In cases of drug overdose fatalities, death certificates can fail to cite the correct cause of death. Why is this a problem? The accurate classification of overdoses is important when it comes to determining the distribution of limited state and federal grant money. Errors in data reporting can mean a community receives less funding for resources used to properly combat the opioid epidemic.
Misreporting of opioid drug overdose deaths is a result of:
- A lack of reporting standards from town to town or county to county
- Misclassification of the cause of death on death certificates
- Not listing the specific drug or drugs involved in an overdose death
According to a 2016-2017 study by the University of Virginia, published in the December 2017 issue of the American Journal of Preventive Medicine, the number of deaths attributed to an opioid overdose are going underreported. Dr. Christopher J. Ruhm examined thousands of death certificates from 2008 to 2014 and many death certificates simply state “unspecified drug” or only list one drug when many were involved. After looking at the corrected data, Rhum concluded that mortality rates in certain states could be up to 22 percent higher for heroin and up to 24 percent higher for opioids than had been previously reported.1
Chanda Lynn, Recovery Advocate at Transformations Treatment Center, recently attended the Many Faces of Addiction Forum held at Jamestown Community College in New York. Jamestown, a city of about 30,000 residents located in Chautauqua County has been hit hard by the addiction epidemic. The forum was also attended by Jamestown Police Department Chief Harry Snellings who shared, “One of the hurdles that we have to overcome is that we don’t have a medical examiner here in Chautauqua County. So, a lot of the overdoses that we have, unless there is a criminal charge, a lot of these deaths don’t result in an autopsy or a toxicology report. So, while the death may be reported as cardiac arrest, the contributing factor could be a drug overdose.”5
Lack of Overdose Reporting Standards and Cause of Death Misclassification
Jamestown does not have a medical examiner (ME). There are four coroners in the city that handle anything from elderly deaths to drug overdoses. Unfortunately, because there is no medical examiner in Jamestown, autopsies are rarely performed.
In a comment made on Chandra Lynn’s Facebook page George Borrello, Chautauqua County Executive elect says, “Currently we have a team of county coroners that attend each death and perform blood tests, etc. as needed to determine the cause of death. Autopsies are performed by the Erie County Medical Examiner.”3
So, if an autopsy is deemed necessary, the body would have to be transported to the Medical Examiner’s Office in Erie County.4 A medical examiner would run toxicology tests on a deceased person suspected of overdose to determine their exact cause of death and what drugs were involved.
Also, due to lack of reporting standards even when drugs are involved, they still might not be listed as the primary cause of death. In a city like Jamestown, with no medical examiner, often times an overdose death is labeled as heart attack or respiratory failure on the death certificate.
|Overdose Cause||Chautauqua County||Erie County||New York Statea||New York City|
|All Opioid Overdoses||24||271||1879||1100b|
|Opioid Pain Reliever Overdoses||16||247||1478||241|
Table 1 – Comparing Number of Overdose Deaths in 20164
a -Excluding New York City.6
b – Of the 1374 total drug overdose deaths occurring in New York City in 2016, approximately 80% were due to an opioid overdose.7
Inequity in Rehab and Recovery Funding
The NY State Office of Alcoholism and Substance Abuse Services (OASAS) provides a listing of all available Federal, State, Foundation and Corporate Grant opportunities. These funds are available to those who are working on preventing and treating individuals with a substance use disorder although the specifications for awarding each grant varies.8
These funds are necessary to support treatment centers, help the local police department fight the drug epidemic and support the local Mental Health Association and other organizations that deal with addiction. This lack of resources not only affects a place like Jamestown, its residents and even children in the community, but it also affects the entire nation.
There are about 30 counties in NY State that are without a medical examiner.
How Wrong Are We About the Addiction Epidemic?
If overdose numbers are being inaccurately classified, either due to the absence of a medical examiner or inaccurate reporting standards, then the overall statistics are much lower than what’s being reported. This means that America is not grasping the entire scope of the drug addiction epidemic because it has incorrect data. What can be done about this?
Should county legislators request funding for a ME in areas that lack this resource? When asked about the lack of medical examiners in Jamestown, and other towns in Chautauqua County, Borrello says, “This is a topic that I will put on the priority list to review with the Countywide Alliance for Enforcement and Rehabilitation (CAER). CAER is a brand-new task force I’m forming to combat this epidemic through better communication with all stakeholders involved and more efficient allocation of resources.”
Every county in New York, and throughout the U.S., should have a medical examiner in light of this crisis. If not a medical examiner, then the county coroner’s office should receive more funding to implement software systems and programs capable of determining the exact cause of death and what specific drugs played a role in the death. If the numbers keep going under-reported, or if the drugs that played a role in the death are never reported, no one will have an accurate view of what is really happening in America and how to focus on combatting this issue.9
- American Journal of Preventive Medicine. December 2017, Volume 53, Issue 6, pages 745-753. Geographic Variation in Opioid and Heroin Involved Drug Poisoning Mortality Rates. http://www.ajpmonline.org/article/S0749-3797(17)30313-6/fulltext
- Jamestown Community College Forum. November 15, 2017. Many Faces of Addiction: No one Cause, No One Solution. https://soundcloud.com/wrfaradio/many-faces-of-addiction-drug-6?in=wrfaradio/sets/many-faces-of-addiction-drug-forum-nov-15-2017-at-jamestown-community-college
- Chanda Lynn’s Facebook page. Accessed November 20, 2017. https://www.facebook.com/adnahC33/posts/10203992744934266.
- Erie County, NY Department of Health. Medical Examiner’s Office. http://www2.erie.gov/health/index.php?q=medical-examiner
- Many Faces of Drug Addiction Forum – Part 2 Jamestown Police Department Chief Harry Snellings. https://soundcloud.com/wrfaradio/many-faces-of-addiction-drug-6?in=wrfaradio/sets/many-faces-of-addiction-drug-forum-nov-15-2017-at-jamestown-community-college
- New York State Department of Health. New York State – County Opioid Quarterly Report. Published October, 2017. https://www.health.ny.gov/statistics/opioid/data/pdf/nys_oct17.pdf
- NYC Health Epi Data Brief. Unintentional Drug Poisoning (Overdose) Deaths in New York City, 2000 to 2016. https://www1.nyc.gov/assets/doh/downloads/pdf/epi/databrief89.pdf
- New York State Office of Alcoholism and Substance Abuse Services. Grant and Funding Opportunities. https://www.oasas.ny.gov/hps/grants/
- Trib Live. Study: State’s Overdose Deaths are Underreported, Record-Keeping Fragmented. http://triblive.com/news/healthnow/12598053-74/study-states-overdose-deaths-are-underreported-record-keeping-fragmented