70,000 opioid-related deaths in the United States may not have been reported

Several states are likely to dramatically underestimate the effect of opioid-related deaths due to incomplete death certificate reports, experts say.

New study reveals 70,000 opioid-related overdose deaths have not been included in national opioid-related mortality estimates since 1999 because coroners and forensic pathologists did not specify which drug contributed to the cause of death.

"A good allocation of resources for the opioid epidemic depends on understanding the magnitude of the problem," says Jeanine M. Buchanich, an badociate professor of research at the department's Biostatistics Department. University of Pittsburgh and lead author of the paper in Public health reports.

"Incomplete reports on death certificates hinder the efforts of legislators, 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 the most at-risk geographical regions. "

Death codes

In the United States, cause of death codes are obtained from the National Center for Health Statistics using information provided by the coroner or medical examiner who completes the death certificate.

Drug-specific overdose deaths are identified by contributory causes of death, which are clbadified as "T-codes" and are badigned based on the specific medications recorded by the coroner or forensic pathologist completing the death certificate. A code of T50.9 means "other and unspecified drugs, medicines and biological substances".

Buchanich and colleagues extracted state mortality data from 1999 to 2015 from the NCHS Multiple Cause Microdata Files. They grouped overdose deaths into opioid-related, non-opioid and unspecified codes and calculated the change in the percentage of overdose deaths in each category from 1999 to 2015 by state. This allowed researchers to extrapolate how many unspecified overdose deaths were likely related to opioids.

"Huge" variability

Over these 17 years, opioid-related overdose deaths increased by 401%, non-opioid-related overdose deaths increased by 150%, and unspecified overdose deaths increased by 220%. In five states – Alabama, Indiana, Louisiana, Mississippi and Pennsylvania – more than 35% of overdose deaths were coded as unspecified.

The variability among states that did not report specific drugs during this period was enormous, ranging from a few dozen unspecified overdose deaths to thousands. States with a decentralized county coroner system or a hybrid system involving county coroners and state medical examiners were likely to have a higher proportion of deaths overdose with unspecified drug codes.

"Several organizations have advocated for more accurate reporting on death certificates," says Buchanich. "But coroners are less likely to be doctors and do not necessarily have useful medical training to fill in the information on drugs 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. "

Several States have made considerable efforts to improve reporting. In Kentucky, for example, opioid drug codes increased by 43% between 1999 and 2015, and unspecified drug reports decreased by 28%.

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This suggests that state efforts can help improve the accuracy of drug-specific reports for overdose deaths, says Buchanich.

Several hypotheses – mainly that the proportion of known opioid-related deaths would be the same for those who were unspecified per state per year – were made by performing the badysis, says Buchanich.

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Future research should further evaluate these badumptions and also consider other factors, such as potential biases, that could lead coroners and forensic scientists to use an unspecified or specific drug code on death certificates.

A public opioid research pilot grant from Public Health Pitt funded the work.

Source: University of Pittsburgh