Data-Based Method to Reduce Unnecessary Autopsies in Suspected Overdose Deaths

The New York City (NYC) Office of Chief Medical Examiner (OCME) continues to be severely impacted by the ongoing opioid overdose crisis with over 3000 overdose deaths in 2022 alone. The National Association of Medical Examiners (NAME) recommends that autopsies be performed in all suspected overdose deaths, but this practice is difficult to maintain in the face of an unprecedented number of overdose deaths and a national shortage of forensic pathologists. Using an existing database of suspected overdose deaths (SPOT) maintained by the OCME Drug Intelligence and Intervention Group (DIIG), we sought to assess the ability to correctly certify subsets of suspected overdose deaths based only on known history and circumstances, external examination, and toxicology testing (View-Tox) using 6 exclusionary criteria for View-Tox eligibility (suspicion of criminality, suicide, trauma, hypothermia/drowning, epilepsy/seizures, and death in a public location). This process resulted in the exclusion of all homicides, suicides, non-overdose accidents, and most undetermined manner deaths. Of the remaining cases eligible for View-Tox, 99.2% could be correctly certified based only on toxicology testing results and information known before autopsy. This approach to overdose deaths would have resulted in a 32.8% reduction of autopsies in suspected overdose deaths at OCME in 2022.