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U.S. opioid, heroin overdose deaths may be one-fifth higher.

THE LACK OF DETAIL on which drug is involved in a fatal overdose may be causing a significant underestimation of the rates of opioid and heroin mortality across the United States.

Christopher J. Ruhm, PhD, of the University of Virginia, Charlottesville, conducted an analysis using improved estimates of state-level opioid and heroin overdose fatalities during 2014 and changes over time during 2008-2014. The analysis suggests that, in 2014, national opioid mortality rates were actually 24% greater than reported and heroin overdose fatality rates were 22% higher than reported (Am J Prev Med. 2017 Aug 7. doi: 10.1016/j.amepre.2017.06.009).

The study attempted to address the estimated one-fifth to one-quarter of death certificates for fatal overdoses in which no specific drug is identified. "This leads to an underestimate of the involvement rates of specific drugs at a point in time and additional errors when measuring changes in drug involvement rates across time," Dr. Ruhm wrote.

To correct for this, Dr. Ruhm extrapolated the drug category in these unspecified cases by using information from death certificate reports where at least one specific drug category was identified as the cause of death. The patient variables considered included sex, ethnicity, marital status, and education. Details of death included day of the week, location where death occurred (such as in a hospital ward or the emergency department) or being dead on arrival, and interactions among these variables. "The corrected rates provide the best currently available information on geographic variation in opioid--and heroin--involved fatality rates," Dr. Ruhm noted.

The differences between corrected and reported rates of fatal opioid and heroin overdose varied significantly between states; in some cases, the correct rates were more than double the reported rates.

In Pennsylvania, for example, the corrected rates of opioid and heroin overdose fatalities were 108% and 107% greater than the reported rates, respectively; in Mississippi, the corrected rates were 107% and 139% higher than reported. Alabama, Indiana, and Louisiana also showed large disparities between corrected and reported rates.

Dr. Ruhm noted significant variability among the states in whether a specific drug was mentioned on the death certificate or not. In Rhode Island, Connecticut, and New Hampshire, a drug category was mentioned for more than 99% of drug poisoning deaths; but in Pennsylvania, Indiana, Mississippi, Louisiana, and Alabama, this was reported in only about half of these incidents.

There was a general trend toward underreporting in the South, while rates of nonreporting were lower in parts of the Northeast and the West.

Overall, the growth in opioid--involved drug deaths from 2008 to 2014 was similar between the reported and corrected rates.

However, in the case of heroin-related mortality, the increase was underestimated by the reported data by about 18%. Again, this difference varied among states, with substantial underestimates seen in Pennsylvania, Indiana, New Jersey, Louisiana, and Alabama.

"Understanding the inaccuracies resulting from the lack of specificity of drug involvement on death certificates is also important because federal policies often target states believed to have especially severe opioid or heroin problems," Dr. Ruhm explained.

Dr. Ruhm declared no conflicts of interest.

imnews@frontlinemedcom.com

BY BIANCA NOGRADY

FROM THE AMERICAN JOURNAL OF PREVENTIVE MEDICINE

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Author:Nogrady, Bianca
Publication:Internal Medicine News
Date:Sep 1, 2017
Words:539
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