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CDC: Some states’ sloppy death forms hurt battle vs. drug overdoses

The U.S. medical community is finding an ironic foe in its fight to curb drug overdose deaths: Itself.

The U.S. Centers for Disease Control found in a recent analysis of death certificate data in all 50 states – echoed in a report published Friday by Stateline – that many were far from precise in how they labelled overdose deaths. The findings mean researchers, lawmakers and the general public are missing out on the only sure, scientific way to determine which drug caused a particular death.

Specifically, the CDC found that, nationwide, only 80.7 percent of overdose death certificates mention which particular drug was involved, up slightly from 77.9 percent in 2013. The rest of the certificates simply mention general phrases, such as “drug overdose” or “multiple drug toxicity.”

The percentages plunge dramatically in some states, with Alabama bringing up the rear. Less than half of Alabama’s 2014 overdose death certificates – 47.7 percent – were precise, the CDC found. Louisiana was second-worst, at 48.3 percent. Rhode Island topped the list, with a 99.6 percent precision rate in its drug-related death certificates, followed by Connecticut at 99.2 percent.

Alabama’s practices are particularly alarming when the CDC also found the state has the highest per-capita rate of drug prescriptions in the U.S., and was one of 14 states to show a “statistically significant” increase in its year-to-year overdose deaths.

Robert Anderson, chief of the CDC’s mortality statistics branch, told AMI Newswire that the problem has improved. As recently as 2010, he said, only about 70 percent (compared with today's 80.7 percent) of drug-related death certificates were filed with adequately precise information – and technology has improved in the meantime.

But he said that, while the information is “more detailed than it used to be, it’s still not very detailed.” The problem becomes important, he said, in everything from creating state policies to individual interventions.
“There is a value in knowing which drug you have to deal with,” he said. “If you’re looking at drugs commonly available by prescription, there are specific interventions and programs for that that are somewhat different than those for illegal drugs.”

The discovery comes as federal statistics show nearly 80 people die daily in the U.S. from either legal (prescription) or illegal opioid drugs; two million are considered addicted to prescription opioids and nearly a half-million are addicted to heroin.

The Department of Health and Human Services recorded 28,000 drug overdose deaths in 2014, up 14 percent from 2013 and the highest year total on record. Sixty percent of the deaths involved opioids.

After months of squabbling over how to respond to the situation, Congress in July passed the Comprehensive Addiction and Recovery Act (CARA), which was soon thereafter signed into law by President Obama, to expand prevention efforts and access to treatment programs. In addition, it calls for allowing more first responders to carry a lifesaving drug that can halt overdoses. CARA also will help launch medical studies to improve treatments.

However, the bill stops far short of full funding. It includes $181 million in immediate funds, but leaves the bulk of funding decisions for later in the year. Democrats had sought $920 million.

The Stateline report found Alabama’s official system of responding to unnatural deaths to be a patchwork of tasks handled in various different ways by elected coroners, medical examiners and physicians in the state’s 66 counties.

Anderson cautioned against reading too much into state-by-state statistics, since changes in reporting methods can give a confusing picture of trends within a state. For example, South Carolina vastly improved the precision of its practices between 2013 and 2014, only to see a misleading apparent jump in the number of overdose deaths.

He said the lack of a centralized system is a large part of the problem in states such as Alabama, and may only be rectified in some cases by new laws.

“In states where you have a state medical examiner, a central authority, you generally see better reporting overall because it’s usually a physician or pathologist who’s guiding and making policy with regard to reporting,” he said.

“State laws seem to be the most efficient idea. You can make a difference with individual outreach, but it can be difficult when you have a lot of counties and a lot of different people. Generally coroners and MEs tend to respond to what they see as a legal mandate.”