- In 2016 alone, a record 64,000 Americans died of opioid overdoses
- But a new study from the University of Pittsburgh study found that 70,000 opioid overdoses were likely counted ‘unspecified’ since 1999
- Death certificates were more likely to be left incomplete in counties with politically appointed coroners who do not have to have medical degrees
- The under-reporting may have skewed funding allocations to fight the opioid crisis
The opioid epidemic’s death toll has been underestimated by a staggering 70,000 lives lost, new research reveals.
Since 1999, coroners in several US states have omitted the drug involved in overdose deaths from thousands of death certificates.
Not only does the reporting failure change the record of the opioid epidemic, it also means that areas in dire need may have been overlooked in the allocation of resources based on the local impact of the opioid epidemic.
The new study from the University of Pittsburgh suggests that, for all of the attention it has garnered, there is much we still don’t know about the magnitude and drivers of the American opioid epidemic.
Now, researchers have discovered that an even greater number of such deaths went undocumented over the least 17 years.
The University of Pittsburgh team found dramatic inconsistencies in death certificate reporting from state to state.
The National Center for Health Statistics assigns codes to each cause of death.
A broad category of ‘T’ codes designates drug-related deaths. Deaths certificates marked ‘T50.9’ indicate that the particular drug involved was not specified.
The team looked at the increases in drug-related deaths in three categories – opioid, non-opioid and deaths in which the type of drug involved in the death was unspecified – nationally and divided by state.
The increases and proportion of those deaths that were ‘unspecified’ was suspiciously high in five states: Pennsylvania, Alabama, Indiana Louisiana and Mississippi.
Over 35 percent of the drug-related deaths that occurred in those states were categorized as unspecified.
Based on the disparity between that proportion and others, the researchers determined that a total of about 70,000 of those uncategorized deaths were actually caused by opioids.
While Vermont, for instance, only left 10 drug deaths unspecified, Pennsylvania neglected to work out the drug involved in more than 11,000 deaths.
The under-reporting phenomenon is explained, in part, by the different types of professionals and systems that handle deaths and bodies from state to state.
Death certificates are completed in some counties by coroners, who are politically appointed, while medical examiners do this job in others.
Medical examiners are typically at least medical doctors, if not trained forensic pathologists.
Coroners, on the other hand, do not have to have any medical degree or training.
‘Coroners are less likely to be physicians and do not necessarily have medical training useful for completing drug information for death certificates based on toxicology reports. And states with a decentralized or hybrid system are likely to have less standardization, leading to greater variation in reporting accuracy,’ said Dr Jeanine Buchanich, who led the study.
Alongside hospitalizations, over-prescription estimates and the number of people in addiction treatment programs, statistics on opioid overdose deaths are key determining factors to the (modest) federal funding each state and county receive to fight the opioid epidemic.
‘Proper allocation of resources for the opioid epidemic depends on understanding the magnitude of the problem,’ said Dr Buchanich.
‘Incomplete death certificate reporting hampers the efforts of lawmakers, treatment specialists and public health officials.
‘And the large differences we found between states in the completeness of opioid-related overdose mortality reporting makes it more difficult to identify geographic regions most at risk. (Click to Source)
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