a test for pharmaceutical fentanyl. Instead, the lab must test for the specific derivative. Moreover, we have encountered cases in which there was probable cause to test for a specific fentanyl analog, and said analog was detected, yet neither fentanyl nor 6-mam was detected. This indicates that Kentucky’s standard post-mortem toxicological testing protocol will fail to identify some cases of fatal illicit drug use. The Enhanced State Surveillance of Opioid-Involved Morbidity and Mortality (ESSOMM) supplement provides an opportunity to expand comprehensive toxicology testing in Kentucky. This will accomplished in collaboration with the Kentucky Medical Examiners’ Office, which will use the supplemental funds to revise its standard testing protocol as described in this proposal. As a result of expanded testing, we expect to see an increase in positive toxicology findings for fentanyl derivatives, which will enable more effective and timely public health interventions to reduce morbidity and mortality caused by these substances.