Incidence of Heroin Fatalities Actually Much Higher Than First Thought

By Zachary Siegel 05/22/15

It’s likely hundreds who have died from heroin overdose are not counted in the latest statistics.

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The latest statistics have revealed that heroin-related deaths nearly quadrupled in the last 13 years. But experts say that state-by-state statistics are leaving out hundreds of cases of opioid overdose deaths as a result of vague details on death certificates, making the figures much higher than previously thought.

In Pennsylvania, for instance, where it is estimated opioids killed at least 1,300 people last year, there is no requirement for coroners to report the specific details of drug overdoses. What happens is death certificates will read “accidental multiple drug toxicity” and will therefore not be counted as a heroin-related death, even though heroin could be one of the drugs involved.

In an NPR report, Stacy Emminger of Pennsylvania showed her son Anthony’s death certificate. He was addicted to heroin and that’s what killed him, she said. But on his death certificate there is no note of him doing heroin, only the vague phrase, "immediate cause of death is multiple drug toxicity, accidental.”

Anthony and likely hundreds of others will not be counted among heroin-related deaths as long as coroners continue not to specify chemicals on death certificates.

Accurate statistics matter when it comes to combating this complex problem. If policymakers and emergency personnel are unable to know how many people are dying and from what drugs, they won't know which methods to use in order to successfully reduce the shockingly high mortality rates.

"The interventions for whether it's heroin or other illicit substances are different than, for example, if they are prescription drugs," Dr. Kurt Nolte, executive vice president for the National Association of Medical Examiners, told NPR. "And if you can't tell the difference because everybody's classified as multi-drug toxicity, you have no idea what's killing people," he said.

Not listing all of the drugs on a death certificate is particularly salient for EMTs in cases where fentanyl, a powerful opioid, is mixed with the heroin because there may need to be multiple administrations of naloxone in order to reverse the overdose and save a life.

For example, last year in western Pennsylvania heroin laced with fentanyl killed 22 people in a matter of weeks. If EMTs are aware of a lethal batch of heroin going around they will show up to an overdose prepared to give those extra shots of naloxone.

As it stands, coroners in states like Pennsylvania can now send the state a form detailing all the drugs in someone's system. However, the extra steps to do so aren't required and there's no public database set up yet.

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Zachary Siegel is a freelance journalist specializing in science, health and drug policy. His reporting has also appeared in Slate, The Daily Beast, Salon, Huffington Post, among others. He writes often about addiction, sometimes drawing from his own experience. You can find out more about Zachary on Linkedin or follow him on Twitter.