Review ArticleContribution of Opiates in Sudden Asthma DeathsHlavaty, Leigh MD*†; Hansma, Patrick DO‡; Sung, LokMan MD*†Author Information From the *Department of Pathology at the University of Michigan, Ann Arbor; †Wayne County Medical Examiner’s Office, Detroit; and ‡Department of Pathology, William Beaumont Hospital, Royal Oak, MI. Manuscript received August 13, 2014; accepted October 23, 2014. The authors report no conflict of interest. Reprints: Leigh Hlavaty, MD, Wayne County Medical Examiner’s Office, 1300 E, Warren Ave, Detroit, MI 48207. E-mail: email@example.com. The American Journal of Forensic Medicine and Pathology: March 2015 - Volume 36 - Issue 1 - p 49-52 doi: 10.1097/PAF.0000000000000138 Buy Metrics Abstract Asthma is a common disease in the United States and is frequently encountered during medicolegal autopsies. Patients are often young and have a witnessed collapse or are found dead. Opiate abuse is also pervasive and is repeatedly seen in death investigations. All cases over a 7-year period involving asthma investigated at the Wayne County Medical Examiner’s Office were reviewed for demographics, circumstances, autopsy toxicology findings, and cause and manner of death. Ninety-four cases met these criteria. Ten cases (10.5%) were positive for opiates, 8 listed drugs as the cause of death, and 2 listed asthma. Of cases with established asthma opiate positivity, 8 (80%) were found dead, and only one had a witnessed collapse. Compared with those without opiate abuse, asthmatic patients abusing opiates had a higher mean age, no reported respiratory symptoms immediately preceding death, and higher frequency of being found dead. A discernable difference exists between deaths in asthmatic patients in the presence of opiates and those without. These findings indicate that it may be possible to predict the presence of opiates given history investigation information, thereby focusing toxicology panels to promote cost-effective practices when ordering supportive tests. © 2015 by Lippincott Williams & Wilkins.