The Mississippi Bureau of Narcotics believes the state faces a drug crisis, but has difficulty fighting the problem because some county coroners are slow with reporting deaths from drug overdoses. 

“People need to understand… that we are in fact in an epidemic related to opioids – whether it be heroin or prescription painkillers,” John Dowdy, director of the Mississippi Bureau of Narcotics, said. “It affects every socioeconomic class within the state of Mississippi and it knows no age.”

Nationwide, the Centers for Disease Control and Prevention reports that opioids – both prescribed and illicit – accounted for 33,091 U.S. deaths in 2015. The CDC reported 351 overdose deaths in Mississippi, 59 more than the Mississippi Department of Health reported and more than twice the 135 deaths the state narcotics bureau reported during the same time period.

The discrepancy comes from reporting methods. The CDC and the Mississippi Department of Health both obtain their numbers from death certificates. The bureau draws its numbers from coroners, enabling them to begin investigations immediately rather than waiting for a death certificate to be processed.

Though required by law to report overdose deaths to the MBN, the bureau said approximately six of the state’s 82 coroners reported their overdose deaths in 2015.

These numbers improved in 2016 when 27 coroners, roughly a third of the state’s coroners, reported 99 overdose-related deaths to the bureau. In addition to these reports, the bureau verified an additional 112 overdose deaths for a total of 211 overdose deaths in 2016, according to Dowdy.

“The majority of coroners throughout the state are not complying with the state statute and are not providing us that information. Which, in turn, inhibits our ability to get out there and potentially investigate these deaths,” Dowdy said. “It becomes a public safety issue because if we’re notified of that death we’re able to get in there and begin a criminal investigation… so we can potentially get this guy’s product off the street and get him in custody so nobody else in the community dies from it.”

Dowdy said Clarke, Coahoma, Copiah, DeSoto, Harrison, Hinds, Lafayette, Lauderdale, Lee, Leflore, Madison, Monroe, Neshoba, Panola, Pearl River, Pike, Pontotoc, Prentiss, Rankin, Stone, Tate, Tippah, Union, Warren, Webster, Winston and Yazoo Counties reported their overdose deaths to the bureau in 2016.

Dowdy said most of the coroners who report to the bureau come from heavily-populated places, though a few come from the state’s more rural areas.

By law, coroners must report overdose deaths to the MBN within 24 hours. But a lack of state funding for the state’s medical lab means coroners may not know the cause of death for months.

“In a case where we go out and it’s obvious – maybe we find a needle in somebody’s arm or we find drug paraphernalia or we find evidence that leads us to believe that this person probably died from a drug overdose then, sure, we can make that report within 24 hours of the investigation,” Derek Turnage, the Pearl River County Coroner and vice president of the Mississippi Coroners-Medical Examiners Association, said. “But if we’re investigating a case that we don’t know what the circumstances are… we may not know that we’re looking at a drug overdose. We may not suspect a drug overdose until we get that toxicology back. And with the current state of our crime lab and our medical examiners office right now, we’re underfunded. So, with being underfunded, it takes sometimes three to six months longer for us to get toxicology reports back.”

Turnage, one of the coroners Dowdy said complied with the reporting requirement, gave the example of someone who died of apparent heart problems and did not appear to be linked to an overdose.

“Sometimes we’ve got a person that suffers from severe heart disease – they have a medical history, they might have a history of some back injuries and they’re on normal, routine medication – narcotics – that they take every day. And we question whether (it’s) heart disease or congestive heart failure or is there a cause of death in that manner that is natural,” Turnage said. “We’re still not necessarily suspecting an overdose death in this situation, but it comes back that there’s high levels of whatever narcotic that they’re on. Which tells us, ‘Hey, this person accidentally took too many medications – too many narcotics.’ And then six months later – six months after the date of death or seven months however long it takes to get these reports back – then we find out that we’ve got a drug overdose death. Then it’s accidental and we are required by law to report that to (the bureau).”

Dowdy cited the experiences of agents in the field and his experience as director, saying “in the vast majority of situations in which a coroner is called to the scene of an overdose death, there is generally evidence present at the scene that would give them a good reason to believe that the death was the result of a drug overdose.

“My position is that if there is evidence at the scene that this was a potential drug overdose death I think the coroners – if they’re wanting to help with the solution to the problems that we’re facing – would at least pick up the phone and call the Bureau of Narcotics,” Dowdy said.

Once coroners received confirmation from toxicology, they could pass that information to the bureau.

“We are in an epidemic right now and the coroners are in a position to play a vital role in helping us try to combat this plague by not waiting until they get the toxicology. If there’s clear evidence there on the scene that it’s likely a drug overdose death – getting MBN involved in it at an early stage so that if we got a dealer in that area that’s dealing fentanyl-laced heroin we can potentially take investigative steps that will allow us to try to determine who the dealer is and try to get that person in custody,” Dowdy said.

One possible reason for the delay in reporting is the staffing shortage at the State Medical Examiner’s Office.

Coroners request autopsies through the State Medical Examiner’s Office. The three medical examiners perform more than 1,450 autopsies a year, according to the State Medical Examiner website.

Sam Howell, the director of the state’s crime lab, did not respond to requests for an interview. In an interview last month with Mississippi Today, however, he said, “We have three doctors doing the work of 12. We have had two doctors leave and three technicians because they were underpaid and overworked.”

Still, in the proposed budget for the next two years, the funding for the state crime lab continues to decrease, making it increasingly difficult for the crime lab to address its backlog of death certificates, process crime scene evidence, and complete toxicology reports.

“Again and again the story is lack of funding. Having to cut down on programs and cut down on the staffing that handles these cases when they come in. If the money’s not there, if they can’t access the money that’s there, things slow down in the state of Mississippi,” Turnage said.

Additionally, some coroners may not be aware of the statute.

“Maybe they just don’t know,” Clayton Cobler, the Lauderdale County Coroner, said.

Cobler, without prompting, said he reported overdose deaths to the bureau, though they occur rarely. Cobler estimated that one occurred “every few months” and confirmed the bureau’s reports of one overdose death in 2016 and three overdose deaths in 2015.

Dowdy and Turnage, like Cobler, didn’t have a reason why a majority of the state’s coroners do not report overdose deaths to the bureau.

“If I knew the answer to that question I’d win the lottery next month,” Dowdy said.

But three coroners and representatives from the Office of the State Medical Examiner proposed a new system last month for processing death certificates, as reported by Mississippi Today.

Coroners Sharon Grisham-Stewart, of Hinds County; Ricky Shivers, of Yazoo County; and David Ruth, of Rankin County, asked legislators to require that death certificates be processed online, reducing the time families might spend waiting for death certificates.

Unfortunately, this would require everyone to process records electronically, an obstacle that could hurt rural counties.

Turnage said funding for coroners comes from their respective county, not from the state. This means that in counties with smaller populations, coroners don’t receive the same funding as bigger counties and the position functions similar to a part-time job.

“Some coroners work two to three calls a month in some of the lower-populated, impoverished counties and they don’t have a lot of money to fund the office. So some coroners may be using the sheriff’s office fax machine (for work)… and then you’ve got counties with larger populations (that) have a lot more volume,” Turnage said.

Both Turnage and Dowdy recognized the need for improved communication between coroners and the MBN. Recently, Dowdy said he has assigned agents in each of his districts to act as a liaison for coroners. This agent is supposed to introduce herself or himself to each of the coroners in their district, approximately an eight-county area, and give their phone numbers.

Still, to Dowdy, one of the important goals of the MBN is to increase public awareness of the state’s drug crisis.

“This is a problem that can be addressed by law enforcement but it is not a law enforcement only problem,” Dowdy said.