Nick Corsi, a first-year medical student at the Wayne State University School of Medicine, is seeing the fruits of a case study he pursued looking at deaths related to heroin laced with carfentanil, a project he pursued following a job shadow opportunity with Oakland County Chief Medical Examiner L.J. Dragovic, M.D.
In August 2016, when he began the project, the U.S. Drug Enforcement Administration had issued a nationwide warning on the fentanyl analog carfentanil, warning first-responders and law enforcement that carfentanil is 10,000 times more potent than morphine, and estimated a lethal dosage at 21-millionths of a gram, the size of an average grain of table salt.
“Additionally, there was a huge spike in opioid-related mortality in our community (Wayne County, Michigan) from July 2016 through February 2017,” Corsi said.
According to the 2017 Michigan Death Certificates File, more 2,600 people in Michigan died from opioid-related overdoses.
“Fatal overdoses involving carfentanil: A case series,” published last month, details the results of a retrospective review of each public death reported in Oakland County, Michigan, with a subsequent toxicology report investigated for carfentanil use. To characterize each fatality, the autopsy results, including postmortem findings at the scene and the decedent's medical and social history, were collected.
The presence of the anti-overdose medication naloxone was also available through expanded postmortem drug screens, which were performed through liquid chromatography/time-of-flight mass spectrometry.
“To know that people in my own community, near my home, were dying from heroin laced with carfentanil at potential concentrations the size of a grain of salt was very upsetting,” he said. “At the time, there was so little known about the illicit-street form of carfentanil (ex. “cut/laced” into heroin) not only on an epidemiological basis, but also the biological and metabolic effects in humans. There were no published toxicology records in the literature when I began my work. NMS laboratories, the National Reference Laboratory, had just began to offer carfentanil-analyte screening through liquid chromatography and tandem mass spectrometry.”
As a medical student, Corsi later joined the student organization Detroit vs Addiction, through which he clinically volunteered at the Tolan Park Clinic, a methadone dispensing clinic where students shadow physicians trained in addiction medicine and observe group therapy sessions.
“To gain more perspective, I also shadow in the Narcotics Anonymous Veteran support group. My time spent at the methadone clinic has been the most impactful experience I’ve had in medical school so far. It is beautiful to see patients’ resilience and willpower. Additionally, I see the impact of the opioid epidemic as well with my current involvement as a board member in Street Medicine Detroit. Wayne State gets us very personal with the community,” he said.
Corsi started the project as an undergraduate, but submitted a manuscript to the journal at the beginning of medical school.
“From just shadowing, Dr. Dragovic encouraged me to chase the project and experience the learning curve of clinical research. I hope to emulate this and make an impact in others’ education one day. On top of that, I gained a deeper respect for those experiencing the pain of addiction as I reviewed all the witness statements and medicolegal investigator reports to profile the postmortem findings,” Corsi said.
His data was first presented at the 2018 American Academy of Forensic Sciences Annual Scientific Meeting in Seattle.