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CDC's Efforts to Quantify Prescription Opioid Overdose Deaths Fall Short.
John F Peppin1,2,3, John J Coleman4
1College of Osteopathic Medicine, Pikeville University, Pikeville, KY, USA.
Pain and Therapy
|March 24, 2021
Summary
The Centers for Disease Control and Prevention (CDC) miscoded thousands of prescription opioid overdose deaths due to errors in data collection and classification. This led to an inaccurate understanding of the opioid epidemic, particularly concerning illicitly manufactured fentanyl.
Area of Science:
- Public Health
- Epidemiology
- Mortality Statistics
Background:
- A 2018 report revealed errors in the Centers for Disease Control and Prevention's (CDC) 2016 prescription opioid overdose death data.
- The acknowledged error stemmed from miscoding deaths involving illicitly manufactured fentanyl (IMF) as prescribed fentanyl deaths.
- Systemic issues in data collection, including errors and omissions in death certificates, contribute to inaccuracies.
Purpose of the Study:
- To investigate the causes behind the CDC's miscoding of prescription opioid overdose deaths.
- To analyze the CDC's methodology for compiling drug-related mortality data and identify systemic problems.
- To evaluate the suitability of the international mortality reporting program used by the CDC for drug overdose data.
Main Methods:
- Examination of the CDC's methodology for compiling drug-related mortality data.
- Analysis of source data from approximately 2.8 million annual death certificates.
- Review of the CDC's explanation for the fentanyl miscoding error and its coding practices for various opioids, including methadone.
Main Results:
- Significant errors and omissions were found in the source data used by the CDC.
- The international mortality reporting program is ill-suited for accurately compiling drug overdose deaths.
- Methadone-involved deaths are consistently miscoded as prescribed, despite greater use in opioid use disorder treatment.
Conclusions:
- The CDC failed to recognize and correct critical data miscoding problems prior to 2016.
- Inaccurate mortality data has significant public policy implications for addressing the opioid epidemic.
- Revisions to data collection and classification methodologies are necessary for accurate drug overdose surveillance.
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