Pitt study: 70K opioid overdose deaths went unreported on death certificates
The scope of the national opioid epidemic is dramatically underestimated because of incomplete death certificate reporting, according to a study released Wednesday by the journal of the U.S. Surgeon General.
The problem is most evident in Pennsylvania, according to the study’s lead author, Jeanine M. Buchanich, a research professor at the University of Pittsburgh Graduate School of Public Health.
The study was published Wednesday in the journal, Public Health Reports, and it found that between 1999 and 2015 as many as 70,000 opioid-related overdose deaths were not included in national opioid death estimates because coroners and medical examiners did not specify the drug that contributed to the cause of death when they filled out death certificates.
When that happens, those “unspecified” deaths aren’t counted as being opioid-related and the incomplete statistics can make it more difficult to identify places that are plagued by the problem more than the overdose numbers indicate.
“Proper allocation of resources for the opioid epidemic depends on understanding the magnitude of the problem,” Buchanich said. “When (the type of drugs) go unreported on death certificates it does affect how we view these statistics.”
The researchers, including Buchanich, Pitt Public Health Dean Donald S. Burke and Allegheny County Medical Examiner Karl E. Williams, looked at overdose death data by state for the period covered in the study. By grouping the deaths by whether they were opioid, non-opioid-related and unspecified, they were able to extrapolate how many of the unspecified overdose deaths were likely opioid-related.
The potential for under-reported opioid deaths was greatest in Pennsylvania, Alabama, Indiana, Louisiana and Mississippi. In each of those states more than 35 percent of the overdose deaths were coded as unspecified, according to the study.
States such as Pennsylvania, where the county coroner system isn’t centralized, have a higher proportion of unspecified overdose deaths, Buchanich said. Three counties in the state — Allegheny, Delaware and Philadelphia — have medical examiners, which lessens the likelihood of unspecified death reporting, she said.
Before he became Allegheny County’s medical examiner more than a decade ago, Williams assisted county coroners throughout the region in death investigations, and the opioid crisis has overwhelmed them, he said.
They’re doing their job even when they list a cause of death as an unspecified overdose, but doing so doesn’t provide the necessary information to get a handle on the opioid epidemic, as the drugs involved vary from place to place and changes over time — from pills to heroin to fentanyl to what’s now referred to as “fentanyl-related substances,” Williams said.
“If you’re going to approach the problem based on the evidence, we should have the most complete evidence,” Williams said.
That means listing the specific drugs involved in each overdose on death certificates, he said.
“It’s better than leaving it unknown,” he said. “I think it’s important to realize there could be 70,000 nationwide we don’t know about. The pattern of what (drugs are) causing overdoses is rapidly changing. The more specific you can be the better you can be at trying to find a solution to the problem.”
That said, there isn’t a push to standardize overdose reporting across the nation or in Pennsylvania, Williams said.
Doing so improves the numbers, as evidenced by Kentucky’s numbers over the course of the study. Between 1999 and 2015, officials there made efforts to improve reporting and there was a 43 percent increase in overdose deaths coded as opioid-related in that time and unspecified overdose deaths decreased by 28 percent, according to the study.
Awareness of the issue can only help solve the problem, Williams said.
“Nobody ever wanted to acknowledge what we did… until your personal family is affected by a death, you don’t want to know what we do here (as death investigators),” Williams said.
Because the opioid epidemic has impacted so many people, things are changing, he said.
“This is important information,” Buchanich said.
Tom Davidson is a Tribune-Review staff writer. Reach him at 724-226-4715 or [email protected].