Study Suggests Thousands More Opioid Deaths

 Katelyn Newman

TENS OF THOUSANDS MORE people have potentially died from opioid-related overdoses than previously thought, according to a new study by researchers from the University of Pittsburgh Graduate School of Public Health.

Death certificates that did not specify the drugs involved in fatal overdoses may have masked more than 70,000 opioid-related deaths across the U.S. from 1999 to 2015. In Alabama, Indiana, Louisiana, Mississippi and Pennsylvania – where more than 35 percent of overdose deaths per state were tied to unspecified drugs – the potential number of opioid-related overdose deaths may be more than double in each, according to the study.

"Proper allocation of resources for the opioid epidemic depends on understanding the magnitude of the problem," Dr. Jeanine Buchanich, the study's lead author and a research associate professor in Pitt Public Health's Department of Biostatistics, said in a statement. "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."

For the analysis, published Wednesday in the journal Public Health Reports, researchers examined death data by state from 1999 to 2015 from the National Center for Health Statistics, which gathers and codes death certificate information from coroners and medical examiners nationwide. The study also involved the chief medical examiner of Allegheny County, Pennsylvania.

Buchanich and her team specifically looked at reported drug overdose deaths, categorizing them into opioid-related, non-opioid-related and unspecified groups. They examined the proportional changes in each group over the 17-year period, and from there extrapolated how many unspecified overdoses were likely related to opioid use.

The reallocation of unspecified drug overdose deaths to possible opioid-related deaths ranged over the period from 9 in Vermont to 11,152 in Pennsylvania. California, Florida and Pennsylvania each added more than 5,000 opioid-related overdose deaths, bringing their respective totals to 30,813, 25,144, and 20,521.

Before and after deaths were reallocated, West Virginia ranked first among states in opioid-related overdose mortality rates for 2015, going from 31.2 to 31.6 deaths per 100,000 people. Indiana saw its ranking change the most, going from a 7.2 mortality rate and 34th among states to a No. 15 ranking with a rate of 13.3.

The state that saw the most significant change in its 2015 opioid-related death rate was Pennsylvania, whose rate increased by 103 percent to 20.1 per 100,000 people, moving it from 22nd to seventh place.

At least some of the shifts reportedly boiled down to whether states have a decentralized county coroner system or a hybrid system involving state medical examiners and county coroners, both of which tended to have higher proportions of unspecified drug overdose deaths.

"Multiple organizations have advocated for more accurate drug reporting on death certificates," Buchanich said. "But coroners are less likely to be physicians and do not necessarily have medical training useful for completing drug information 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."

More than 350,000 people died from an opioid-related overdose from 1999 to 2016, according to the Centers for Disease Control and Prevention, and the number of overdose deaths involving opioids – ranging from prescription drugs like hydrocodone and oxycodone to illegal opioids like heroin and synthetic fentanyl – was five times higher in 2016 than in 1999.

On average, more than 115 Americans die every day from an opioid overdose, the CDC reports.

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