Researchers say part of the explanation is a patchwork system of coroners and medical examiners who may have differing levels of training or incorrect expertise for using toxicology reports, among other information, for death certificates. Photo by chuck stock/Shutterstock
THURSDAY, June 28, 2018 -- The actual number of opioid overdose deaths in several U.S. states is likely far higher than death certificates suggest, a new study says.
Incomplete reporting of overdose deaths can hamper efforts to fight the nation's opioid epidemic, according to the University of Pittsburgh researchers.
They said that as many as 70,000 opioid overdose deaths were not included in nationwide estimates between 1999 and 2015, because coroners and medical examiners did not specify on death certificates that opioids were a contributing cause.
During those 17 years, opioid overdose deaths rose 401 percent nationwide; non-opioid overdose deaths increased 150 percent; and there was a 220 percent rise in unspecified overdose deaths.
In five states -- Alabama, Indiana, Louisiana, Mississippi and Pennsylvania -- more than 35 percent of overdose deaths were listed on death certificates as unspecified, according to the study.
There were wide state-to-state differences in unspecified overdose deaths, ranging from fewer than 10 in Vermont to 11,152 in Pennsylvania.
States with a county coroner system or a hybrid system of county coroners and state medical examiners tended to have a higher percentage of unspecified overdose deaths, the study found.
Lead author Jeanine Buchanich said coroners may not have medical training useful for completing drug information for death certificates based on toxicology reports. She added that states with a decentralized or hybrid system tend to have less standardization and gaps in reporting accuracy.
"Proper allocation of resources for the opioid epidemic depends on understanding the magnitude of the problem," Buchanich said in a university news release. She is a research associate professor in the School of Public Health.
"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," Buchanich said.
Several organizations have called for more accurate drug reporting on death certificates, she noted.
The study was published June 27 in the journal Public Health Reports.
The U.S. Centers for Disease Control and Prevention has more on opioid overdose.
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