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Announcing New Recommendations for Epidemiologists to Improve Reporting of Drug Overdose Deaths on Death Certificates

Posted By Jennifer Sabel, Friday, May 13, 2016
Updated: Thursday, May 12, 2016

Did you know that drug overdoses are the leading cause of injury death in the nation? However, about 20% of death certificates on drug overdose deaths do not include information about the specific drugs involved in the overdose. The lack of detail on the specific drugs involved varies between 1-52% of drug overdose deaths by state. Knowing the specific drugs involved is critical to developing appropriate prevention strategies.

A new recommendations document developed by the CSTE Overdose Subcommittee provides concrete steps and lessons learned to epidemiologists and public health professionals wanting to improve drug overdose reporting in their jurisdiction.

These new recommendations include resources for how to review the quality of your jurisdiction’s drug overdose data, and how and why to collaborate with your state’s vital statistics registrar and medical examiners and/or coroners to enlist their support in helping to improve the quality of the data.

The new recommendations document also includes specific examples from jurisdictions that have made efforts to improve data quality. For example, in Kentucky, staff produced a figure showing that a third of drug overdose deaths had no specific drugs listed on the death certificate. This figure was widely shared with stakeholders who then collaborated to develop a drug overdose fatality reporting framework to improve the reporting of drug overdose deaths.

In New York City, staff identified a large number of deaths that listed “morphine” on the death certificate. Morphine is identified in toxicology testing, but the original source can be either heroin or pharmaceutical morphine. Discussions with the chief medical examiner identified that the majority of these deaths involved heroin. Staff worked with the chief medical examiner to develop recommendations to improve reporting of deaths involving heroin or morphine.

In Washington State, staff worked with the vital statistics office to start a query process for gathering additional information for the unspecific drug overdose death certificates that were submitted to their office. Receipt of an unspecific death certificate generated questions back to the medical examiner or coroner for more detailed information on the death and the drugs involved.


The new recommendations document is available on the CSTE website: http://www.cste.org/OverdoseRecommendations.
We hope that you will use the recommendations to improve specific drug reporting on drug overdose death certificates in your jurisdiction.


Jennifer Sabel, PhD is an epidemiologist in Non-Infectious Conditions Epidemiology in the Office of the Secretary at the Washington State Department of Health. Holly Hedegaard, MD, MSPH is an injury epidemiologist at the National Center for Health Statistics at the CDC Office of Analysis of Epidemiology. David Nordstrom, PhD, MPH, MS resides in Oregon and Wisconsin and works as a consultant in injury epidemiology for government and academic settings. Svetla Slavova, PhD is associate professor at the Kentucky Injury Prevention and Research Center at the University of Kentucky. Denise Paone, EdD, is senior director of research and surveillance and Ellenie Tuazon, MPH is an epidemiologist at the Bureau of Alcohol and Drug Use Prevention, Care, and Treatment at the New York City Department of Health and Mental Hygiene. Amy Poel, MPH is an epidemiologist at the Center for Health Statistics, Washington State Department of Health.

Join the Overdose Subcommittee by logging in as a CSTE member and clicking “join” on the webpage. The Overdose Subcommittee meets on the second Thursday each month at 1-2PM Eastern. Join the subcommittee to receive the monthly phone number and passcode, and contact CSTE Senior Research Analyst Megan Toe for more information.

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