One hundred seventy two deaths involving the use of oxycodone in Palm Beach County

Oxycodone is a potent semi-synthetic narcotic prescribed for the management of pain. Previous investigators have reported that the abuse of oxycodone is most frequently seen in conjunction with the abuse of other drugs, although fatalities have been reported with oxycodone alone. We undertook a retrospective review of cases investigated by the Palm Beach County Medical Examiner's Office in which postmortem toxicologic studies indicated the presence of oxycodone. A total of 172 consecutive cases were studied, including 18 in which death was attributed to oxycodone toxicity, 117 to combined drug toxicity, 23 to trauma, 9 to natural causes and 5 to another drug or drugs. The postmortem blood concentrations of oxycodone overlapped among the groups. The mean blood oxycodone concentration among the cases of oxycodone toxicity was 0.69 mg/L, combined drug toxicity 0.72 mg/L and trauma 0.62 mg/L. Concentrations were lower in cases of deaths attributed to natural causes and to another drug or drugs (mean each 0.087 mg/L). Benzodiazepines, detected in 96 cases, were the most common co-intoxicants in the cases of combined drug toxicity, followed by cocaine, which was found in 41. The most frequently encountered benzodiazepine was alprazolam. This study confirms that deaths in which oxycodone is a factor are most commonly cases of combined drug toxicity. The high incidence of alprazolam as a co-intoxicant has not been previously recognized.     

Projections of economic well-being for Social Security beneficiaries in 2022 and 2062

Policymakers considering potential changes to the Social Security program need to be able to assess how such changes would affect the economic well-being of future retirees. The first step to understanding these effects is to determine the well-being of future retirees under the current Social Security system. To this end, this article projects the retiree populations aged 62 or older in 2022 and 2062 using the Social Security Administration's MINT (Modeling Income in the Near Term) model and assesses their well-being. Because no one measure can fully capture whether future retirees will have adequate resources to meet their needs, we employ several indicators to assess retirement prospects. In addition, because current-law Social Security promises cannot be financed from current-law taxes, we project an alternative 2062 baseline that adjusts Social Security benefits downward to reflect the amounts that current-law taxes can support. Our results illustrate the importance of using several measures when assessing the well-being of future Social Security beneficiaries. When using absolute measures, retirement well-being will improve for Social Security beneficiaries in 2062 compared with those in 2022. Median per capita income of Social Security beneficiaries is projected to increase by a third (in real terms) between 2022 and 2062, with a corresponding decline in projected poverty rates. In addition, median financial wealth will increase between 2022 and 2062. Relative measures of well-being, however, suggest a decline in well-being between Social Security beneficiaries in 2022 and those in 2062. The share of beneficiaries who have low income relative to their peers, measured as the share whose income-to-needs ratio is less than half of the median ratio, will increase over time. In addition, income replacement rates are projected to fall between 2022 and 2062, indicating a decline in how well-being during retirement compares with that during the working years. And although median financial wealth will increase between 2022 and 2062, it will actually fall relative to economy-wide average wages. Projected improvements over time would lessen, and declines would be exacerbated, if instead of assuming the payment of currently scheduled Social Security benefits we assumed that benefits would be reduced according to what is payable under current-law taxes. Regardless of which measure of well-being is used, certain groups fare worse than others, including beneficiaries who never married, nonwhites, beneficiaries without a high school degree, and those with fewer years of labor force experience and low lifetime earnings. These vulnerable groups are likely to be more dependent on Social Security benefits for their retirement income. As a result, they fare particularly poorly under the assumption that Social Security benefits are reduced to reflect what is payable under current-law taxes.     

Comparison of presumptive blood test kits including hexagon OBTI

Four presumptive blood tests, Hexagon OBTI, Hemastix(R), Leucomalachite green (LMG), and Kastle-Meyer (KM) were compared for their sensitivity in the identification of dried bloodstains. Stains of varying blood dilutions were subjected to each presumptive test and the results compared. The Hexagon OBTI buffer volume was also reduced to ascertain whether this increased the sensitivity of the kit. The study found that Hemastix(R) was the most sensitive test for trace blood detection. Only with the reduced buffer volume was the Hexagon OBTI kit as sensitive as the LMG and KM tests. However, the Hexagon OBTI kit has the advantage of being a primate specific blood detection kit. This study also investigated whether the OBTI buffer within the kit could be utilized for DNA profiling after presumptive testing. The results show that DNA profiles can be obtained from the Hexagon OBTI kit buffer directly.     

Sudden unexpected death due to a previously undiagnosed plasma cell dyscrasia

The plasma cell dyscrasias are a diverse group of disorders characterized by the production of a clonal paraprotein. Sudden death is a recognized complication of the plasma cell dyscrasias, most commonly in individuals with cardiac involvement by amyloidosis. However, the current forensic literature has no reported cases in which sudden death resulted from complications of a plasma cell dyscrasia that was first diagnosed by postmortem histologic examination. We present the case of a woman whose sudden and unexpected death resulted from a seizure. Postmortem examination revealed no evidence of trauma or a grossly identifiable natural disease process that would have accounted for her death. However, microscopic and immunohistologic studies revealed a previously undiagnosed plasma cell dyscrasia, the clonality of which was determined by immunohistochemical studies for immunoglobulin light chains, that was not associated with amyloid deposition. This case elucidates a previously unrecognized cause of sudden unexpected death and illustrates the importance of microscopic studies in selected cases examined in medical examiner/coroner offices.