Form 0920-1050 Customer Feedback Forensic Toxicology

Attachment 1: Customer Feedback Forensic Toxicology

OMB Control No. 0920-1050

Exp. Date 05/31/2022

The Division of Overdose Prevention at the Centers for Disease Control and Prevention (CDC), in collaboration with state health departments, would like to ask you about the forensic toxicology testing patterns that is used to investigate suspected drug overdose deaths. Answers will inform CDC efforts to support comprehensive forensic toxicology testing of suspected drug overdose deaths, particularly those involving opioids and other psychoactive substances. The information gathered by this survey will not be identified by individuals or offices responding. If you have questions about the survey, please contact [email protected].

Please read all questions carefully and answer as best as you ca. Some questions require you to check all that apply or provide text responses. You may need to consult with other people (e.g., contact at lab conducting testing) to answer all questions. You can save and leave the survey to complete later if needed.

Public reporting burden of this collection of information is estimated to average 30 minutes per respondent. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB Control Number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Information Collection Review Office, 1600 Clifton Road NE, MS D-74, Atlanta, Georgia, 30333; ATTN: PRA (0920-1050).

____________________________________________________________________________________

1. Indicate the job of the person(s) completing this survey. (Please check all that apply)

__Coroner

__Medical examiner

__Forensic pathologist

__Administrative staff

__Other, specify:_______________________________________

Background questions about your office: This section asks you to describe your office, including accreditation.

2. Select the state in which you work. If you work in more than one state, please list the state in which your primary office is located followed by the other state(s) in which you work:

(2 Drop-down menus with all states followed by a text box to list additional states)

3. Which of the following best identifies the type of office you work in?

__Medical Examiner office

__Coroner office

__Other, specify:_______________________________________

3a. [If Medical Examiner selected] Please specify the type of Medical Examiner in charge of your office (please select only one response):

__Medical Examiner – forensic pathologist

__Medical Examiner – other physician

__Other, specify:_______________________________________

3b. [If coroner selected] Please specify the type of Coroner in charge of your office (please select only one response):

__Coroner – forensic pathologist

__Coroner/Medical Examiner – forensic pathologist

__Coroner – other physician

__Coroner/Medical Examiner – other physician

__Coroner – non-physician/non-sheriff

__Coroner – non-physician/sheriff

__Other, specify:_______________________________________

4. What entity operates your jurisdiction’s death investigation system?

__City

__County

__State

__Regional (e.g., District)

__Other, specify:___________________________________________

5. Is your office accredited by any of the following? (check all that apply)

__National Association of Medical Examiners (NAME)

__International Association of Coroners & Medical Examiners (IACME)

__College of American Pathologists (CAP)

__Other: specify____________________________________________

5a. If your office is not accredited, is your office currently seeking accreditation or planning to seek accreditation in the future?

__Not seeking accreditation in near future

__Yes, currently seeking accreditation/obtained provisional accreditation, specify accreditation: ____________________________________________________________

__Yes, plan to seek accreditation in the near future, specify accreditation: _______________________

5b. [If “Not seeking accreditation” selected] Please list the top two or three barriers or challenges to seeking accreditation?

1. ___________________________________________________________________________

2. ___________________________________________________________________________

3. ___________________________________________________________________________

6. List the professional guidelines/standards you currently use for conducting autopsies and post-mortem toxicology testing (Please write “none” if no standards are used):

1. _______________________________________________________________________

2. ___________________________________________________­­­____________________

3. _______________________________________________________________________

7. What is the approximate number of drug overdose deaths (where any drug contributed to death) investigated by your office in 2019?

____________________________________________________________________________________

Forensic toxicology testing of a suspected drug overdose death: This section asks about the toxicology tests that are ordered for suspected drug overdose deaths (i.e., all drug poisonings).

8. In 2020, did your office order toxicology tests on suspected drug overdose deaths?

___Yes, my office orders toxicology tests [will continue with next question]

___No, another office in the state collects all specimens and orders tests? [will skip to #19]

9. Describe the laboratories your office uses to conduct toxicology testing of suspected drug overdose deaths (i.e., all drug poisonings) in 2020. Providing the names of the laboratories allows us to better identify opportunities to support forensic toxicology testing in the future.

Name of laboratory	Type of laboratory	Percent of specimens from suspected drug overdose deaths usually sent to this laboratory	How do you receive the results for most of the cases you send to this laboratory? (50% or more of cases)	Primary reason(s) for using this laboratory? (check all that apply)
	Drop-down menu: In-house laboratory (i.e., operated by ME/C Office), Referral/Send-out laboratory, Hospital laboratory, Crime laboratory, Other laboratory (specify):_______	Drop-down menu: 0-25%, 26-50%, 51-75%, 76-100%	Drop-down menu: Per-case paper (e.g., via mail), Per-case fax, Per-case electronic file, Aggregate electronic file, Other (specify)______	Checkboxes: __Accreditation __Cost __Convenience __Trust/reliability __Scope of testing __Mandated use __Other-specify: _______________

Toxicology testing policies for suspected drug overdose deaths in 2020

10. Identify the approach your office typically uses to order toxicology tests when investigating a suspected drug overdose death in 2020? (please select one response)

___ Conduct a screening test to determine what additional tests should be done (e.g., confirmatory testing).

___ Conduct a standard set of screening and confirmatory analyses offered by the laboratory. Additional tests are run rarely.

___ Conduct a standard set of screening and confirmatory tests offered by the laboratory, with additional analyses often done after receiving initial results (e.g., targeted testing for fentanyl analogs).

___ Other, specify:____________________________________

11. In 2020, how often does your office order targeted analysis for drugs/drug metabolites not included in screening and confirmatory testing (e.g., order additional testing for fentanyl analogs or synthetic cathinones that are not included on standard screening and confirmatory tests)?

___ Never (0%)

___ Rarely (1-33%)

___ Sometimes (34-67%)

___ Often (68-90%)

___ Almost always (91-100%)

Substance/substance class-specific testing: This section asks about which drugs are tested for during investigations of suspected drug overdose deaths as well as the type of specimens collected. Please answer for investigations conducted in 2020.

12. For each substance class and specific substances listed below, please indicate how frequently it is ordered for suspected drug overdose deaths:

    1. Never (0%)

    2. Rarely (1-33%),

    3. Sometimes (34-67%),

    4. Often (68-90%), or

    5. Almost always (91-100%).

If you are not sure how to answer these questions, please consult your forensic toxicologist.

Substance class and specific substances	Frequency of testing
	Drop-down menu: Never, 0%; Rarely, 1-33%; Sometimes, 34-67%; Often, 68-90%; Almost Always 91-100%
Volatiles Acetone, Ethanol, Isopropanol, Methanol, Others (e.g., inhalants)
Amphetamines Amphetamine Methamphetamine Methylenedioxymethamphetamine (MDMA)
Barbiturates
Benzodiazepines
Cannabinoids Cannabinoids (marijuana, THC) Synthetic cannabinoids (e.g., K2 or Spice)
Cocaine
Opiates/Semi-synthetic Opioids Common opioid medications (e.g., hydrocodone, methadone, morphine, oxycodone) Buprenorphine 6-AM (metabolite of heroin)
Synthetic Opioids Fentanyl Fentanyl analogs Other synthetic opioids (e.g., U-47700)
Opioid Antagonist Naloxone
Other Prescription Medications Anticonvulsants/anti-seizure (e.g., lamotrigine) Antidepressants (e.g., citalopram) Antipsychotics (e.g., quetiapine) Muscle relaxants (e.g., carisoprodol) Sedative-hypnotics (e.g., zolpidem)
New Psychoactive Substances (NPS) Cathinones Phenethylamines Piperazines Tryptamines Other NPS (e.g., designer benzodiazepines)
Specific Analytes Gabapentin Gamma-hydroxybutyrate (GHB) Ketamine Lysergic Acid Diethylamide (LSD) Mitragynine (Kratom) Phencyclidine Xylazine
Over-the-Counter Medications
Other Drugs, not mentioned above (list)

13. For each specimen source below, please answer two questions about its use in 2020 drug overdose death investigations:

    1. Preferred source for testing - Does your office want to test this specimen source for suspected drug overdose deaths (i.e., it is a preferred source for every case if resources were unlimited)?

    2. Often submitted for testing - Did your office often obtain and test the specimen source for suspected drug overdose deaths occurring in 2020 [i.e., tested specimen source for greater than 67% (roughly two-thirds) of suspected drug overdose deaths where possible]?
       
       

Specimen source	Preferred source for testing	Often submitted for testing
Blood-peripheral	__Yes __No __Don’t know	__Yes __No __Don’t know
Blood-central	__Yes __No __Don’t know	__Yes __No __Don’t know
Blood-other, post-mortem	__Yes __No __Don’t know	__Yes __No __Don’t know
Blood-antemortem (e.g., hospital)	__Yes __No __Don’t know	__Yes __No __Don’t know
Urine	__Yes __No __Don’t know	__Yes __No __Don’t know
Bile	__Yes __No __Don’t know	__Yes __No __Don’t know
Vitreous fluid	__Yes __No __Don’t know	__Yes __No __Don’t know
Stomach contents	__Yes __No __Don’t know	__Yes __No __Don’t know
Tissue (e.g., liver, kidney, brain)	__Yes __No __Don’t know	__Yes __No __Don’t know
Oral cavity fluid	__Yes __No __Don’t know	__Yes __No __Don’t know
Other-specify:_________________	__Yes __No __Don’t know	__Yes __No __Don’t know

14. Were there suspected drug overdose deaths in 2020 for which you were unable to perform all tests you wanted to run? (e.g., comprehensive testing for all novel psychoactive substances - NPS)?

__No

__Yes

1. If yes, how often in 2020 were you unable to perform all desired tests for suspected drug overdose deaths?

___ Never (0%)

___ Rarely (1-33%)

___ Sometimes (34-67%)

___ Often (68-90%)

___ Almost always (91-100%)

2. Provide the top three reasons you were unable to perform all desired tests for suspected drug overdose deaths in 2020.

   1. Reason 1:_____________________________________________________________

   2. Reason 2:_____________________________________________________________

   3. Reason 3:_____________________________________________________________

Turnaround time and cost of death investigations of suspected drug overdose deaths

15. In 2020, what is the average cost to perform toxicology testing per suspected drug overdose death investigation in your office? __________

16. How often is an autopsy performed for suspected drug overdose deaths?

___ Never (0%)

___ Rarely (1-33%)

___ Sometimes (34-67%)

___ Often (68-90%)

___ Almost always (91-100%)

17. After accepting jurisdiction, does your office experience substantial delays in conducting autopsies for drug overdose deaths?

__Yes

__No

18a. [If yes] Please list the top three barriers to conducting autopsies in a timely manner.

1. ___________________________________________________________________

2. ___________________________________________________________________

3. ___________________________________________________________________

From the date of death, in days:

18. For most cases, what is the turnaround time to obtain post-mortem toxicology testing results?

___ 30 days or less

___ 31 to 60 days

___ 61 to 90 days

___ More than 90 days

19. For most cases, what is the turnaround time from the date of post-mortem examination to determining cause of death and finalizing the report?

___ 30 days or less

___ 31 to 60 days

___ 61 to 90 days

___ 91 days to 120 days

___ More than 120 days

Your opinions/needs

20. Does your Medical Examiner/Coroner Office perceive any major gaps in your office’s toxicology testing procedures for suspected drug overdoses for 2020?

__No

__Yes

If yes, please describe: _________________________________________________________________

21. Did your office receive funding from your state health department as part of the CDC Overdose Data to Action grant?

___ Yes

___ No

___ Unknown

If yes, please describe how you are using the funds: ___________________________________

22. Would epidemiologic reports provided to you by your state health department on the drugs involved in overdose deaths every 6 months be useful?

__Yes

__No

__Don’t know

a. If yes, at what level? (Check all that apply)

__Local

__Regional

__State

__National

23. Do you have any additional requests or is there anything else you would like to share about your experience investigating suspected drug overdose deaths? open ended text box