This document summarizes a presentation on investigating and prosecuting drug-related homicides. It discusses signs that can indicate an overdose death, such as the presence of drugs, track marks, and foam coming from the mouth. It emphasizes treating the death scene like a homicide scene by thoroughly photographing and collecting all potential evidence. This includes searching for drug packaging, needles, phones and surveillance footage. The document also outlines interviewing witnesses to build a timeline and identify the victim's source of drugs. It suggests attempting a controlled buy from suspects to obtain contemporaneous drug samples and strengthen cases.

1. Drug-Related Deaths: Investigation,
Prosecution and Review Strategies
Presenters:
• Patricia Daugherty, JD, Assistant District Attorney, Milwaukee
County (WI) District Attorney's Office
• Michael Baier, Overdose Prevention Director, Maryland
Department of Health and Mental Hygiene
• Erin Haas, MPH, Overdose Prevention Local Programs Manager,
Maryland Department of Health and Mental Hygiene
Law Enforcement Track
Moderator: Connie M. Payne, Executive Officer, Department of
Specialty Courts, Kentucky Administrative Office of the Courts, and
Member, Operation UNITE Board of Directors

2. Disclosures
Michael Baier; Erin Haas, MPH; Patricia
Daugherty, JD; and Connie M. Payne have
disclosed no relevant, real, or apparent personal
or professional financial relationships with
proprietary entities that produce healthcare
goods and services.

3. Disclosures
• All planners/managers hereby state that they or their
spouse/life partner do not have any financial
relationships or relationships to products or devices
with any commercial interest related to the content of
this activity of any amount during the past 12 months.
• The following planners/managers have the following to
disclose:
– John J. Dreyzehner, MD, MPH, FACOEM – Ownership
interest: Starfish Health (spouse)
– Robert DuPont – Employment: Bensinger, DuPont &
Associates-Prescription Drug Research Center

4. Learning Objectives
1. Identify strategies for investigating and
prosecuting drug-related homicides.
2. Explain how multiple tools can be utilized to
build prosecutable cases.
3. Describe how Overdose Fatality Review can
make recommendations for law, policies and
programs.

5. Drug-Related Deaths: Investigation,
Prosecution, and Review Strategies
Patricia Daugherty
Assistant District Attorney—Milwaukee Co.

6. Financial Disclosure Statement
ADA Patricia Daugherty has disclosed no
relevant, real or apparent personal or
professional financial relationships with
proprietary entities that produce health care
goods and services.

7. Learning Objectives:
1. Identify strategies for investigating and
prosecuting drug-related homicides.
2. Explain how multiple tools can be utilized
to build prosecutable cases.

8. Intro
• Assistant District Attorney for 8 years
• First 2 years as Violent Crime/Felony Drug ADA
• Last 5+ assigned to WI HIDTA
– Focusing on RX Drug cases, Pharmacy Robberies,
Higher-level heroin trafficking, and overdose
death prosecutions

9. Overview
• Overdose Stats/Why These Cases Matter
• Investigative Techniques & Building a Case
• Use of Illustrative Case Studies

10. Why Are We Here?

11. 2013: 38,851 PEOPLE DIED FROM
DRUG OVERDOSES IN THE US
…But what about in Wisconsin?

12. Milwaukee County
• 2009: 127 Fatal Drug Overdoses
• 2014: 249 Fatal Drug Overdoses
• A 96% increase in deaths in 5 years
• Approx. 3.5x the number of traffic deaths

13. 38,851 US Deaths-2013
• Given the US POP  12.3 deaths/100,000
• Milwaukee has 956,406 people
• Meaning our OD death rate = 26
deaths/100,000

14. Legal Standard
• So-Called “Len Bias” Homicides
• State Statutes Differ…so confer with your local
prosecutors about the law in your state
• I’ll use Wisconsin law as an example, but the
basics should be the same…

15. First Degree Reckless Homicide
• 940.02(2)a
• Whoever causes the death of another
– By manufacture, distribution or delivery of a
controlled substance (Sch. I or II or analog or
Ketamine/ flunitrazepam) if another human being
uses the controlled substance and dies as a result
of that use.

16. Len Bias Homicide
• We have to prove:
– Target delivered a substance
– The substance was a CS
– Target knew it was a CS
– Victim used that CS
– And died as a result of that use
• Died as a result = Drug was a substantial factor
in the death

17. Conclusion
• Again, your local laws likely differ
• However, at the core, you will have to prove
that:
1. Your target delivered a drug
2. Your victim used that drug
3. Your victim died from using that drug

18. HOW DO WE KNOW IT’S A
LIKELY OVERDOSE DEATH?

19. OVERVIEW:
Signs of Overdose
• Presence of Drugs/Drug Paraphernalia
• Deceased has drug history
• Evidence on phone (drug-related texts)
• Witnesses report that deceased was snoring
loudly prior to death
– Loud Snoring is not a positive sign, it is a sign of
respiratory distress!
• Physical Appearance/Evidence…

20. Foam Cone
• Opiates = Central Nervous System (CNS)
depressant
• Decrease in heart rate and breathing  fluids
gathers in lungs
• People drown in their own fluids.
• “Foam Cone”

21. • Common features
– Pulmonary congestion
and edema
– “Foam cone”

22. Milwaukee Deaths
2014 % of Deaths
Cocaine Only 19/249 7.6%
Cocaine Present 60/249 24.1%
Heroin Only 52/249 20.9%
Heroin Present 116/249 46.6%
Combo Heroin and Cocaine 14/249 5.6%
RX Drugs Only 96/249 38.6%
RX Drugs Present 163/249 65.5%
Combo Heroin/Cocaine/RX 11/249 4.4%
Opiates Present 223/249 89.6%
Morphine Present 31/249 12.4%
Fentanyl Present 15/249 6.0%
Oxycodone Present 82/249 32.9%

23. • “Track Marks”
• Recreational drug use
• Therapeutic
administration

24. Preliminary Investigation:
DEATH SCENE

25. EVIDENCE RECOVERY OVERVIEW
• Scene Search: If suspected OD death,
toxicology not back for 10-12 weeks
• Person and Area
– Include garbage and ashtrays
– Friends/Family may have “cleaned” area
• Vehicles
• SEIZE PHONES and/or obtain numbers

26. First Steps
• Treat an overdose scene as a homicide scene from
the beginning.
• All too often, evidence is lost because the scene is
not secured or properly processed.

27. First Steps At The Scene
• Photograph and document the scene as you
would with ANY homicide case.
• Take photos of:
• the body as it was found and then once moved
• Frequently, items of evidence are located underneath
the body (baggies, cookers, etc.)
• The scene (overalls) before, during, and after
search

28. First Steps
• Look for drug packaging (corner cuts, etc.)
• Check trash, toilet bowl, etc.
• It is possible to do a quantification of a drug sample to
determine the “cut” of the drug. This can later be
compared against any drugs you might obtain from
your target via a controlled buy.
• Bag each item separately & wear gloves
• Search everywhere

29. Don’t Advertise…
• Consider NOT having squads visible on the
street…may try to do a CI buy later.
• Better chance of successful buy if the target
isn’t aware of the death

30. Searching The Scene
Once you can lawfully search, what
should you look for?

31. First Steps
• Look for method of ingestion
•Syringe, mirror with residue, etc.
• Any relevant paraphernalia
•cooking tins, hose clamps/ grinders, etc.
• Process items for fingerprints/ DNA

32. Packaging Material
• It is possible to have the packaging analyzed
for prints/DNA
• Also possible to have residue drug-tested
• If DNA/Prints are absent, the kind of packaging
used can connect a death to your target
– i.e. the target sells in plastic corner cuts, etc.

33. SYRINGES
• Crime Lab can do a chemical
test/wash for heroin or substance
used
• We can also submit for
fingerprints/DNA as necessary.

34. Narcan
Naloxone Hydrochloride
• Naloxone prevents and/or reverses the effects of
opiates, especially the respiratory depression
• Needle exchange provides free doses of Narcan
• Does NOT remove the opiate from the system
and users can “rebound” into an OD

35. Narcan
• Look for evidence of Narcan use at the crime
scene
• This may be evidence that your victim was
with someone prior to their death.
• Rebound ODs are common
• It can also impact your timeline

36. Scene Search:
Electronic Devices
• More on this later, but these are extremely
important to take during your search.
• Look for cell phones, tablets, and other
devices (watch phones, Google Glass,
beepers?)
• If Apt. complex or surrounded by businesses,
look for surveillance footage. May capture
video of supplier and/or car.

37. Searches: Conclusion
• Remember: The scene may have been
cleaned.
• Look in common area dumpsters, etc.
• If applicable, seek consent to search the
personal property (purses/bags/cars) of
anyone on scene.
• They may try to remove relevant evidence
from the scene.

38. Interviews

39. INTERVIEWS OF WITNESSES
 Start Immediately
 Record whenever possible.
 Build a 24-48 hour timeline
 Gather historic information on
Victim

40. Witnesses
• What did they see? Did they witness the
buy/use? Who else was present? Who does
Vic use with? When did they last see Vic
prior?
• Are they (Witness) a user? Track marks? Did
they go with the Vic to get drugs?
When/Where? Can they do a buy?
• Obtain their phone #’s and consent to search
if they are willing.

41. Interviews….
• Knowledge of Victim’s Use (Snort, IV, etc.)
• Knowledge of drug combinations
• Illicit
• Prescription
• Victim’s Previous Overdoses
• Do they know Vic’s Source(s) of supply, friends
– phone numbers, street names, Facebook,
etc.
• Who are Vic’s doctors, pharmacies

42. CREATE TIMELINE
• Interviews
• Telephone Records
• Receipts
– gas, restaurant, bank…
• Surveillance Videos
– often deals at public places
• Physician/Pharmacy Records

43. Interviewing The Suspect
• Try to be as specific as possible about their
dealings with victim. When and where did the
transaction occur? Amount bought and $.
• Did they middle the deal? Co-user?
• You don’t have to tell them that victim is deceased
if they are unaware.
• Will they consent to a search of their phone,
house, car, etc.?

44. Interviewing The Suspect
• Ask about their business (how many people
do they supply, phone numbers used, how
long selling/using, how do they package their
drugs)
• Who is their supplier? Photo arrays if relevant.
How much do they get from supplier and how
often? How is contact made? How is payment
made?
• Are they willing to cooperate if approved?

45. Arranging for Controlled Buys

46. First Steps
• If you have a suspect, it is advantageous to
attempt to do a recorded controlled buy ASAP.
• This will give us a case against him while we wait for
the ME’s determination (and possibly keep him in
custody)
• It will be extra leverage in negotiating a resolution
• Can obtain a contemporaneous sample of dealer’s
drug (if not RX) which can be compared with the cut
from your scene of death. Can be like a fingerprint.

47. First Steps
• You can get the suspect to confirm the
delivery in the overdose case
• For ex: “Do you have any of that stuff you gave me
and [the deceased] on Sunday night? It was really
good.”
• It is best to do this ASAP, preferably before
your target knows the victim has died. That
tends to spook them a bit.

48. First Steps
• If your victim utilized text messages to contact
their supplier, consider using the victim’s cell
phone to send messages to the target
• You may be able to set up a buy/bust without
using a CI

49. Buys
• If your CI has a regular pattern of ordering
from their supplier, it might be
advantageous to have them do an order up
so as to not raise the supplier’s suspicion.
• Heroin users are creatures of habit and their
suppliers will become suspicious if they miss
too many “appointments.”
• Be aware of this if trying to work someone after you
have had them in custody

50. Buys
• If you do get a buy—Video and Audio Record
it. This is a homicide case. The jury will not
be sympathetic to excuses
• On recording, try to have CI reference prior
deal (date)
• This buy can help us establish patterns
• Working off same phone # as dealer in OD
• Drugs are packaged in same material (signature, etc.)
• It is also good leverage

51. Tying your suspect to the phone
used in the homicide is crucial
•Buys can help with this
•Better than “subscriber info” because it
puts the target in physical control of the
device.

52. Can’t Get a CI/Buy
• If you can’t get someone to do a buy or it
doesn’t work out:
• Consider garbage pulls, surveillance of
target/pretext stop when we believe he has
scored, etc.
• If it is a known target or we have a phone number,
check with HIDTA to see if they have had any
contact or intel.

53. Can’t Get a CI/Buy
• With Target’s phone records, develop “Top 10”
list of customers
• Build case on customers (traffic stops, drug
paraphernalia, etc.)
• Flip the customers on their supplier

54. Court Orders and Records
 This section will detail the kinds of
orders/evidence/data we can get
 The following section will discuss what
analysis is available once we lawfully obtain
the evidence/records/data

55. Cell Phones
Often the Most Important Piece of
Evidence

56. Cell Phones
• In many cases, you will locate cell phones at
the scene of the death.
• Phones can be invaluable in building your case
and identifying your suspect(s)

57. Phones & Timelines
• Once we ID a target who delivered drugs to
our victim:
• We want to show that the victim did not obtain
also drugs from ANOTHER source
• Phone records can show that the victim did not
have drug contacts AFTER getting drugs from the
target.

58. Phone Searches
• Often, you may need to get a warrant to
search the victim’s telephone.
• I recommend a sealing motion/order

59. Passcodes
• HIDTA, etc. can defeat some passcodes, but
not all. THIS IS ALWAYS CHANGING
• Ask the family/friends if they know the
passcode
• Importance of preservation letters

60. First Steps
- Send preservation letters for text messages and
cell tower information ASAP
- Obtain SW to search any relevant phone
recovered and obtain subpoena/warrant for call
records and subscriber information as needed
- Request that records be provided with a certification
from the phone company. This will save a lot of
headaches at trial.

61. Content
• Supplier’s phone/phone records will reveal
their other contacts (customers, etc.) from the
incident date. You can locate and interview
those people to establish your target’s
possession of the target phone
• The physical phone search is your best shot at
getting useful text message content.

62. For Example:
From: Victim To: Supplier
From: Victim To: Supplier
From: Supplier To: Victim

63. Court Orders For Records
• Your state statutes will differ, but…
• The phone company will require a court order to
produce these records.
• What follows references WI statutes, but is
applicable to all orders

64. Text Messages…
• Call company immediately
• How long are messages kept ?
• Preservation Letter (on letterhead)
• Need a warrant for text content/cell tower
data

65. Retention Periods Vary
Some companies don’t keep text
content at all, while others keep it
for only a few days

68. Other Court Orders

69. Other Orders
• GPS on your suspects’ cars.
• Trap/Trace/Cell Tracker
• Warrant for computers
• Warrant for Social Media
• Order for PDMP

70. Cell Tracker
• Track the location of the phone (similar to
a ping order)
• Useful if you know the number used by
your dealer, but not their location/identity

71. GPS
• A warrant allowing for the
installation/monitoring of a
tracking device
• Can lead to the identification of
your target’s stash houses
• Can also show target travelling to
re-supply

72. Social Media
• Many social media platforms have chat and/or
email features
• Won’t be accessible to the public
• Warrant for Content
• Preserve publically available social
media/YouTube content

73. PDMP Records
• PDMP = Prescription Drug Monitoring
Program
• Basically, every time a RX for a Scheduled CS is
filled, a record is transmitted to a state
database
• We can get that info with a valid court order**
** You may not need an order in your state

74. AUTOPSY AND TOXICOLOGY
I am not a doctor, but…

75. Toxicology
• Cause of Death can be 1 drug or a “Mixed
Drug” overdose
• Three Common Examples
• Mixed Drug
• Heroin OD
• “Morphine” OD

76. Toxicology Examples

79. • 7 different
substances
• Don’t have to
prove Heroin =
Sole cause, only
SUBSTANTIAL
FACTOR in the
death

82. • Presence of Morphine & 6-MAM =
Heroin OD
• Nothing but Heroin metabolizes into
6-MAM
• Codeine frequently found too

84. EVEN WITHOUT 6-MAM, WE CAN
STILL PROVE IT WAS HEROIN
…a look at “Morphine” overdoses

88. • Morphine OD NOT Heroin OD
• Absence of 6-MAM, but presence of
Morphine
• We prove the Morphine came from
heroin through other evidence
• Testing of drug paraphernalia, text messages,
etc.

89. Case Studies
• Not just “war stories”
• Included here to illustrate implementation of
the strategies discussed earlier
**All defendants not yet convicted are
presumed innocent of all charges

90. State v. Defendant TJ
• Two Deaths (VD. and TS.)
• 25 days apart
• Both “Morphine” ODs

91. Implementation of Investigative
Strategies
• Store (Walgreens) Security Footage
• ALPRS
• Phone Dumps
• Phone Mapping
• Jail Calls
• Utilities Searches
• Phone Frequency Charts + Common Calls
• Facebook

92. TS Death
• Early December 2013
• Uncle visiting his Nephew and Nephew’s
friend in the dorms
• Bought heroin from “Playboy” at 414-841-
6135
• Nephew & Friend testified at trial for the State
• “Playboy” only sold $50 bags and only sold
knotted topped baggies

93. TS Death
• Deal took place at Walgreens in parking lot
• Video showed Playboy arriving in dark 2 door
car with hubcaps
• We brought in a car expert who could ID it as
a late 90’s Olds Achieva.
• ALPRS found a car listing to TJ.

94. Still Photo of Target Vehicle

95. Mapping Put Playboy’s Phone at
Walgreens at the time the Achieva is
on camera

96. Witness IDs
• Both Nephew & Friend ID Def. as the supplier
that night known to them as Playboy
• Both ID his phone number (burner phone) as
414-841-6135
• Phone records from Nephew & Friend show
hundreds of calls to this number in the
months leading up to death…corroborating
their connection to Playboy/ID of Def.

97. Victim VD
• About 25 days later, VD is found deceased
• Body not found for about a week

98. VD
• Military Vet, injured overseas…became
addicted to pain pills at the VA
• At the VA, met another Vet (AB) who would
later middle the fatal deal between VD and
Def. TJ

99. VD was found approximately 7 days after her
death, by a roommate…

100. Date of Death
• ME can give an approximation, but not 100%
• Look at phone patterns:
– She sent 100s of texts every day, but they stopped
entirely within an hour of her contact with TJ.
Same with Facebook
– Missed calls started piling up at the same time
• Med taker…pill calendar--SMTWTHFS

101. VD
• Phone Dump  Texts between VD and ABRemember: College witnesses said their dealer only sold $50
bags. Same thing here.
Additional texts set up AB picking VD up
AB’s phone records show her calling her dealer thereafter

102. VD
–AB provided information on her heroin
supplier known to her as “Memphis” at phone
number 414-722-5218
• Dump of her phone  Contact = Def. TJ
• Admitted to buying the heroin from Def. TJ at
his residence

103. Mapping

104. Utilities
• WE Energies records list TJ as the subscriber
for the address ID’d by AB as the location of
the deal
• Mapping puts the “Memphis” phone in that
area at the time of the contact with AB/VD

105. Facebook Photos

106. Two Phones
• Two Different Phones were used in the two
deaths.
– “Playboy” is 841-6135
– “Memphis” is 722-5218
• 18 common contacts
• AB’s number in both phones
• CLEARLY not two unrelated #s!

107. Two Phones
• Also showed that there were numbers that
would call 1 phone, get no answer, and then
call the other
• Clearly connected, notwithstanding both are
“burner” phones

108. Jury Trial
• West Allis and UW-Milwaukee witnesses
testified (proffer agreements)
• Expert Witness testified on suspect vehicle
• Officer/Investigators testimony
• HIDTA Analyst – cell phone mapping
• West Allis Analyst – frequency and common
calls
• Medical Examiner testified to cause of death

109. Jury deliberated after a week-
long trial and finds TJ guilty of
all charges…

110. …in about 45 minutes

111. Sentencing

112. Thank You - Family

113. Take Aways…
• Shows that lots of little things can add up to
build a very solid case
• When you have “users” who will testify, juries
want CORROBORATION…
• Why should they believe this “heroin addict”?
• Because all of these phone records, utility
records, store video, cell tower data, etc.
backs them up.

114. Email me if you want…
• “Cheat Sheet” for OD investigations
• Longer “Best Practices” Guide
• Telco Info & Retention Periods
• Sample Preservation Letter
• Sample WI Warrant for Cell Records

115. Thanks/Questions

116. CONTACT INFO:
A.D.A. Patricia I. Daugherty
Milwaukee County District Attorney's Office
T: (414) 278-5183
Patricia.Daugherty@da.wi.gov
Thanks again to Det. Nick Stachula

117. Overdose Fatality Review
in Maryland
Michael Baier
Overdose Prevention Director
Maryland Department of Health and Mental Hygiene
Erin Haas, MPH
Overdose Prevention Local Programs Manager
Maryland Department of Health and Mental Hygiene

118. Michael Baier has disclosed no relevant, real or apparent
personal or professional financial relationships with
proprietary entities that produce health care goods and
services.
Erin Haas, MPH, has disclosed no relevant, real or
apparent personal or professional financial relationships
with proprietary entities that produce health care goods
and services.

119. Learning Objectives:
1. Identify strategies for investigating and prosecuting
drug-related homicides.
2. Explain how multiple tools can be utilized to build
prosecutable cases.
3. Describe how Overdose Fatality Review can make
recommendations for law, policies and programs.

120. Overdose Fatality Review Background
• 2011-2012: State tracks significant rise in OD deaths (Rx
opioid & heroin-related)
• Jan. 2013: Maryland Opioid Overdose Prevention Plan
o Implement Prescription Drug Monitoring Program
o Surveillance of problematic prescribing/dispensing
o Overdose education & naloxone distribution
o Continue access expansion for opioid replacement
therapy (methadone & buprenorphine)
o Local overdose prevention plans
o Pilot local overdose fatality review teams (LOFRT)

121. Overdose Fatality Review Overview
• Modeled after existing mortality review programs
(Child Fatality Review)
• Multi-agency/multi-disciplinary team assembled at
local (county/Balt. City) level to conduct
confidential reviews of overdose death cases
• Goal to prevent future deaths by:
o Identifying missed opportunities for prevention and gaps in system
o Building working relationships b/t local stakeholders on OD
prevention
o Recommending policies, programs, laws, etc. to prevent OD
deaths
o Informing local overdose prevention strategy

122. Overview Ctd.
• Implementation supported by 2013 DOJ Harold Rogers PDMP grant
• DHMH interagency collaboration to provide T/A & data to teams,
including:
o Death investigation records from Office of Chief Medical
Examiner
o Confirmed decedent info from death certificate
o Coded toxicology data
o Substance use disorder treatment records from statewide
database
• Team members bring info from respective agencies about decedents
to inform review
• 2014: 3 Pilot Teams → Baltimore City, Cecil County, Wicomico
County
• Currently 18 teams active (out of 24 total jurisdictions)
• 200+ cases reviewed to date

123. OFR Legal Authority
• Pilot phase: Existing state “medical review committee” statute
provided authority for local health depts. to establish teams
• OFR law effective October 2014:
– Direction on team structure and operations (membership,
goals, etc.)
– Requires healthcare providers & gov. agencies to provide
decedent records on request from team
– Civil liability protection for team members and those that
provide information
– Confidentiality requirements
– Establishes DHMH oversight and team reporting
requirements

124. Social-Ecological
Model

125. Sample Case: Mr. Leighman
• OCME Data:
– 48 AA Male
– DOD: 10/1/2015
– COD: Heroin Intoxication
– Autopsy? Yes
– Other substances in toxicology screen: Benzoyle,
Cocaine, Codeine, Freemorphine, Morphine
– Manner of death: undetermined
– Location of residence: Somerset County
– Location of incident: Wicomico County

126. OCME Activity Comments
Stewart Gilbert Leighman, B/M, DOB 7/29/1967, lives in a wooded area in a
small tent near Salisbury, Wicomico County, Md. on 10-1-15 at 0830 hrs. He
met his girl friend, Lesha in Salisbury, Md. And they walked to PRMC where
Lesha visited with her mother and apparently borrowed some money from her
mother, thirty dollars of which she gave to Mr. Leighman. The two parted ways
at 1200 pm and Mr. Leighman said he would see her back at the tent. Lesha
did not return to the tent because of the heavy rain, instead, she called Robert
Lewis, Mr. Leighman’s cousin, to check on him. Mr. Lewis went to the tent at
1845 hrs. And discovered Mr. Leighman lying on his back in the tent with just
his shorts on, he was unresponsive and Mr. Lewis could not awaken him. Mr.
Lewis called 911 and he says he started CPR. Arriving EMS found him in
asystole and transported him to PRMC ED. He was given life saving treatment
to no avail. He was determined dead at 1942 hrs. Mr. Leighman has a history of
Diabetes and stomach problems. He has a history of Cocaine use and Heroin
use. The family requested Smith funeral home and they were called and
agreed to respond. OCME was notified of this case and autopsy was ordered
by the F.I.

127. Sample Case : Mr. Leighman
• EMS: day of death only
• Hospital: Yes (multiple ER visits for stomach pain)
• Social Services: Yes (food stamps and MA)
• Sherriff's Office: Yes
• State’s Attorney’s Office: Yes
• Court System: Yes (3 open cases, all drug related)
• Community supervision: Yes
• Drug Treatment: Yes
• Pain Management: Unknown
• Pharmacy records: Unknown

128. Team Conclusions: Mr. Leighman
• Mr. Leighman had open cases in different
bordering counties on the Eastern Shore of MD
• Spent the better part of the past 25 years
incarcerated
• Lived in 3 different counties, homeless at the
time of death, did not have a good system of
care
• No known referrals for Diabetes case
management
• No cell phone made it difficult to provide follow
up care

129. Team Conclusions: Mr. Leighman
• Risk factors: transience/homelessness,
history of addiction, co-occurring chronic
illness, older adult, possible long period of
abstinence
• System-level implications: need for improved
coordination of healthcare services for
transient population, overdose prevention
and substance use disorder treatment access
for incarcerated individuals, community
naloxone trainings targeting homeless
population

130. Reach Points/Interactions
Agencies Total Of Cases Percentage
Community Supervision 46 27%
Court System (Drug Court, Family Court, etc.) 37 22%
Department of Social Services (inc. Human Services) 60 35%
Department of Juvenile Services 4 2%
Detention Center 30 18%
Substance Use Disorder Treatment 92 54%
Emergency Medical Services (EMS) 107 63%
Hospital 64 37%
Insurance Coverage 13 8%
Mental Health Treatment 44 26%
Pharmacy 20 17%
Law Enforcement 143 84%
Syringe Services Program Baltimore City 14 8%
State's Attorney's Office 53 31%
Total interactions: 727 171 cases

131. Notable LOFRT Findings
Decedent factors:
• Prior overdose(s)
• DUI/DWI
• Suicide attempts/ideation
• Intimate partner violence (as victim or perpetrator)
• Heavy social services & criminal justice involvement
• Poly-pharmacy
• Pain management
• Occurrence of trauma just before death (loss of a loved one, struggles with
child custody, etc.)
• Older drug users with many co-occurring chronic health issues
• Involvement w/ treatment services, but poor care coordination & follow
through on referrals
Incident factors:
• Deaths at home, often w/ family/housemates at home too
• Hotels and motels
• Recent release from jail
• Alcohol along w/ opioids in COD

132. Statewide Impacts/Outcomes to Date
Local:
• Training organization staff to use naloxone (Tx providers, LE, etc.)
• Increased attention to care coordination and referrals b/t service providers
• Changes to intake questionnaires to include questions about overdose history
• Promoting addiction education and assessment at all levels of the
organization
• More direct outreach to families on overdose prevention and wraparound
services by those that serve people at risk of overdose
State:
• System to monitor SUD provider reporting of patient OD deaths
• Research project investigating suicide overdose deaths
• Potential project to identify and provide services to decedents’ family

133. Considerations for Team Development
• Identify legal authority
• Important to have multidisciplinary approach
• Utilize existing relationships
• Heavy reliance on collaboration
• Encourage ongoing participation from members
• Social-ecologic vs. individual focus
• Task oriented
• Establish processes and expectations early on
• Consistently and frequently review goals of the team
• Formalize your observations and recommendations
• Allows for agencies to improve their practices based on
evidence

134. Drug-Related Deaths: Investigation,
Prosecution and Review Strategies
Presenters:
• Patricia Daugherty, JD, Assistant District Attorney, Milwaukee
County (WI) District Attorney's Office
• Michael Baier, Overdose Prevention Director, Maryland
Department of Health and Mental Hygiene
• Erin Haas, MPH, Overdose Prevention Local Programs Manager,
Maryland Department of Health and Mental Hygiene
Law Enforcement Track
Moderator: Connie M. Payne, Executive Officer, Department of
Specialty Courts, Kentucky Administrative Office of the Courts, and
Member, Operation UNITE Board of Directors