Opioid testing information was unavailable in half of injury death investigations in the U.S. and in one in 10 unintentional overdose death investigations conducted in 2021, according to a recent Northwestern Medicine study published in JAMA.
The study reveals the potential undermeasurement of opioid-related deaths and underscores the need for more testing to accurately identify the scope of drug-related mortality in the U.S., said Alexander Lundberg, PhD, assistant professor of Emergency Medicine and lead author of the study.
Medicolegal death investigations, or an inquiry by a coroner or medical examiner’s office to determine how an individual died, can identify specific substances in drug-related mortality and have been critical for public health surveillance of the U.S. opioid epidemic. According to recent data from National Institute on Drug Abuse, more than 81,000 individuals in the U.S. died from an opioid-involved overdose in 2022 alone.
For the current study, Lundberg’s team analyzed the percentage of opioid tests unavailable in U.S. injury death investigations in 2021 using data obtained from the National Violent Death Reporting System (NVDRS) — which collects and standardizes information on individual violent deaths of persons of any age from death certificates, coroner and medical examiner reports and law enforcement reports — and the State Unintentional Drug Overdose Reporting system (SUDORS), in which five states provided data access.
Of more than 74,000 injury death investigations included, the investigators found that opioid test information was unavailable in approximately half, or 51 percent.
They also discovered that results varied by manner of death. For the NVDRS cases, opioid test information was unavailable for 65 percent of non-poisoning suicide cases, 59 percent of undetermined intent deaths, 53 percent of homicide cases and 32 percent of poisoning suicide cases. For the SUDORS unintentional overdose deaths, opioid test information was unavailable for roughly 1 in 10 cases (13 percent).
“It was a surprise to us to see that frequently we do not have information in our data systems about whether an opioid test was conducted, or in many cases one was not conducted,” Lundberg said. “Based on the data that we do know, opioids are involved in about three-quarters of fatal drug overdoses, but the results suggest that we’re not entirely sure, that it may actually be a slightly higher rate if we were to have more testing.”
Future work should aim to identify which factors, such as resource constraints, legal requirements, or the perception of a clear external cause of death, influence orders for opioid tests among death investigators, according to Lundberg and the team.
“We want to look more specifically about the death classifications and how coroners and medical examiners make the determination that a death is an unintentional drug overdose death if they may not have forensic toxicology reports including an opioid test for the assessment,” Lundberg said.
Maryann Mason, PhD, associate professor of Emergency Medicine, was senior author of the study. Co-authors include Lori Post, PhD, the Buehler Professor of Geriatric Medicine and director of the Buehler Center for Health Policy and Economics and Danielle McCarthy, ‘06 MD, ‘12 MS, ‘10 GME, vice chair for Research in the Department of Emergency Medicine.
This work was supported by the National Institutes of Health National Institute on Drug Abuse award R21DA059189.
