Causes of Opioid-Related Overdose Deaths

Obtaining Adequate Data to Determine Causes of Opioid-Related Overdose Deaths | Pain Medicine – 1 June 2011

Current data collected by medical examiners and coroners are incomplete and inadequate to evaluate the factors that lead to fatalities involving prescription opioids.

Determining cause of death is critically important.

This issue is now 5 years old and nothing has been done.

Pinpointing the causes of opioid-related overdose deaths would show data that the anti-opioid zealots do not want to publicize: that most are caused by combinations of illegal drugs and very few by only prescribed opioids.  

Two methods are proposed to improve consistency and accuracy in the collection and analysis of decedent data in opioid-related poisoning deaths

First, an improved death certificate is needed to collect evaluative data, including:

  • extent to which opioids were judged to 1) cause, 2) contribute to, or 3) be present in investigated deaths;
  • extent to which opioids as a cause of death were found 1) alone, 2) combined with other prescription drugs, 3) combined with alcohol, or 4) combined with illicit drugs; the time of death;
  • the presence or absence of a valid prescription; and
  • the estimated quantity of opioids taken proximal to death.

Patient characteristics for analysis include

  • age,
  • gender,
  • race/ethnicity,
  • geographic area (particularly whether urban or rural),
  • body mass index,
  • duration of opioid usage and daily average dose during the last 2 weeks of life, and
  • histories of chronic pain/medical conditions, substance abuse, and mental illness/psychiatric diagnoses

Second, expanding the scope of opioid toxicology categories used to classify and code cause-of-death data reported by death investigators would improve identification of individual drugs and classes most often associated with overdose deaths

Formulation-specific codes should be added to facilitate consistent recording of findings by death investigators and entry into national vital statistics databases.

Introduction

To reverse the trend of annually increasing poisoning deaths associated with prescription opioids, it is necessary to systematically collect and study those factors involved in the deaths.

However, inconsistent data collection, reporting, and cataloging methods employed by medical examiners and coroners (MEs/Cs) nationwide impede this goal.

Consider, for example, that people who overdose on opioids and subsequently die

  1. may be nonmedical users who consume toxic amounts of opioids in the absence of medical need, or they
  2. may be medical patients who consume toxic amounts of opioids in an effort to escape pain, self-treat a comorbid condition, or follow inappropriate prescribing directions.

This type of information is critical because nationally proposed interventions will vary dramatically depending on the motives for overuse

In addition, collection methods fail to illuminate the specific drugs, classes of drugs, and important related issues involved with the death.

As a result, many recorded causes of death reflect only medical opinion.

We propose two methods to improve consistency and accuracy in the collection and analysis of decedent data in opioid-related poisoning deaths.

To obtain better information to study root causes, we must first acknowledge that the data are collected for administrative purposes; despite our reliance upon it, the system is not designed to collect research grade data.

Coroners at the local level may not be trained to assess all the dimensions needed for meaningful overdose assessment. Shrinking state budgets may result in fewer autopsies and less thorough toxicology panels.   

While there is plenty of money to spend on the failing drug war, they cannot find the money to help determine what is causing drug overdoses.

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