Medical examiner: 1 in 17 dead persons last year positive for meth

One out of every 17 cases investigated by the Office of the Chief Medical Examiner in 2023 tested positive for methamphetamine, outgoing Chief Medical Examiner Dr. Jeffrey Nine said during a sit down at the Legislature on Friday.

Nine said his office investigates just about every death on Guam.

“So in this room, hate to say it, there’s more than 17 people in this room. One of them may be using meth,” he told senators and others gathered in the legislative public hearing room.

Among those bodies that are brought into his office for examination for generally suspicious or non-natural deaths, the ratio is higher, at one in six testing positive.

The meth problem was the first point Nine raised, when Speaker Therese Terlaje asked what insights lawmakers should be aware of.

“Obviously, methamphetamines. Methamphetamine abuse is a problem,” Nine told senators.

There were 37 deaths caused by methamphetamine use and abuse.

Meth accounted for the vast majority of the 41 drug-related deaths seen last year, according to a report from Nine’s office.

Prior to his term in office, Nine said those who died from seemingly natural causes were not being screened for methamphetamine use that could have been the true cause of death.

He said there is now a test present at the autopsy table, to screen the urine of the deceased for drugs. In cases where that can’t be done, the office now has a contract with a stateside, postmortem toxicology lab.

Asked by Sen. Chris Barnett about the prevalence of meth overdoses before his arrival, the doctor said he had discussed the issue with his administrative assistant, who has worked on Guam for the past 20 years.

“She thinks that we likely did have an increase in methamphetamine deaths before I arrived. But we had no way to document that because we were not testing for it,” Nine said.

The doctor told Barnett that there was likely a “steep curve” that brought overdose deaths up to where they are now.

“Methamphetamine primarily damages the heart and the brain,” the doctor noted, “so what you see in methamphetamine use chronic or acute overdoses is either what looks like a heart attack, or what looks like a stroke.”

His administrative assistant had taken to working as a death investigator for his office in the past year—without compensatory pay for the work—and was going out and looking into cases where it appeared a person may have died from meth use.

Nine said he’s even seen cases where people are suffering from meth-induced heart failure, and “what they’re using to treat their heart failure is more methamphetamine.”

Though not a good solution, the reasoning made some sense, as meth can increase heart rate, he said.

Meth can also damage the lungs, in a manner similar to the damage from cigarette smoking, but with ill effects that appear earlier and more severe, the doctor noted.

“Methamphetamine doesn’t really cause kidney failure or diabetes ... but if people have those, they can make it worse,” he said.

“What we typically see at the autopsy room is a person that’s usually smaller, they usually are underweight, they’re malnourished, because they’re spending money on the drugs and not on their physical care and their medical care,” he said.

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The average person who died from a meth overdose was typically in their mid 30s to late 40s. They may be without work, have a low education level, and little social structure or social contact, Nine said.

Meth contributing to homicides, suicides

“We see it not just only as the cause of death. In many cases, we see it as a contributing factor in a lot of cases. And we see it in a contributing factor in the homicides, the accidents, the suicides, it’s prevalent throughout all the different categories of death,” he said.

Two of the seven people who died from homicide had meth in their systems, according to Nine’s annual report.

Meth use can cause irrational behavior, and can also contribute to other issues that lead to homicide, like money problems and gambling debts.

Data shows almost a third of the 32 suicides recorded in 2023, or 10 individuals, tested positive for meth.

According to Nine, meth is usually a contributing factor in suicide among older residents. Younger people tend to use marijuana and alcohol.

Death investigator needed

Nine, whose term ends at the end of the month, said a key need for his office is a certified death investigator to do the work that his administrative assistant has picked up.

In the case of meth-related deaths, a death investigator was the one out in the community, gathering information that could help lead to the determination of the case of death.

“Without that death investigator, what happens is the medical examiner receives a body with no information,” Nine said, which was the case before he came onboard at the office.

A death investigator could also help Guam to handle examinations with the virtual consultation of a forensic pathologist, once he left his office.

Only autopsies require a medical examiner to be present, Nine noted, and the database that stores information for the medical examiner’s office is fully accessible online, and can be reviewed remotely.

Replacement sought

The doctor is working with the local Commission on Postmortem Examinations to get a replacement for himself in place before he leaves.

“I’d have verbal commitment from three other forensic pathologists and I probably could get more after I leave and go back to the mainland and have communications ... that would be a team of four forensic pathologists to begin with, that could rotate to come in and do the autopsies,” he told senators.

Nine, who is leaving the island due to family medical reasons, said he has a “deep love for Guam.”

“The work that we’ve been doing here, I don’t want to see that disappear,” he said.

Shortly after the roundtable discussion Friday morning, the speaker presented Nine with a certificate recognizing him for his service while on Guam.

Terlaje said he had provided his services when the island was in “desperate need” of a medical examiner.

Barnett said the information he provided has helped the government to have an “honest conversation” about the meth issue Guam faces, and that his departure is a loss for the island.