Opioid Epidemic May Be Underreported, CDC Finds

By Kelly Burch 04/27/17

“Over half the cases that we found that were toxic or lethal were not counted in the system," said one researcher in Minnesota.

woman holding a handful of white pills.

A lot of attention has been given to the opioid epidemic that claims a shocking 91 lives in the U.S. every day. However, a new report from the Centers for Disease Control and Prevention (CDC) indicates that deaths from opioids may be widely underestimated because of inconsistent reporting. 

“It's quite concerning, because it means that the (opioid) epidemic, which is already quite severe, could potentially be even worse," said Dr. Victoria Hall, a CDC field officer based in Minnesota, according to a CNN report. "It does seem like it is almost an iceberg of an epidemic.”

This is a national issue, said Hall, complicated by inconsistent ways of filling out death certificates. “While my research cannot speak to what percent we are underestimating, we know we are missing cases,” she said. 

Hall said that more than half of Minnesota deaths that involved opioids between 2006 and 2015 were not captured in the state’s total. She presented the case of an elderly man in Minnesota who had been using opioids to manage back pain. His family was concerned that he may be abusing the drugs, and when he died the autopsy found evidence of pneumonia and a toxic level of opioids.

"However, on the death certificate, it only listed the pneumonia and made no mention of opioids," Hall said 

Hall led a team of researchers that examined death records from cases that involved unexplained deaths. The researchers looked at records of people over the age of 12 who had died of infectious diseases. The team identified 1,676 cases that fit the criteria, and found that 59 deaths—or 3.5%—involved opioids. Twenty-two deaths involved toxic levels of opioids, yet none of the 59 had been reported to the state’s opioid surveillance system because the autopsies were labeled with a different cause of death. 

“Over half the cases that we found that were toxic or lethal were not counted in the system," Hall said. Many of the deaths involved pneumonia, which can be complicated by opioids in the system. 

“Opioids at therapeutic or higher than therapeutic levels can impact our immune system," Hall said. "It actually impacts your macrophages—so that's one of your main immune cells that's going to help fight off infections—and it kind of dampens them down. It also dampens down your antibody response.”

Opioids can also affect how people breathe, she added. "When you take an opioid and it makes you breathe more shallow and breathe slower and less likely to cough, it's a lot more likely things can settle in your lungs," Hall said.

The data indicates that more research needs to be done into how deaths involving opioids are reported. 

“While my data doesn't support a percent that we're underestimating, it puts out the question: Is there something we need to look into further?" Hall said. "This is not just a Minnesota problem."

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Kelly Burch writes about addiction and mental health issues, particularly as they affect families. Follow her on TwitterFacebook, and LinkedIn.