Quantifying drug overdose deaths: A troubled path from start to finish

Area of Science:

• Public Health
• Epidemiology
• Medical Coding

Background:

• Nearly 450,000 deaths from prescribed opioid overdoses occurred between 1999 and 2019 in the US.
• The Centers for Disease Control and Prevention (CDC) compiles drug overdose death data using the International Classification of Diseases (ICD) coding system.
• Current methods may not accurately capture the full picture of drug-involved fatalities.

Purpose of the Study:

• To examine the CDC's methodology for compiling drug overdose death statistics.
• To assess the suitability of the International Classification of Diseases (ICD) for accurately coding drug-involved mortality.
• To identify limitations in the current data collection process that may obscure the causes of fatal drug overdoses.

Main Methods:

• Review of the CDC's source data for drug overdose deaths.
• Analysis of the standard death certificate process in fatal drug overdose cases.
• Examination of the International Classification of Diseases (ICD) coding system's application to drug-involved deaths.

Main Results:

• Death certificates are often issued before post-mortem toxicology results are available, leading to potential inaccuracies.
• Ambiguous terms like "suspected acute drug intoxication" can be listed as causes of death.
• The ICD coding system may fail to capture the complexity of polysubstance abuse as a cause of death, obscuring individual substance lethality.

Conclusions:

• The current ICD system may be ill-suited for accurately reporting drug-involved mortality.
• Data compilation processes can lead to the loss of crucial information regarding the specific substances involved in fatal overdoses.
• There is a need to improve data collection and coding to better understand and address the drug overdose crisis, particularly polysubstance abuse.