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.

Keywords: Drug overdose death; Drug poisoning; Enhanced opioid overdose surveillance; Opioid overdose; Postmortem toxicology; Prescription opioid, heroin, and fentanyl.

Fig. 1

Medicolegal death investigation, certification, registration, surveillance, and epidemiology of drug overdose deaths. Abbreviations: Medicolegal Death Investigation (MDI), Medical Examiners and Coroners (ME/Cs), Enhanced State Opioid Overdose Surveillance (ESOOS), State Unintentional Drug Overdose Reporting System (SUDORS), Centers for Disease Control and Prevention (CDC), National Center for Injury Prevention and Control (NCIPC)