Reports May Have Dramatically Underestimated US Opioid-Related Deaths, Study Finds

Misrepresenting opioid deaths may be taking away from resources necessary to battle the opioid epidemic. KieferPix/Shutterstock

Madison Dapcevich 27 Feb 2020, 20:00

American deaths from opioid-related overdoses may be 28 percent higher than previously reported, new data suggests.  

Almost 72 percent of drug overdoses between 1999 and 2016 that did not list a specific drug on the death certificate likely involved prescription opioids, heroin, or fentanyl, adding to more than 99,000 additional opioid-related deaths during that timeframe. Some states were disproportionately affected. According to the research published in the journal Addiction, the “striking” discrepancies were more pronounced in Alabama, Mississippi, Pennsylvania, Louisiana, and Indiana where the number of deaths doubled.

The findings suggest that the magnitude of the opioid crisis is likely not met by programs and funding required to battle the epidemic.

"A substantial share of fatal drug overdoses is missing information on specific drug involvement, leading to underreporting of opioid-related death rates and a misrepresentation of the extent of the opioid crisis," said study author Elaine Hill, economist and assistant professor in the University of Rochester Medical Center Department of Public Health Sciences, in a statement. "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."

When an otherwise healthy individual dies unexpectedly or from unnatural causes, medical examiners use the evidence collected at the scene, an autopsy report, and toxicological analysis of blood and tissue to determine the cause of death. If drugs are involved in the death, either accidental or intentional, specific drugs are to be listed on the death certificate. According to the researchers, the specific drug involved in an overdose is not always listed on the death certificate, with up to one-quarter of death overdoses listing the cause as “other and unspecified drugs.”

US county map shows the change in 2016 death rates. University of Rochester Medical Center

To account for this discrepancy, Hill and her team collected death records of individuals identified as having died from drug overdoses from the CDC’s National Center for Health Statistics, of which 22 percent did not indicate which drugs were involved. This information was cross-referenced with other health-related information included on the record, such as previous opioid use or whether a person suffered from chronic pain that would require a prescription in order to determine unclassified overdose deaths. The researchers note that their statistical analysis may have oversimplified the link between medical history and death, but shows that opioid-related deaths are vastly underreported nonetheless.

"The underreporting of opioid-related deaths is very dependent upon location and this new data alters our perception of the intensity of the problem," said Hill. "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."

Though the overall percentage of unclassified deaths declined over time likely because law enforcement officials prioritized listing associated drugs so as to gain more insight into the opioid epidemic, the researchers add that misrepresenting opioid deaths may be taking away from resources necessary to battle the opioid epidemic. More than 70,000 known drug overdose deaths occurred in the US in 2017, which amounts to about 192 each day, according to the Centers for Disease Control and Prevention (CDC). Of those, 68 percent were known to be related to opioids. 

Deaths from opioid-related overdoses may be 28 percent higher than previously reported. This discrepancy is more pronounced in several states, including Alabama, Mississippi, Pennsylvania, Louisiana, and Indiana, where the estimated number of deaths more than doubles. University of Rochester Medical Center
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