According to a study, researchers found overdoses report vary widely across states and counties. As a result, no data were captured properly, so the country undercounts opioid-related overdoses by 20 to 35%
In the coroner’s office blood, urine and vitreous samples are waiting for testing. In overdose cases, the fluids may contain clues for investigators. These samples are sent to toxicology lab to be tested for drug abuse.
The results often include drugs such as cocaine, heroin, fentanyl or prescription pharmaceuticals. After testing, coroners typically make a note of the drugs involved in an overdose on the death certificate — but not always.
Data from death certificates move from coroners and medical examiners to states and eventually the Centers for Disease Control and Prevention, which publishes reports on overdose counts across the U.S. According to the CDC, more than 42,000 people died from opioid-related overdoses in 2016, a 30% increase from the year before.
But that number is only as good as the data states submit to the CDC. Ruhm said the real number of opioid overdose deaths is closer to 50,000. He came to the higher estimate through an analysis of overdoses that weren’t linked to specific drugs.
On a death certificate, coroners and medical examiners often leave out exactly which drug or drugs contributed to a death. Ruhm et al. said, “In some cases, they’re classifying it as a drug death, but they don’t list the kind of drug that was involved.”
Many overdoses not linked to a specific drug were likely opioid-related, Ruhm said, so the lack of specificity leads to undercounting. According to Ruhm’s earlier research published in 2017, Indiana’s opioid overdose fatality rate is especially far off. He estimated the state’s rate in 2014 was 14.3 overdose deaths per 100,000 people, twice as high as the rate reported that year.
“States that have centralized oversight with medical examiners tend to do better than those with coroners,” said Ruhm. In some places, death investigators don’t list substances on a death certificate because they haven’t tested for them. Brad Ray said toxicology reports cost hundreds of dollars each, which could strain county budgets.
Indiana’s legislature recently passed a bill to standardize how coroners handle suspected overdoses, and Republican Gov. Eric Holcomb is expected to sign it. Starting in July, coroners will have to run toxicology screens and report the results to the state health department. The state will also help cover the added costs.
Data that is more accurate would likely make the opioid problem look worse as the numbers go up. But Ray said realistic data could help the state access federal funds to tackle the opioid epidemic and keep better track of drug problems.
Marion County’s Ballew learned at a conference last year that she could help improve the state’s data. Her office was already getting toxicology reports for all suspected overdoses, and now her team will list the drugs involved in an overdose on the death certificate.
“We’ll say ‘drug overdose’ or ‘drug intoxication,’ and then we identify the drugs,” she said. “So if it’s five drugs that have caused or contributed to the death, then we put those five drugs down.”