New study generates more accurate estimates of state opioid and heroin fatalities

August 7, 2017
Reported and corrected 2014 overdose death rates (per 100,000). Credit: American Journal of Preventive Medicine

Although opioid and heroin deaths have been rising dramatically in the U.S., the magnitude of the epidemic varies from state to state, as does the relative proportion of opioid vs heroin poisonings. Further complicating the picture is that up to one-quarter of all death certificates fail to note the specific drug responsible for the fatality, complicating efforts to target enforcement and treatment programs at both state and federal levels. A new study in the American Journal of Preventive Medicine presents a correction procedure to refine this data, which results in significant shifts in state-by-state mortality rates. This truer picture helps to remove an important barrier to formulating effective policies to address this serious drug epidemic.

On a national basis, these corrected were 24% higher for opioids and 22% higher for . For opioids, uncorrected mortality growth rates were considerably underreported in Pennsylvania, Indiana, New Jersey, and Arizona, but dramatically overestimated in South Carolina, New Mexico, Ohio, Connecticut, Florida, and Kentucky. Increases in heroin death rates were understated in most states, and by a significant margin in Pennsylvania, Indiana, New Jersey, Louisiana, and Alabama.

According to author Christopher J. Ruhm, PhD, Frank Batten School of Leadership and Public Policy, University of Virginia, Charlottesville, Virginia, "A crucial step to developing policy to combat the fatal epidemic is to have a clear understanding of geographic differences in heroin- and -related mortality rates. The information obtained directly from understates these rates because the drugs involved in the deaths are often not specified."

This study develops correction methods to provide more accurate information. The corrected estimates often differ considerably from reported rates. To provide an example, in 2014, the opioid and heroin death rates based on death certificate reports in Pennsylvania were 8.5 and 3.9 per 100,000, respectively, but a drug category was specified in only half of fatal overdose cases in that year. Correcting for this understatement yields estimated actual opioid and heroin overdose deaths of 17.8 and 8.1 per 100,000.

Counts of drug deaths of U.S. residents were obtained from the 2008 and 2014 Centers for Disease Control and Prevention Multiple Cause of Death (MCOD) files. The MCOD data provide information from death certificates on a single underlying cause of death, up to 20 additional causes, and also provided age, race/ethnicity, gender, year, weekday, and place of death. The death certificate may also list one or more drugs involved as immediate or contributory causes of death, included separately as ICD-10 T-codes. T-codes 40.0-40.4 and 40.6 indicate the involvement of opioids and T-code 40.1 refers to heroin.

There were 36,450 fatal overdoses nationwide to U.S. residents in 2008 and 47,055 in 2014. However, for about half the overdose fatalities, unspecified drugs were mentioned, and in one-fifth to one-quarter of the cases, this was the only drug-related designation included. To develop corrected rates, information from death certificate reports where at least one specific drug category was identified were used to impute drug involvement for cases where drug involvement categories were left unspecified. These corrections were then applied on a state-by-state basis to produce opioid- and heroin-specific death rates.

Dr. Ruhm notes that these corrections have a substantial influence on state mortality rankings. "For instance, Pennsylvania had the 32nd highest reported opioid mortality rate and the 20th highest reported heroin death rate, but ranked seventh and fourth based on corrected rates. Similarly, Indiana's rankings moved from 36th and 29th to 15th and 19th, respectively, and Louisiana's from 40th and 31st to 21st and 20th, respectively. There were 19 states whose corrected and reported opioid rankings differed by at least five places and eight states where this occurred for heroin."

Understanding the inaccuracies resulting from the lack of specificity of drug involvement on death certificates is particularly important because federal policies often target states believed to have especially severe opioid or heroin problems. "More fundamentally, geographic disparities in drug poisoning deaths are substantial and a correct assessment of them is almost certainly a prerequisite for designing policies to address the fatal drug epidemic," concludes Dr. Ruhm.

Explore further: More Australians dying of accidental overdose of pharmaceutical opioids

More information: American Journal of Preventive Medicine (2017). DOI: 10.1016/j.amepre.2017.06.009

Related Stories

More Australians dying of accidental overdose of pharmaceutical opioids

July 24, 2017
In a reversal of the heroin epidemic of the late 90s and early 2000s, older Australians aged 35 to 54 are now more likely to die from an opioid overdose, a new report reveals.

US opioid crisis at epidemic proportions

May 4, 2017
Many US communities are facing an epidemic of opioid and heroin abuse that is straining resources from police, to jails, to emergency medical personnel and treatment centers.

Expert says opioid epidemic is even worse than we thought

August 22, 2016
In the last two decades, drug overdoses have slowly overtaken motor vehicle fatalities as the leading cause of death in the United States. In Virginia alone, the Office of the Attorney General estimates that more than 900 ...

Heroin's use rising, costing society more than $51 billion

June 9, 2017
Heroin use in the United States was estimated to cost society more than $51 billion in 2015, according to new research at the University of Illinois at Chicago.

US drug overdose deaths soar in 2016: report

June 6, 2017
US drug overdose deaths surged 19 percent to at least 59,000 last year as deadly manufactured drugs like fentanyl intensified a national opioid addiction crisis, New York Times data showed Tuesday.

Drug overdose deaths increase significantly in past five years

December 16, 2016
Drug overdose deaths have increased by 33 percent in the past five years across the country, with some states seeing jumps of nearly 200 percent.

Recommended for you

Fighting opioid addiction in primary care—new study shows it's possible

October 18, 2017
For many of the 2 million Americans addicted to opioids, getting good treatment and getting off prescription painkillers or heroin may seem like a far-off dream.

With no morphine, 25 million die in pain each year: report

October 13, 2017
Every year, some 25 million people—one in ten of them children—die in serious pain that could have been alleviated with morphine at just a few cents per dose, researchers said Friday.

Study finds few restrictions on Rx opioids through Medicare

October 9, 2017
Medicare plans place few restrictions on the coverage of prescription opioids, despite federal guidelines recommending such restrictions, a new Yale study finds. The research results highlight an untapped opportunity for ...

Nocebo effect: Does a drug's high price tag cause its own side effects?

October 5, 2017
Pricey drugs may make people more vulnerable to perceiving side effects, a new study suggests—and the phenomenon is not just "in their heads."

Pre-packaged brand version of compounded medication to prevent preterm births costs 5,000 percent more

October 2, 2017
Preventing a preterm birth could cost as little as $200 or as much as $20,000, depending on which one of two medications a doctor orders, according to a new analysis from Harvard Medical School.

Cancer drugs' high prices not justified by cost of development, study contends

September 12, 2017
(HealthDay)— Excusing the sky-high price tags of many new cancer treatments, pharmaceutical companies often blame high research and development (R&D) costs.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.