Faculty

Rhonda Mittenzwei

MD
Associate Medical Examiner
King County Medical Examiner's Office

After completing a Bachelor of Science in Biology and subsequent Doctor of Medicine program, both at the University of Nevada, Reno, I completed Anatomic and Clinical Pathology Residency training at Duke University Medical Center in Durham, North Carolina. With a clear goal of becoming a medical examiner, I completed fellowships in Neuropathology and Forensic Pathology at the University of Washington in Seattle, Washington. I currently work as an Associate Medical Examiner at the King County Medical Examiner's Office, based in Seattle, and am an Assistant Professor of Neuropathology at the University of Washington. My dual roles allow me to perform autopsies, provide expert forensic neuropathology consultation services, and conduct research about traumatic brain injuries including chronic traumatic encephalopathy. In my free time, I love to do the NYT crossword puzzles and go to concerts.

2027 Sessions

Unintentional Fentanyl Overdoses Among Cocaine Users: A Novel Framework to Identify "Powder and Rock Confusion"

Session Description: This session introduces an under-recognized overdose risk pathway among individuals who use cocaine: unintentional fentanyl exposure due to substance misidentification, or what we call "powder and rock confusion." Drawing on five years of fatal overdose data from King County, Washington, this presentation highlights a subset of deaths in which individuals with no known opioid use history died after using fentanyl believed to be cocaine. These cases are not the result of deliberate fentanyl-laced cocaine but reflect visual misidentification at the point of use or sale. Participants will learn how to apply a scene-integrated toxicological framework to identify similar deaths in their own jurisdictions using available data sources such as toxicology, scene evidence, and substance use history. The session will also discuss how these findings can inform targeted harm reduction messaging, outreach strategies for stimulant-using populations, and clinical conversations with patients who do not report opioid use. Takeaways include: a replicable method for identifying unintentional fentanyl deaths among presumed cocaine users; red flags to look for in toxicology and scene evidence; and public health messaging adaptations that acknowledge stigma and improve engagement. This presentation emphasizes the power of cross-sector collaboration between forensic professionals, public health agencies, and community partners to detect and respond to hidden overdose trends-ultimately saving lives.

Presenter

Wednesday, March 31 7:30–8:45 AM
1.25 Credits
Illicit Drugs
Faculty

Emily Dalgo

MA, Sociology
Overdose Fatality Review Coordinator
King County, WA Medical Examiner's Office

Emily Dalgo is the Overdose Fatality Review Coordinator for King County, Washington, working within the Medical Examiner’s Office to lead multidisciplinary reviews of overdose deaths and identify system-level interventions. She is also the Founder and Executive Director of the Overdose Prevention Collective, a Seattle-based 501(c)(3) nonprofit dedicated to overdose prevention through naloxone distribution and substance use education. Previously, Emily served as Associate Director of Regulatory Policy for a national healthcare association and as Executive Director of a patient safety advocacy coalition in Washington, DC. She holds a master’s degree in Sociology from the University of Washington.

Faculty

Maria Esquivel

B.A., Criminal Justice, Forensic Psychology
Disease Research & Intervention Specialist
King County Medical Examiner's Office

Maria Esquivel is a Disease Research Specialist with the Fatal Overdose Surveillance Program at the King County Medical Examiner’s Office. In this role, she monitors patterns and trends in fatal overdoses across King County to support data-informed public health responses and community awareness. Working closely with a multidisciplinary team, Maria helps compile and interpret toxicology results from narcotics, urine, and blood specimens. This information supports forensic pathologists in the preliminary and rapid certification of overdose-related deaths. Her work contributes to both advancing public health knowledge and offering timely closure for affected families. Maria holds a Bachelor’s degree in Criminal Justice with a specialization in Forensic Psychology from Seattle University.

Faculty

Alana Golding

BS, Criminal Justice
Program Manager II – Washington State Fatal Overdose Surveillance
King County Medical Examiner's Office

Alana Golding is the Program Manager for the Washington State Fatal Overdose Surveillance Program at the King County Medical Examiner's Office, working to track information on overdose deaths in real-time. The dissemination of this information is used across Washington state to assist in identifying potential overdose fatality trends and system-level interventions. Alana received a bachelor's degree in Criminal Justice with a specialization in Forensic Science from Seattle University, where she researched the effects of the COVID-19 pandemic on overdose deaths.

Faculty

Rhonda Mittenzwei

MD
Associate Medical Examiner
King County Medical Examiner's Office

After completing a Bachelor of Science in Biology and subsequent Doctor of Medicine program, both at the University of Nevada, Reno, I completed Anatomic and Clinical Pathology Residency training at Duke University Medical Center in Durham, North Carolina. With a clear goal of becoming a medical examiner, I completed fellowships in Neuropathology and Forensic Pathology at the University of Washington in Seattle, Washington. I currently work as an Associate Medical Examiner at the King County Medical Examiner's Office, based in Seattle, and am an Assistant Professor of Neuropathology at the University of Washington. My dual roles allow me to perform autopsies, provide expert forensic neuropathology consultation services, and conduct research about traumatic brain injuries including chronic traumatic encephalopathy. In my free time, I love to do the NYT crossword puzzles and go to concerts.

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