ArticleThe International journal on drug policy2018
Using medical examiner case narratives to improve opioid overdose surveillance.
Article in The International journal on drug policy, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- Misclassification of opioid-involvement in drug-related overdose deaths in the United States: A scoping review.Annals of epidemiology · 2025Article
- Identification of Behavioral, Clinical, and Psychological Antecedents of Acute Stimulant Poisoning: Development and Implementation of a Mixed Methods Psychological Autopsy Study.JMIR formative research · 2025Article
- The impacts of governing agency: A comparison of resources in the patchwork of medicolegal death investigation systems.Forensic science international. Synergy · 2024Article
- Using death scene and toxicology evidence to define involvement of heroin, pharmaceutical morphine, illicitly manufactured fentanyl and pharmaceutical fentanyl in opioid overdose deaths, 38 states and the District of Columbia, January 2018-December 2019.Addiction (Abingdon, England) · 2022Article
- Examining the Examiners: How Medical Death Investigators Describe Suicidal, Homicidal, and Accidental Death.Health communication · 2022Article
- Firearm-Related Deaths in Multnomah County, Oregon, 2010-2016: Linking Medical Examiner Data to State Vital Records Data.Public health reports (Washington, D.C. : 1974) · 2020Article
- Unclassified drug overdose deaths in the opioid crisis: emerging patterns of inequity.Journal of the American Medical Informatics Association : JAMIA · 2019Article
- Methodological Complexities in Quantifying Rates of Fatal Opioid-Related Overdose.Current epidemiology reports · 2019Review
- Opportunities to Prevent Overdose Deaths Involving Prescription and Illicit Opioids, 11 States, July 2016-June 2017.MMWR. Morbidity and mortality weekly report · 2018Article
- Accuracy of Medical Examiner's Assessment for Near-Real-Time Surveillance of Fatal Drug Overdoses, King County, Washington, March 2017-February 2018.Public health reports (Washington, D.C. : 1974)Article
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Authors and funding
8 authors.
Funding
Abstract
backgroundCurrent opioid overdose mortality surveillance methods do not capture the complexity of the overdose epidemic. Most rely on death certificates, which may underestimate both opioid analgesic and heroin deaths. Categorizing deaths using other characteristics from the death record including route of drug administration may provide useful information to design and evaluate overdose prevention interventions.
methodsWe reviewed California Electronic Death Reporting System records and San Francisco Office of the Chief Medical Examiner (OCME) toxicology reports and investigative case narratives for all unintentional opioid overdose deaths in San Francisco County from 2006 to 2012. We chose this time period because it encompassed a period of evolution in local opioid use patterns and expansion of overdose prevention efforts. We created a classification system for heroin-related and injection-related opioid overdose deaths and compared demographic, death scene, and toxicology characteristics among these groups.
resultsWe identified 816 unintentional opioid overdose deaths. One hundred fifty-two (19%) were standard heroin deaths, as designated by the OCME or by the presence of 6-monoacetylmorphine. An "expanded" classification for heroin deaths incorporating information from toxicology reports and case narratives added 20 additional heroin deaths (13% increase), accounting for 21% of all opioid deaths. Two hundred five deaths (25%) were injection-related, 60% of which were attributed to heroin. A combined classification of expanded heroin and injection-related deaths accounted for 31% of opioid overdose deaths during this period.
conclusionsUsing additional sources of information to classify opioid overdose cases resulted in a modest increase in the count of heroin overdose deaths but identified a substantial number of non-heroin injection-related opioid analgesic deaths. Including the route of administration in the characterization of opioid overdose deaths can identify meaningful subgroups of opioid users to enhance surveillance efforts and inform targeted public health programming including overdose prevention programs.
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