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Medical examiners struggle to keep up with autopsies for overdose deaths in NH

Hospital emergency sign in NH
Dan Tuohy
Hospital emergency sign in Portsmouth, NH.

Less than half of the people who died of suspected drug-related deaths in New Hampshire this year received autopsies. The National Association of Medical Examiners recommends that an autopsy be performed whenever a drug-related death is suspected.

The most recent data from the Office of the Chief Medical Examiner shows that there were 327 confirmed and 61 suspected drug overdose deaths in 2023 so far. 157 of the confirmed deaths and 30 of the suspected overdose deaths had autopsy examinations.

New Hampshire’s Chief Medical Examiner, Dr. Jennie Duval, spoke with NHPR’s Morning Edition host Rick Ganley about how a national shortage of forensic pathologists who can perform autopsies is affecting New Hampshire.


Your office investigates sudden and unexpected deaths in New Hampshire. Why is it important to perform an autopsy in a suspected drug overdose death?

An autopsy is the gold standard for determining cause of death. It can rule out other causes of death, or it may show something totally unexpected that caused the individual's death. So I have many, many examples of what were thought to be drug overdose deaths that came in for autopsy for various reasons, and the autopsy showed something completely different.

So I think that's important information that can be passed on to the family. And it's important information if there will be death resulting charges against whoever provided the drug. Because if it's not a drug intoxication death, we don't want to say that it is. And if it is a drug intoxication death, we want to be very sure.

So what are the issues that your office is facing that's making it difficult to perform autopsies on all suspected cases?

It's like many other agencies and businesses are experiencing -- it's a workforce shortage issue. We can't possibly keep up with the number of drug overdose deaths we see every year in this state, and it's been that way since about 2013. So we're currently staffed with just two. We will have a third pathologist joining us next summer if all goes well.

Is this part of a national trend?

Oh, yes.

And why is that?

There just aren't enough forensic pathologists coming through the pipeline. The training takes many years. And when graduates complete the training, there are many jurisdictions and offices like ours that are desperately trying to recruit those newly trained forensic pathologists. So it's just a matter of recruiting more medical students into the field. And I suppose the real answer would be to solve the opioid epidemic, but that seems to be insurmountable.

I imagine there's a big personal toll on that kind of a workload.

Oh, there is. It's long hours. You know, I think there's a misconception that all we do as medical examiners is investigate murders, homicide deaths. That's just 1% of our caseload. We are fortunate to live in New Hampshire, which has a very low homicide rate. So we do spend most of our time investigating other deaths. And that includes all of the accidents that occur in the state, all of the suicides that occur in the state, the sudden, unexpected natural deaths in young people or relatively young people without a medical history. So we do a lot more than just homicides.

What we've all experienced since the opioid epidemic began is that now a large proportion of those deaths, those other deaths, are drug overdose deaths. And it's every day. We see them every single day. And I think it does get discouraging. Every death that we investigate, I provide the toxicology results to these families. And it seems like almost a recording. Every day I tell these families that the cause of their family member's death was a drug intoxication, usually involving fentanyl, and that does take a toll.

And as you said, of course, solving the opioid epidemic ultimately would be the best thing for everyone. Do you see those numbers at all relenting?

I've just been reviewing more recent data. I think we'll have a few less overdose deaths this calendar year than we did last year, but it's still in the mid-400s at least. So it's still an unacceptable number of fatal overdoses. And that's the tip of the iceberg because there's many, many more non-fatal overdoses and there's many, many more persons out there who have substance use disorder.

Jackie Harris is the Morning Edition Producer at NHPR. She first joined NHPR in 2021 as the Morning Edition Fellow.

For many radio listeners throughout New Hampshire, Rick Ganley is the first voice they hear each weekday morning, bringing them up to speed on news developments overnight and starting their day off with the latest information.
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