Christopher J. Ruhm, PhD


An important barrier to formulating effective policies to address the rapid rise in U.S. fatal overdoses is that the specific drugs involved are frequently not identified on death certificates. This analysis supplies improved estimates of state opioid and heroin involved drug fatality rates in 2014, and changes from 2008 to 2014.


Reported mortality rates were calculated directly from death certificates and compared to corrected rates that imputed drug involvement when no drug was specified. The analysis took place during 2016–2017.


Nationally, corrected opioid and heroin involved mortality rates were 24% and 22% greater than reported rates. The differences varied across states, with particularly large effects in Pennsylvania, Indiana, and Louisiana. Growth in corrected opioid mortality rates, from 2008 to 2014, were virtually the same as reported increases (2.5 deaths per 100,000 people) whereas changes in corrected heroin death rates exceeded reported increases (2.7 vs 2.3 per 100,000). Without corrections, opioid mortality rate changes were considerably understated in Pennsylvania, Indiana, New Jersey, and Arizona, but dramatically overestimated in South Carolina, New Mexico, Ohio, Connecticut, Florida, and Kentucky. Increases in heroin death rates were understated in most states, and by large amounts in Pennsylvania, Indiana, New Jersey, Louisiana, and Alabama.


The correction procedures developed here supply a more accurate understanding of geographic differences in drug poisonings and supply important information to policymakers attempting to reduce or slow the increase in fatal drug overdoses.


I think it’s important to have records not only of the fact that there was an “opiate overdose” but also WHAT opiates were used to overdose.  I was investigated by my state medical board because 2 of my patients (married couple) died within weeks of each other of “opiate overdose”.  Fortunately, the coroner documented the scene of death for the 2nd of them quite well.  There were numerous bottles for opiates prescribed to OTHER PEOPLE, as well as records from a probation officer indicating that there had been numerous problems with breaking and entering and drug trafficking.  I had been weaning these two down significantly on their prescribed opiates.  They did not meet the criteria (by patient reported history) and no evidence of doctor shopping in the prescribers databases for a 6 state area).  This information exonerated me with the state medical board.   It would have also been helpful to know exactly which opiates and what the levels were but that information is not commonly documented.  Had heroin been involved as well?  We don’t know all to often!

Dr. Raymond Oenbrink
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