Methodological Complexities in Quantifying Rates of Fatal Opioid-Related Overdose

Abstract

Purpose of Review Effective responses to the US opioid overdose epidemic rely on accurate and timely drug overdose mortality data, which are generated from medicolegal death investigations (MDI) and certifications of overdose deaths. We identify nuances of MDI and certification of overdose deaths that can influence drug overdose mortality surveillance, as well as recent research, recommendations, and epidemiological tools for improved identification and quantification of specific drug involvement in overdose mortality. Recent Findings Death certificates are the foundation of drug overdose mortality surveillance. Accordingly, counts and rates of specific drug involvement in overdose deaths are only as accurate as the drug listed on death certificates. Variation in systematic approaches or jurisdictional office policy in drug overdose death certification can lead to bias in mortality rate calculations. Recent research has examined statistical adjustments to improve underreported opioid involvement in overdose deaths. New cause-of-death natural language text analysis tools improve quantification of specific opioid overdose mortality rates. Enhanced opioid overdose surveillance, which combines death certificate data with other MDI-generated data, has the potential to improve understanding of factors and circumstances of opioid overdose mortality. Summary The opioid overdose crisis has brought into focus some of the limitations of US MDI systems for drug overdose surveillance and has given rise to a sense of urgency regarding the pressing need for improvements in our MDI data for public health action and research. Epidemiologists can stimulate positive changes in MDI data quality by demonstrating the critical role of data in guiding public health and safety decisions and addressing the challenges of accurate and timely overdose mortality measures with stakeholders. Education, training, and resources specific to drug overdose surveillance and analysis will be essential as the nation’s overdose crisis continues to evolve.

Drug Addiction in Bangladesh: “A Consequence of Social Demoralization Rather Than Individual Flaws”

“…The prevalence of alcohol use disorder is highest in Europe (7.5%) and the lowest among East Mediterranean Regions which includes Afghanistan, Bahrain, and Egypt [1]. In the US, the largest national economy of the world, 75% of high-school students have reportedly used illegal drugs, drunk alcohol or smoked tobacco [8], more than a million used heroin in 2016 [9] and opioids claim 70,000 death from overdose in 2017 [10,11]. Bangladesh is situated in the crucial point between the 'golden triangle' (Myanmar, Thailand and Laos) and the 'golden crescent' (Pakistan, Afghanistan and Iran) in terms of geographical location [12].…”

Operationalizing and selecting outcome measures for the HEALing Communities Study

“…Previous research has identified several methodological challenges for identification of opioid involvement in drug overdose deaths (e.g., lack of routinely performed postmortem toxicology testing, especially for fentanyl and designer opioids; challenges to detection and quantification of new designer opioids; variation in jurisdictional office policy in completion of drug overdose death certificates; differences in the proportion of drug overdose death certificates completed by different jurisdictions that do not list the specific contributing drugs) ( Buchanich et al, 2018 ; Ruhm, 2018 ; Slavova et al, 2015 ; Slavova et al, 2019 ; Warner and Hedegaard, 2018 ; Warner et al, 2013 ). Prior to the evaluation period, the research sites are administering surveys among the coroners, medical examiners, and toxicology labs serving both Wave 1 and Wave 2 communities to collect information related to death investigations of suspected drug overdose deaths (including postmortem toxicology testing, timelines for death certificate completion, and possible COVID-19-related changes in these processes that could have lasting effects during the HCS evaluation period) in order to understand possible limitations and changes in the completeness and accuracy of the primary outcome measure.…”

Commentary: “Ockham’s Razor” Doesn’t Apply to “Opioid” Overdose Death

“…The CDC estimates that one in three death certificates are in error [14]. Other studies suggest even higher error rates, especially when dealing with opioid overdose deaths [15]. Death certificates require a single cause of death, but allow for secondary causes.…”