National Association of Medical Examiners (NAME) Position Paper on Opioid-Related Deaths

National Association of Medical Examiners (NAME) Position Paper on Opioid-Related Deaths

The Centers for Disease Control and Prevention (CDC) engaged CDC’s federally funded research and development center (FFRDC) – known as the CMS Alliance to Modernize Healthcare — to support the National Association of Medical Examiners (NAME) to update the recommendations for investigating, diagnosing and certifying opioid-related deaths. Research Triangle Institute (RTI International), an alliance partner of the FFRDC, led the project to revise recommendations described in the 2013 position paper from the National Association of Medical Examiners (NAME) [1]. The revised recommendations are intended to cover the new face of the opioid crisis more fully, including emerging synthetic drugs and interpretation of deaths involving multiple drugs.

A course titled Investigation & Certification of Drug Toxicity Deathwas created as a training resource. This training course includes four modules focusing on the following objectives:

  1. Identify the key investigative stages that teams use for conducting a necessary and appropriate death investigation when there is a suspected drug-related death.
  2. Describe best practices and challenges related to performing autopsies when there is a suspected drug-related death.
  3. Describe the best practices and challenges associated with using toxicological testing for establishing the cause of death.
  4. Explain the essential components for consideration when determining the cause and manner of drug-related deaths.

This training offers:

    • 3.75 AMA PRA Category 1 CME Credits
    • 0.4 IACET CEU’s
    • 3.75 ABMDI Credits

To access training for CME through AMA click here.
To access training for ABMDI credit click here.

In support of this effort, RTI worked with NAME to establish a working group of ME/C experts. This working group was charged with improving the information reported on deaths by refining existing recommendations. Discussion focus was placed on evidence-based recommendations for the practice of death investigation and autopsy, toxicological analysis, interpretation of toxicology findings, and death certification. The following subject matter experts participated in the working group:

Gregory G. Davis, MD, MSPH (Lead Author)
Associate Coroner/Medical Examiner
Jefferson County Coroner/Medical Examiner Office
Professor of Pathology at the University of Alabama at Birmingham
Margaret Warner, Ph.D. (Ex-Officio)
Health Scientist
National Center for Health Statistics
Centers for Disease Control

Emma R. Hall
Boulder County Coroner’s Office


Eric Tonsfeldt
Deputy Medical Examiner
Clackamas County Medical Examiner’s Office
Department of Disaster Management

Craig Thomas Mallak, MD
Chief Medical Examiner
District 17, Broward County, FL

Agnieszka Rogalska, MD
Deputy Chief Medical Examiner
Dane County Medical Examiner’s Office


Kent E. Harshbarger, MD, JD, MBA
Montgomery County Coroner’s Office

Thomas P. Gilson, MD, FCAP
Medical Examiner and Executive Director
Regional Forensic Science Laboratory
Cuyahoga County Office of Medical Examiner

Jerri L. McLemore, MD
Associate Professor of Pathology
Medical Director, Autopsy Service
Department of Pathology
Wake Forest University School of Medicine


Owen L. Middleton, MD
Assistant Chief Medical Examiner
Hennepin County Medical Examiner’s Office

Corinne L. Fligner, MD
Emeritus Professor,
Department of Pathology
University of Washington School of Medicine, Seattle, Washington

Robert A. Middleberg, Ph.D., F-ABFT, DABCC
Sr. Vice President of Quality Assurance and Operations
National Medical Services, Inc.


Robert Kronstrand, Ph.D. (Pending Approval)
Research Strategist
National Board of Forensic Medicine
Department of Forensic Genetics and Forensic Toxicology

Jeff P. Walterscheid, Ph.D., F-ABFT
Chief Toxicologist
Armed Forces Medical Examiner System

Amy B. Cadwallader, PhD
Director, Science and Drug Policy
American Medical Association


Ruth E. Winecker, Ph.D., F-ABFT
RTI International
Center for Forensic Sciences

Lewis S. Nelson, MD
Professor of Emergency Medicine
Chair, Department of Emergency Medicine
Chief of Service, Emergency Department, University Hospital
Rutgers New Jersey Medical School





Acknowledgement: We would like to express great appreciation to all the individuals who made this project possible. We would like to offer special thanks to Dr. Daniel Dye of the University of Alabama at Birmingham School of Medicine, who provided extensive knowledge and expertise to the content development for this training. We would also like to thank the National Association of Medical Examiners (NAME) for their support during the development of the position paper and this training. We are particularly grateful for the assistance given by the CDC staff who worked so hard on this project, including Dr. Margaret Warner and Dr. Kelly Brown. We also wish to acknowledge the help provided by the pilot test participants’ who volunteered to evaluate the training, to ensure its effectiveness.

[1] Davis, G. National Association of Medical Examiners Position Paper: Recommendations for the Investigation, Diagnosis, and Certification of Deaths Related to Opioid Drugs. Available at:

Approved for Public Release; Distribution Unlimited. Public Release Case Number 19-0135
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