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Thousands of opioid deaths are never counted by feds, USF study says

Routine delays in toxicology results are one reason for the lapse.

Drug overdose data is greatly underreported in nationwide statistics, a researcher at the University of South Florida has found.

Troy Quast, an associate professor at the USF College of Public Health, found that data related to overdose deaths vary significantly from state to state, masking the size of the crisis. Overdoses are a “bigger problem” than federal statistics make them appear, he said.

Quast published his findings Tuesday in the journal Drug and Alcohol Dependence.

He examined data from 2008 to 2017, which showed that the federal government did not report more than 7,000 overdose deaths in Florida caused by prescription opioid medication and heroin. That works out to roughly one-in-three cases.

The study also revealed that nearly 3,000 deaths in Florida caused by cocaine were not included in the total reported federal data.

The lapses became evident after Quast compared data from the Florida Medical Examiners Commission and the U.S. Centers for Disease Control and Prevention’s “multiple cause of death” database.

Troy Quast
Troy Quast [ Courtesy of the University of South Florida ]

The data from the centers "is used across the board by the news and other agencies, but that data is incomplete,” Quast said in an interview. “Having more comprehensive data available in places like Florida gives policymakers and health care providers a better view of what’s going on. It’s already tough for providers and lawmakers to understand what’s going on at the ground level. Better data gives a more complete perspective on the trends — like what drugs are emerging.”

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The study showed that the CDC undercounted overdose deaths from benzodiazepines, or prescription drugs like Xanax or Vallium, by 45 percent and amphetamines, a compound in drugs like Adderall, by 17 percent.

In Florida, medical examiners are required to wait for toxicology results before submitting an official cause of death to the commission. Quast said it can take weeks or months to identify the exact drug or mixture of drugs that caused an overdose, which is likely the reason more states do not have such strict rules related to cause of death rulings.

“Most death certificates don’t specify which drugs cause the overdose, but examiners are required to report that information in Florida,” Quast said. “This practice varies across the states, and the CDC counts on data it collects from each state.”

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The CDC collects data from local authorities in various states that doesn’t always include detailed cause of death information. Because of this, Quast found that the federal data shared on overdose deaths underestimate which drugs are related to overdose deaths.

“The CDC is well aware of this problem. I’m certainly not the first to study it,” Quast said. “But I don’t think the general public is aware of the issue. Some kind of requirement like what’s happening in Florida needs to happen in more states to get more complete data. It’s complicated though. That involves added costs, and it’s happening at a traumatic time for the families involved.”

The CDC’s Enhanced State Opioid Overdose Surveillance program recently gave states $13 million to help them more quickly conduct comprehensive toxicology reports, Quast said.

His study also examined data by demographics, and found similar undercounted rates of overdose death by gender, race and socioeconomic status. However, men died at almost twice the rate as women from drug overdoses.