Dr Lindsey Haldiman: \"Taking these pills laced with fentanyl is like playing Russian Roulette.Jackson County Chief Medical Examiner Dr. Lindsey Haldiman, D.O.

Fentanyl: A Medical Examiner's Perspective


TUESDAY, JANUARY 23, 2024

Editor's Note: Dr. Haldiman became Chief Medical Examiner of the Jackson County ME's Office in September of 2023, after previously serving as the Deputy Chief ME (August 2019 - September 2023) and Deputy ME (July 2016 - August 2019). The following is her first-person account of the fentanyl overdose crisis.

“What’s the worst thing you’ve ever seen?”

It’s a question I am asked frequently. As a medical examiner, working in a busy office serving a metropolitan area, I have seen things unimaginable for most other people. When I provide examples of some of the “worst” things I have seen, I am usually met with stunned silence.

But those of us who’ve chosen a career in forensic death investigation quickly develop coping mechanisms. We accept what we have to see—what we have to look at—as part of our jobs.

The cases that are the most difficult for me to accept, though, are deaths that could have been easily prevented. Deaths like those caused by fentanyl overdoses.

700% Increase In Fentanyl-Related Deaths

From 2018 to 2022, the Jackson County Medical Examiner’s Office saw more than a 700% increase in deaths due to fentanyl, from 23 deaths in 2018 (an average of one every 16 days), to 189 in 2022 (an average of one every other day). And all these deaths were completely preventable.

Fentanyl does not discriminate. I’ve seen deaths from fentanyl in individuals 10 months of age to 73 years old. 

I’ll spare you the details about the chemical properties of fentanyl. What’s most important to know about fentanyl is that it’s killing people—people of all ages, races and genders. 

Fentanyl is extremely potent. Fifty times more potent than heroin! That potency makes it highly addictive, but also potentially lethal in one single use. 

Yes, it is a medication—administered in microscopic doses under carefully controlled conditions—that can alleviate severe pain. But this synthetic opioid is now being commonly mixed with other drugs and to also manufacture counterfeit prescription drugs. Illicit drug manufacturers are not interested in quality control. Some of the drugs and fake pills they sell will contain larger amounts of fentanyl than others.

When little hands can get hold of fentanyl-laced counterfeit pills the results can be tragicTRAGIC COMBINATION — When little hands can get hold of counterfeit pills laced with fentanyl, the outcome can be tragic. Nine children under 3 years old have died due to fentanyl-related overdoses in Jackson County during the last five years.

First Use Could Be Fatal

Which pill will contain a fatal amount? Taking these pills or other drugs laced with fentanyl is like playing Russian Roulette. Eventually, the outcome will be death. The first time you “play” might kill you.

Most of the fentanyl deaths I see in our office are individuals less than 40 years of age. They’ll often be found in their homes in bed with a large amount of dried foam around the mouth and nose.  Drug paraphernalia may be next to them, an indication they’d used the drug and laid down—never to rise again.

Fentanyl overdose victims slowly suffocate from the edema fluid building up in their lungs secondary to the respiratory depression caused by fentanyl. Their lives are literally drowned out. Their bodies are zipped up in body bags and transported to the Medical Examiner’s Office, where they are placed on a metal slab, undressed, photographed and autopsied.

Somewhere outside of the Medical Examiner’s Office, there are grieving family members—forced to face the reality that they will never see their deceased loved one again— being consoled. They are in shock and cannot believe their loved one is gone.

I don’t want to continue seeing so many of these deaths—too many lives becoming a statistic, ending due to the awful misuse of this drug. Even for a medical examiner, it is difficult to cope knowing each and every one of these deaths was preventable. None of these lives needed to end this way.

The Grim Statistics

Opiate-related overdose deaths in Jackson County have been rising at an alarming rate in recent years—in line with national trends related to the increased use of fentanyl.

This chart was compiled from autopsies performed at the Jackson County Medical Examiner's Office from 2018 through last year:

Opiate Overdose Death Cases In The Jackson County Medical Examiner's office

The death toll for this six-year period stood at 662 through November 20, 2023—with more likely to be added as the ME Office waited for final toxicology reports from late 2023 to be finalized.

The official "Manner of Death" was an "Accident" in all but 27 of these 639 deaths. Under "Cause of Death" the synethic opioid fentanyl is listed in no fewer than 546 of cases. It has often been mixed with at least one of other drug:

  • "Acute fentanyl intoxication"
  • "Cocaine and fentanyl intoxication"
  • "Fentanyl and ethanol intoxication"
  • "Toxic effects of heroin, fentanyl and clonazepam"
  • "Multidrug intoxication (oxycodone, fentanyl, and methadone)"
  • "Fentanyl and methamphetamine intoxication"

The dead include nine children 2-years-old or younger.

  1. Get The Fentanyl Facts_365
    'If you can see it...
    it can kill you!'
    • Is it really true that a small dose of fentanyl—"if you can see it, it can kill you"—can be fatal?
    • Can fentanyl be 50 to 100 times more potent than heroin?
    • Are you willing to bet your life the "prescription" pill sold or given to you illegally isn't counterfeit and laced with a lethal dose of fentanyl? (If it does contain fentanyl, the odds are the amount of fentanyl will be enough to cause a fatal overdose).
    • How is fentanyl used in medical treatments?
    • Is it true that fentanyl-involved overdoses are now a leading cause of death among young adults?

    Get the answers. Spread the word. Warn those you know and love!