More than 99K opioid deaths in U.S. may have gone unreported

Recovering drug users, activists and social service providers hold a morning rally calling for "bolder political action" in combating the overdose epidemic outside of the office of Governor Andrew Cuomo on August 17, 2017 in New York City. (Credit: Spencer Platt/Getty Images)

The number of overdose-related opioid deaths could be 28% higher than reported due to incomplete death records, research shows.

The discrepancy is more pronounced in several states, including Alabama, Mississippi, Pennsylvania, Louisiana, and Indiana, where the estimated number of deaths more than doubles—obscuring the scope of the opioid crisis and potentially affecting programs and funding intended to confront the epidemic, researchers say.

“A substantial share of fatal drug overdoses is missing information on specific drug involvement, leading to under-reporting of opioid-related death rates and a misrepresentation of the extent of the opioid crisis,” says Elaine Hill, an economist and assistant professor in the University of Rochester Medical Center public health sciences department and senior author of the study in Addiction.

“The corrected estimates of opioid-related deaths in this study are not trivial and show that the human toll has been substantially higher than reported, by several thousand lives taken each year.”

Hill and colleagues found that almost 72% of unclassified drug overdoses that occurred between 1999-2016 involved prescription opioids, heroin, or fentanyl. That translates into an estimated 99,160 additional opioid-related deaths.

Inconsistent record-keeping

Hill and coauthor Andrew Boslett first stumbled on the discrepancy while studying the economic, environmental, and health impacts of natural resources extraction. Many regions of the country hit the hardest by the opioid crisis overlap with areas associated with shale gas development and coal mining.

As a part of her research, Hill was attempting to determine whether the shale boom improved or exacerbated the opioid crisis. However, as they started collecting data, the researchers discovered that close to 22% of all drug-related overdoses were unclassified, meaning the drugs involved in the cause of death were not indicated.

A medical examiner or coroner becomes involved during any sudden and unexpected death of an otherwise healthy person and anyone suspected to have died from an unnatural cause.

Under ideal circumstances, a combination of evidence collected at the scene, a toxicological analysis of blood or tissue, and an autopsy help identify the cause of death. If the cause is determined to be drug-related, either accidental or a suicide, then the specific drugs identified in the person’s system are recorded on the death certificate.

However, in practice, this process is expensive and time-consuming, dependent upon the resources and staffing available to the specific medical examiner’s office, and potentially influenced by family members due to the stigma associated with opioid use.

Additionally, the requirements to serve as a medical examiner or coroner varies nationally. In some states, the office is an elected position with no prerequisite for professional experience or training in forensic pathology.

More than 100% more reported opioid deaths

For the study, the researchers obtained death records of individuals identified as having died from drug overdoses from the National Center for Health Statistics, part of the Centers for Disease Control and Prevention.

In addition to the cause, the records also include any additional medical issues that might have contributed to the death. Employing a statistical analysis, the researchers could correlate the information in the death records of unclassified overdose deaths with contributing causes associated with known opioid-related deaths, such as previous opioid use and chronic pain conditions.

While the overall percentage of unclassified deaths declined over time, a phenomenon that the researchers speculate is due to a more focused effort by federal, state, and local officials to understand the scope of the crisis, in several states, the number remained high.

The new estimates of actual opioid-related deaths show a pronounced increase in states like Alabama, Mississippi, Pennsylvania, Louisiana, and Indiana. In fact, in each of these states, the number of opioid-related deaths increased by more than 100%.

In Pennsylvania, for example, the number of reported opioid-related deaths was 12,374. The study estimates the actual number of deaths was 26,586. Consequently, the state’s total number of deaths in places it behind only California and Florida, states with significantly higher populations, and moves Pennsylvania from fifteenth to sixth in terms of highest per capita death rates in 2016.

“The under-reporting of opioid-related deaths is very dependent upon location and this new data alters our perception of the intensity of the problem,” Hill says.

“Understanding the true extent and geography of the opioid crisis is a critical factor in the national response to the epidemic and the allocation of federal and state resources to prevent overdoses, treat opioid use disorders, regulate the prescription of opioid medications, and curb the illegal trafficking of drugs.”

The National Institutes of Health supported the work.

Source: University of Rochester