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Dr. Thomas Andrew is on the front line of New Hampshire's opioid epidemic. Over the course of 20 years as the state's chief medical examiner, he's seen overdoses rise from 30 cases a year to over 500.
Andrew decided to enroll in divinity school so that he can minister to the living, and hopefully help them avoid the path to addiction. Andrew joins Here & Now's Robin Young to talk about the challenges of forensic pathology during the opioid crisis, and his decision to pursue a new path.
On how overwhelmed his office is
"Well, when I first started in 1997, this was a state that saw 30 to 40 drug deaths a year. When you're seeing 500 drug deaths a year, and your national accrediting body says, by way of an autopsy standard, that any known or suspected drug overdose deaths shall be autopsied, the numbers just don't add up. Because if we were to do all of our drug overdose cases and reach our limit of autopsies per pathologist, how would the homicides get done? How would the traffic crashes get done? How would the suicides get done?"
On accreditation issues for some states because of the opioid epidemic
"What I am happy to report is that we were awarded full accreditation on the basis of our most recent inspection. And our inspector was convinced that we, in good faith, were addressing our numbers issue, that the quality of our work product was an exemplary in every other way. And so we were awarded full accreditation with the proviso that they're going to check on us again in a year to see if we made good on our promise to get this problem addressed."
On forensic pathology
"Only 27 young people this year took the certifying examination for forensic pathology. So the applicant pool is very small, and in the face of the opiate crisis, the jobs are multiplying like so many mushrooms after the rain. I just got back from from Scottsdale, Arizona, where we had our National Association of Medical Examiners meeting, to try and recruit to talk up our jobs and our positions and life here in New Hampshire. And I found, to my horror, that we are up against many many many jurisdictions who are now hiring because they've added staff to respond to this."
"I could choose to limp through this another 10 years and see where this goes on the accounting end, or I could finally attack this by way of extension ministry to youth, outside the four walls of a church."Dr. Thomas Andrew
On the nature of the work
"Well, like many things in life, there are seasons in the life of a forensic pathologist, at least that's been my experience. Very early in one's career, I think you find out whether or not you are hardwired to do this for 20, 25, 30 years. And many people wash out quite early. Those who can, go into that next season of their forensic life when they are developing their craft, and they develop with that a fair amount of swag. 'I've seen everything, I've done everything and nothing can faze me now.' And that's a dangerous place to be, because if you completely shut out the humanity that's on the table in front of you, I don't think you can effectively minister to the families who are left behind when you make that phone call after the autopsy to explain to them the findings and give them some sense as to what's going on. And I didn't use the word minister by accident."
On the toll that this work takes
"It seems like a simple question, but it is quite complex. The privilege of actually being able to look inside of that amazing machine that is the human body and try to sort out what has happened to that particular individual is a privilege beyond measure. And at the same time it's scientifically and intellectually exceedingly stimulating. On the other hand, as you enter that next season of your forensic life, then you start asking those bigger questions. How have I contributed? Am I simply cataloging the horrors of interpersonal violence or self-abuse or self-neglect? How have I contributed to the public health's improvement in some way? And I know we do. It's all tremendously important work, but it is taxing on one's soul."
On the opioid epidemic
"As early as 2004, 2005, we were identifying clear cut trends and increased deaths due to opioids, but at that time, the culprit was prescription opioids. At least some subset of them went on to become habituated to their opiates, and as they became medical orphans, so to speak — they were fired by their medical practices for abusing their opiates or using their opiates inappropriately — started to try and get them illicitly from street vendors. And that obviously led to exposure to heroin, which was much cheaper, and then heroin gave way to fentanyl and its analogs. And now we are seeing, not 100 or 200 drug deaths a year, we're seeing 500, and we don't see any end in sight."
On his career and the decision to enter divinity school
"I certainly don't want to give the impression that I was driven from this office by the opioid crisis. As a matter of fact, I told Dr. Duval [the assistant medical examiner], when she was first hired 15 years ago, to please be aware that I was going to retire in September of 2017. After that amount of time under the same leadership, things can become stale. You may be looking at things the same old way.
"Now that being said, the opioid crisis certainly didn't make it difficult to leave either. You know, it does mount, because of the way it has changed one's practice. You have this, you know, rather stimulating mix of cases, but then it becomes dominated by this one type of case, and that's what gets those wheels turning about, 'What am I contributing here? What kind of difference does this make?' The point is it sharpens the call. You realize you've got x amount of gas left in the tank, and either I could choose to limp through this another 10 years and see where this goes on the accounting end, or I could finally attack this by way of extension ministry to youth, outside the four walls of a church. If you can instill moral and ethical values in young people that it can somehow help to inoculate them from that other so-called friend of theirs who's going to come up to them in middle school with the weed or the pill or heaven forbid that packet of powder, then you have maybe, you know, saved that one starfish off the beach."
This segment aired on November 1, 2017.
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