Development of a Coroner-Based Surveillance System for Drug-Related Deaths in Los Angeles County

Abstract

Existing data sources do not provide comprehensive and timely information to adequately monitor drug-related mortality in Los Angeles County. To fill this gap, a surveillance system using coroner data was developed to examine patterns in drugrelated deaths. The coroner provided data on all injury deaths in Los Angeles County. A list of keywords that indicate a death was caused by drug use was developed. The cause of death variables in the coroner data were searched for mentions of one of the keywords; if a keyword was detected, that death was classified as drug related. The effectiveness of the keyword list in classifying drug-related deaths was evaluated by matching records in the coroner death data to records in the state death files. Then, the drug-related deaths identified using the keywords were compared to drug-related deaths in the state mortality files identified using International Classification of Death codes. Toxicological test results were used to categorize drug-related deaths based on the type and legality of the drug(s) ingested. Mortality rates were calculated for each category of drug and legal status and for different demographic groups. Compared to the gold standard state mortality files, the coroner data had a sensitivity of 95.6% for identifying drug-related deaths. Over three quarters of all drug-related deaths tested positive for opiates and/or stimulants. Males, Whites, and 35-54-year-olds each accounted for more than half of all drug-related deaths. The surveillance of drug-related deaths using coroner data has several advantages: data are available in a timely fashion, the data include information about the specific substances each victim ingested, and the data can be broken down to compare mortality among specific subpopulations.

Identifying cases of heroin toxicity where 6-acetylmorphine (6-AM) is not detected by toxicological analyses

“…Other studies have reported concern for underreporting of deaths due to heroin use because the inability to identify 6-AM in a postmortem sample, leads to classification of these deaths as being due to morphine use [ 3 , 7 , 8 ]. These studies suggest that heroin toxicity may be responsible for overestimating the contribution of prescription opiates to accidental deaths in the United States [ 3 , 7 , 8 ]. Other studies have suggested that codeine is also over reported as a cause of unintentional drug overdose deaths for similar reasons [ 9 , 10 ].…”

Underrepresentation of Heroin Involvement in Unintentional Drug Overdose Deaths in Allegheny County, PA

“…In Allegheny County, we found that morphine was overreported as a cause of death on death certificates; heroin was most likely responsible for a majority of deaths attributed to morphine. Other jurisdictions suspect that some heroin deaths are misclassified as morphine deaths , but the extent of the problem nationwide is unknown. In Allegheny County, we also found that codeine was most likely overreported as a cause of unintentional drug overdose deaths.…”

Prescription opioid mortality trends in New York City, 1990–2006: Examining the emergence of an epidemic

“…Attributions of drugs as a cause of death by the OCME are not mutually exclusive: an overdose death may be attributed to more than one drug. Medical Examiner systems have shown high sensitivity, specificity and positive predictive value to identify external causes of death (Comstock et al, 2005; Landen et al, 2003; Sternfeld et al, 2010). Data regarding cause of death, circumstances of death, and toxicology were collected from the OCME files by trained abstractors using a standardized protocol and data collection forms.…”