Dr. Tom Frieden and a number of other CDC experts have put together an excellent public health grand rounds about the epidemic of drug overdoses in the U.S, which is driven mainly by a five fold increase in prescription drug deaths. The situation is in fact substantially worse than the official data reflect, for two reasons.

If you feel as a living voter that you get slow service from government, consider the dead: It takes 3-4 years for cause of death data to work its way from county coroners to states to the federal government. The frightening numbers in this presentation are snapshots from 2007 and 2008. Unless we assume that prescription drug overdose deaths magically stopped their rapid ascent at that time, they have probably increased to the point that they are today the leading cause of accidental death in the United States.

Further, many states don’t invest sufficiently in determining cause of death. For gunshot wounds and car accidents, death determination is typically obvious, but it costs money to do the proper toxicology for assessment of overdose death. In cases where someone has died of, say, a combination of alcohol, tranquilizers and pain killers, many a coroner will detect the alcohol and count it as an alcohol overdose, full stop. Other prescription drug deaths are mistakenly recorded as accidents (e.g., falling down a flight a stairs while intoxicated) or strokes.

When I was on the drug policy making side of the table, the slowness of the data on drug deaths drove me crazy. I remember asking in exasperation if we waited three years to report death data because we just wanted to be really, really sure that the person was in fact deceased. The data problems may seem esoteric until one realizes that not only do they hamper understanding of the current situation, but they also prevent us from figuring out how to respond effectively: We won’t be able to tell if anti-overdose death initiatives now underway (naloxone distribution, prescription monitoring, prescription takeback days, addiction treatment expansion, what have you) are making a difference until 2014 or 2015.

[Cross-posted at Same Facts]

Keith Humphreys

Keith Humphreys is the Esther Ting Memorial Professor at Stanford University. @KeithNHumphreys