Death by Distribution

NIJ and its multidisciplinary partners have released an updated technical guide for conducting collaborative death scene investigations. The 2024 guide accounts for key changes in the field, including:   This revised edition is a collaborative effort to update the content to ensure the best possible outcome for both death and criminal investigations today.

Review of case files and autopsies from WF Baptist Medical Center to determine whether significant disease processes or injuries that would supersede the results of toxicologic testing and external examination findings alone were being missed

Organization of Scientific Area Committee (OSAC) ASB Approved Mar. 2025. Defines relevant terms for the discipline.

Position paper which provides best practices for death scene investigation, autopsy, toxicology, and determining cause of death in overdose cases

Addresses the complexity of drug toxicity deaths and the challenging relationship between the existing diseases and the sequence in which diseases or injuries. Underscores the need for a thorough medical and death scene investigation.

See pp. 241-268 for the National Research Council’s assessment of the disciplines of forensic pathology and death investigation.

Describes assistance that NACDL’s Fourth Amendment Center can provide to defense teams regarding digital evidence

Quick reference for analyzing admissibility of statements under the Confrontation Clause. Created by Phil Dixon in March 2025.

Forensic Resources blog post regarding OCME discovery by Sarah Olson and Dr. Christena Roberts. Describes the items provided through a routine discovery request and additional items from the Medical Examiner file that can be obtained through a subpoena or court order. Drafted in Jan. 2020.

UNC School of Government Criminal Law Blog Post discussing actual and proximate causation, intervening causes, multiple drug cases, pre-existing conditions, and joint users by Phil Dixon. Published in Jan. 2020.

by Cynthia Hernandez & Taleed El-Sabawi, JD, PhD

This checklist has been adapted from the “Drug-Induced Homicide Defense Toolkit” by Beety, et al., and the University of North Carolina School of Government blog post, “Defending Death by Distribution Cases”, by Phil Dixon. This checklist is meant to help criminal defense attorneys identify possible defenses to these new North Carolina drug-induced homicide laws. Created in June 2020.

The Health In Justice Action Lab of the Northeastern University School of Law has created a toolkit for attorneys defending death by distribution of drugs. The toolkit includes recent favorable caselaw and links to the amicus curiae briefs filed by the Action Lab and its partners that were successful in those cases; an expanded section on racial disparities and person-first representation; more material and case law in several of the states that are most aggressive in pursuing DIH enforcement; a brief section on ineffective assistance of counsel claims; and information regarding forthcoming DIH research conducted by the Action Lab. Entire toolkit is available for free download. 2021 Edition.

10-part free webinar series running from Apr. 1 – July 30, 2025 Registration here. The series focuses on improvements to accuracy and consistency in recording cause and manner of death in drug toxicity cases. The sessions will address the complex and variable supply of illicitly manufactured fentanyl and the proliferation of other drug classes including novel benzodiazepines, cathinone stimulants, hallucinogens, and adulterants such as xylazine, medetomidine, and various other novel synthetic opioids. Presentations feature recognized experts in forensic pathology, medicolegal death investigation and toxicology, as well as adjacent fields such as epidemiology, public health, and medical toxicology.

NC Department of Health and Human Services Division of Public Health webpage compiling overdose data by county

Unpublished Court of Appeals opinion addressing proximate cause, chain of causation, intervening acts, and jury instructions on intervening cause and involuntary manslaughter.

Court of Appeals decision finding that circumstantial evidence supported the conclusion that defendant sold fentanyl instead of heroin to the victim. The court also noted “[w]hile the evidence does not foreclose the possibility that fentanyl may not have been the sole cause of [the victim’s] death, there is ample evidence to support a conclusion that it was, in fact, fentanyl that killed [the victim].” Slip Op. at 9. The Court rejected the defendant’s argument that he could not foresee that the victim would consume all the drugs at once. The court found sufficient evidence to submit the question of proximate cause to the jury.   

Testimony of Dr. Jonathan Privette (forensic pathologist) and Dr. Justin Brower (forensic toxicologist) re: fentanyl overdose, mixing of fentanyl and cocaine

Addresses public health consequences of laws creating criminal liability for accidental drug overdose and provides research supporting the following conclusions:

• Controlled substance homicide laws are inequitably enforced and charges brought under these laws represent extreme racial bias;
• Prosecutors who file controlled substance homicide charges are often motivated by false beliefs about the public health benefits such laws that are not supported by any systematic or scientific evidence;
• Controlled substance homicide laws undermine the effects of state 911 Good Samaritan Laws, which are well-tested and well-proven policy-level overdose-prevention strategies;
• Controlled substance homicide laws and charges brought under those laws increase the risk of overdose in the surrounding community; and
• The premise that drug suppliers and people who use drugs are distinct populations analogous to “exploiters” and “exploited victims” is false, does not reflect the realities of substance use in a criminalized market, and causes excess harm against people who use drugs, including excess overdose.

Addresses defendant’s motion to dismiss where evidence on causation was insufficient, failure to instruct the jury on intervening acts of others, failure to instruct the jury on lesser included offense of involuntary manslaughter when the evidence of malice was in conflict, and court’s failure to intervene in state’s closing argument. Reply Brief filed in June 2023 in 2017 case.

Appellant’s Brief addressing trial court’s denial of defendant’s motion to dismiss where the state did not prove the defendant’s actions proximately caused the decedents’ deaths and another individual’s actions were a superseding cause of the decedents’ deaths which broke the chain of causation. Also addresses trial court’s failure to instruct on whether intentional acts by another individual and the decedents were intervening and superseding causes of their deaths. Finally, the brief addresses the trial court’s failure to instruct on the lesser included offense of involuntary manslaughter where the evidence of malice was in conflict. Brief filed in Jan. 2023 in 2017 case.

Addresses complex chain of causation, proximate cause, identify of the controlled substance, and cause of death. Brief filed in Aug. 2023 in 2020 case.

Addresses strict liability crime for drug sharers created by Massachusetts death by distribution statute and public health implications of drug induced homicide statutes. By MA Public Counsel Services and Health in Justice Action Lab, MA Association of Criminal Defense Lawyers. Filed in Jan. 2019.

Death by Distribution Through Unlawful Delivery with Malice of Certain Controlled Substances

Death by Distribution Through Unlawful Delivery of Certain Controlled Substances

Aggravated Death by Distribution Through Unlawful Sale of Certain Controlled Substances

Death by Distribution Through Unlawful Sale of Certain Controlled Substances

Schedule IV controlled substances

Schedule II controlled substances

Drug-related overdose treatment; limited liability (Good Samaritan statute)

Second degree murder by distribution for offenses before 12-1-23

Second degree murder statute

Death by distribution and aggravated death by distribution statute