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May 24, 2017

We're underestimating the toll of opioid overdoses, CDC says

Daily Briefing

    Approximately 91 people die from an opioid drug-related overdose each day in the United States, but that estimate likely is low, according to CDC research detailed at the annual Epidemic Intelligence Service Conference.

    During the meeting, Victoria Hall, a CDC field officer based in Minnesota, said CDC researchers discovered that the way some deaths are reported could be masking the actual number of U.S. residents who die from opioid-related overdoses. She explained, "In early spring, the Minnesota Department of Health was notified of an unexplained death: a middle-aged man who died suddenly at home." She said the man had been taking opioid painkillers long-term for back pain, and his family had been concerned that he was misusing the medication.

    According to Hall, the medical examiner who performed an autopsy on the man tested for and diagnosed the man with both pneumonia and toxic level of opioids. However, Hall said the man's death certificate "only listed the pneumonia and made no mention of opioids."

    CDC researchers said the instance showed that tracking opioid-related overdose deaths might be difficult because the overdoses might not be listed as a cause of death within surveillance systems that rely on autopsy report codes.

    Research identifies underreporting 

    To test that theory, Hall and a team of CDC researchers reviewed death records spanning 2006 through 2015 from the Minnesota Department of Health's Unexplained Death surveillance system. The system, which Hall said was created to "constantly be on the lookout for emerging disease," tracks deaths for which the cause is unclear.

    The researchers specifically looked for death records that listed pneumonia and other infectious diseases as a possible cause of death among Minnesota residents ages 12 and older. Research has shown that individuals who use opioids are more likely to develop pneumonia, CNN reports, and the researchers looked to see whether opioids might have been involved and identified in postmortem toxicology screenings for such deaths.

    According to Hall, the researchers estimated that, in Minnesota, more than 50 percent of deaths involving opioids from 2006 to 2015 were not included in the state's total number of opioid-related deaths. Of the 1,676 death records that aligned with the researchers' criteria, 59 listed evidence of opioid use and had not been reported to the state's opioid surveillance system because they did not have codes associated with opioid use. Further, the researchers found that 22 of those 59 deaths involved toxic opioid levels.

    Researchers say underreporting might occur throughout the country

    Hall explained that there is "no clear-cut line on what an overdose is" and no "national standardization for how to fill out a death certificate." As such, public health officials must rely on medical examiners' judgement when it comes to identifying opioid-related overdoses.

    "It's quite concerning, because it means that the (opioid) epidemic, which is already quite severe, could potentially be even worse," Hall said. She added, "While my research cannot speak to what percent we are underestimating, we know we are missing cases. It does seem like it is almost an iceberg of an epidemic."

    Hall recommended that public health officials work with medical examiners to make sure death certificates are coded properly to help ensure the opioid misuse epidemic is accurately reported (Pascual, Tech Times, 4/25; Scutti, CNN, 4/25; Fox, NBC News, 4/24).

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