Opioid Problems Widely Under Reported in U.S.: Study

As further evidence of the worsening problems with opioids in the United States, a new study indicates overdoses are severely under reported nationwide and that the epidemic may be much worse than data indicates. 

In a study published in the American Journal of Preventive Medicine on August 7, researchers from the University of Virginia analyzed death certificates with no listed cause of death, and corrected death rates for specific drugs involved. The findings indicate that death rates for both opioid and heroin were much higher than previously reported.

Researchers noted that specific drugs involved in an overdose are not often identified on death certificates for various reasons, including privacy issues. Researchers analyzed thousands of death certificates from the U.S. Centers for Disease Control and Prevention (CDC) from 2008 to 2014. They recalculated death rates for specific drugs involved in overdoses.

Corrected opioid mortality rates were 24 percent higher than reported rates and heroin mortality rates were 22 percent greater than reported rates.

Differences between mortality rates varied across states; however the greatest differences were seen in Pennsylvania, Indiana and Louisiana.

In 2014, an exact drug was not listed on overdose death certificates in 20 percent of all fatal overdoses. In 2008, 25 percent did not have drugs identified. However, a 2015 CDC report indicated drug overdose deaths hit a new high, increasing 137 percent.

Other research has also indicated overdose deaths have increased nationwide, despite decreases in opioid abuse.

Opioid problems were considerably underreported in Pennsylvania, Indiana, New Jersey, and Arizona. Heroin death rates were also understated in most states, most significantly in Pennsylvania, Indiana, New Jersey, Louisiana, and Alabama. However, in some cases, opioid and heroin overdoses were overestimated, including in South Carolina, New Mexico, Ohio, Connecticut, Florida, and Kentucky.

Comparatively, Rhode Island, Connecticut, and New Hampshire were several of only a few states which indicated on death certificates the exact drug which caused the overdose on 99 percent of death certificates. This was done less than half the time in Pennsylvania, Indiana, Mississippi, Louisiana, and Alabama.

As a whole, the national rate of fatal opioid overdoses increased in 2014 to 11.2 per 100,000 people to from 9 per 100,000 people in 2008. The national rate of fatal heroin overdoses also increased from 3.3 to 4 per 100,000.

The findings of the new study also changed much of the data ranking the severity of overdoses in specific states. For example, according to CDC data Pennsylvania was ranked 32nd among states with the highest overdose rates. According to the new study Pennsylvania is ranked 7th, with nearly 18 overdoses per 100,000 people.

As for heroin overdoses, Pennsylvania was ranked 20th among overdose cases. Yet, according to the data from the new study it is now ranked as the 4th state with the highest heroin overdoses.

The overdose rates were the highest among males, compared to females, and blacks compared to whites. It was also highest for people in the Rust Belt, Appalachia and some Western states.

Researchers warn that the findings of the new study highlight the need to “expand treatment, education, awareness, and resources for law enforcement and health professionals” to fight the worsening opioid overdose epidemic.

The heightened opioid overdose rates comes amid a recent push to declare a national emergency concerning opioids.

Study authors said one important reason the nation cannot win the opioid epidemic war is due to a lack of reliable information on the specific drugs causing fatal overdoses. This study, and others like it, help to identify the specific drugs, call attention to the problem, and encourage solutions.