National Opioid Overdose Death Stats May Be Off By 35%

By Paul Gaita 03/28/18

In 2016, there were reportedly 42,000 opioid overdose deaths, but it may actually be closer to 50,000.

man drawing a rising red arrow on a wall

In 2017, the Centers for Disease Control and Prevention (CDC) issued a report stating that more than 42,000 Americans died from suspected opioid overdoses in 2016. But a new study suggests that those statistics may actually be higher—by as much as 20 to 35%.

Analysis of data collected from coroners and medical examiners in various states showed disparities in the way overdose deaths are reported to the CDC; in nearly a quarter of overdose deaths between 1999 and 2015, investigators did not specify the type of drug involved, while in 14 states, no drug was listed as a cause of death for 20 to 48% of all overdose cases.

A feature about the study on NPR indicated that national standardized testing requirements for overdose cases could help present a more realistic picture of the overdose epidemic, albeit a more distressing one, given what could be greatly elevated numbers of deaths.

The study was penned by Christopher Ruhm, a health economist at the University of Virginia, and published in the February 2018 edition of the journal Addiction.

Based on his review of the opioid overdose data, Ruhm placed the death toll for 2016 at closer to 50,000. According to Ruhm, there are several primary reasons for the dichotomy in reporting.

"In some cases, [coroners and medical examiners] are classifying it as a drug death, but they don’t list the kind of drug that was involved," said Ruhm, who suggests that omitting such information can lead to cases of undercounting.

A previous study, published by Ruhm in 2017, opined that in at least four states—Pennsylvania, Indiana, New Jersey and Arizona—opioid mortality rates were drastically understated, with his estimate for Indiana nearly double the rate reported by the state in 2014.

Omissions and oversights can be due to budgetary issues; NPR cites information from Brad Ray, a policy researcher at Indiana University's School of Public and Environmental Affairs, who noted that toxicology reports can cost hundreds of dollars and tax state and county budgets. Such reports are also optional for Indiana coroners, so as Ray stated, "If you're not required to pay for it, and you're not required to report it, why would you?"

Standardizing how coroners report suspected overdose deaths may help to not only provide more accurate data, but also direct how states spend federal funds to combat opioids.

Already, some states, like Indiana, have passed legislation requiring coroners to run toxicology screens and pass along that information to its health department. Funding for such tests would be built into the bill.

The downside to providing a clearer picture regarding opioid deaths is that the information will show a drastic increase in the number of deaths—a sobering uptick for an already alarming statistic.

But as Ruhm noted to NPR, "We have a real crisis, and one of the things we need to invest in, if we're going to make progress, is getting better information."

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Paul Gaita lives in Los Angeles. He has contributed to the Los Angeles Times, Variety, LA Weekly, and The Los Angeles Beat, among many other publications and websites.