Inaccurate Counts in Opioid Deaths

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photo by Carol Duff

Health Editor’s Note: More Americans die from overdoses of legal and illegal drugs than from gun violence and car crashes. Drug overdoses are caused by someone taking more than the recommended amount of drugs. If the body cannot metabolize (get rid of) the drug quickly enough, there will be a build-up of the drug and an overdose will occur. Drug overdoses can be deliberate or accidental. Fatal overdoses from illicit drug was reported to have increased by around 210 percent but now we find that fatal overdoses can go unreported and not counted in the number tallies for drug overdose deaths.The picture is even worse than previously reported……Carol   

Undercount Seen in Opioid Deaths

Closer look increases toll by 70,000 during 1999-2015

by Judy George, Contributing Writer, MedPage Today

The number of fatal opioid overdoses may have been higher than previously reported, with some states greatly underestimating the effect of opioid-related deaths, an analysis of National Center for Health Statistics data suggests.

Potentially 70,000 opioid-related overdose deaths from 1999 to 2015 were not included in national figures because coroners and medical examiners did not specify the drugs contributing to death, reported Jeanine Buchanich, PhD, of the University of Pittsburgh, and coauthors in Public Health Reports.

“Our new research tells us that several states are likely dramatically underestimating the effect of opioid-related deaths because of incomplete drug reporting on death certificates,” Buchanich told MedPage Today.

“Incomplete death certificate reporting hampers the efforts of lawmakers, treatment specialists, and public health officials,” she added. “The large differences we found between states in the completeness of opioid-related overdose mortality reporting make it more difficult to identify geographic regions most at risk.”

The analysis supports other recent research that suggests that death certificate reports understate the prevalence of opioid, heroin, and synthetic opioid-involved mortality in the United States.

Drug-specific overdose deaths are identified by ICD-10 T codes, which are assigned by the coroner or medical examiner completing the death certificate. A code of T50.9 indicates poisoning by “other and unspecified drugs, medicaments, and biological substances.”


In this study, Buchanich and colleagues abstracted unintentional drug overdose deaths with contributory T codes (T36.0-T50.9) from the Mortality Multiple Cause Data Files of the National Center for Health Statistics from 1999 to 2015. The team reallocated unspecified overdose deaths for each state and year, assuming that their proportion would be the same as the proportion of opioid-related deaths among all fatal overdoses.

In five states — Alabama, Indiana, Louisiana, Mississippi, and Pennsylvania — more than 35% of overdose death certificates didn’t name a drug. Reallocation reclassified more than 70,000 unspecified fatal overdoses to opioid-related deaths, ranging from nine in Vermont to 11,152 in Pennsylvania.

“Generally, this study provides additional confirmatory evidence that opioid and other sources of drug deaths will be undercounted when not accounting for the T50.9 unspecified drug category,” observed health economist Christopher Ruhm, PhD, of the University of Virginia, who was not involved in the analysis. “It makes the point that better reporting of the sources of drug deaths is needed.”

Part of the problem may stem from the coroner system in each state, Buchanich noted. In most states, elected coroners are not required to be physicians.

“States with a decentralized county coroner system, or those with a hybrid system that involved county coroners and medical examiners, were likely to have a higher proportion of overdose deaths with unspecified drug codes,” she said.

But over the 17-year period, several states made extensive efforts to improve reporting.

“In Kentucky, for example, opioid-related drug codes increased 43% from 1999 through 2015, and unspecified drug reporting decreased 28%,” Buchanich noted. “This suggests that state-based efforts can be instrumental in improving the accuracy of drug-specific reporting for overdose deaths.”

The authors reporting receiving no financial support for the research and having no competing interests.

Primary Source

Public Health Reports

Source Reference: Buchanich J, et al “The effect of incomplete death certificates on estimates of unintentional opioid-related overdose deaths in the United States, 1999-2015” Public Health Reports 2018; DOI: 10.1177/003335491877433.


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5 COMMENTS

  1. A little know fact, perhaps, is the federal data systems designed to track drug use and abuse were largely discontinued by Regan back in the early 1980s. The reason then to stop requiring states to repot statistics to the Federal government was that the States could do it better. This had the effect of breaking the continuity of tren tracking that had been established in the early 1970s when the National Institute on Drug Abuse created data systems to track and report drug overdose mortality and morbidity, treatment admissions to community drud and alcohol centers, and the community based treatment program population itself. Of course the real motivation to disrupt data systems was to obscure the real extent of the proble, which then was cocaine, as well as opiate related deaths. Remember the Nancy Regan slogan “Just Say No” ? As any statistical would tell you, data systems must be both valid and reliable. By disrupting the Federal drug abuse data systems and leaving States to report what they wanted, or could collect, the reliability of data could no longer be assured. No mandated minimum data set was established or adopted by States hence the data collected could not be compared from State to State, nor could it be compared with historical data to see trends. Republican ignorance started long ago and we see it now in spades.

  2. After recent surgery, I told my Surgeon that I stopped Oxycontin the day of surgery after I went to bed. He still wanted to write another script. I told him that I still had 27 pills. Oh well.

  3. If you wanna hang out, you got to take her out, cocaine.
    If you wanna get down, get down on the ground, cocaine.
    She don’t lie, she don’t lie, she don’t lie…cocaine.
    J.J. Cale

  4. Think it is a coincidence that America went in and took out the Taliban who was cutting opium production in Afghanistan? Now the US guards opium fields to insure the Zionists Jews can import the drug into the blood stream of America.

    • It isn’t just the zios involved. The CIA, , certain persons in congress and the Pentagram and of course a number of those with badges and guns. There are a lot of people involved and a lot of corruption.

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