State opi­oid deaths not all tal­lied

Sys­tem for in­ves­ti­gat­ing, re­port­ing them deemed un­re­li­able

El Dorado News-Times - - Front Page - By Amanda Clair Curcio

State of­fi­cials say the four-year death toll from opi­oid over­doses in Arkansas is likely higher than the 800 found in a fed­eral data­base.

They just aren’t sure how much higher — mostly be­cause county coro­ners don’t have a con­sis­tent sys­tem for in­ves­ti­gat­ing deaths and be­cause of gaps in train­ing those coro­ners.

Be­cause of un­re­li­able data, Arkansas was left out of na­tional re­search on opi­oid over­dose deaths.

Ker­mit Chan­nell, ex­ec­u­tive di­rec­tor of the state Crime Lab­o­ra­tory, points to his own agency’s num­bers as ev­i­dence of “us miss­ing some­thing.”

More than half of the bodies sent to the Crime Lab for au­top­sies on drug over­doses have pre­scrip­tion opi­oids in their sys­tems, Chan­nell said.

The lab con­ducted 207 drug over­dose-re­lated au­top­sies in 2016 and 300 last year.

But the of­fi­cial tally of pre­scrip­tion opi­oid deaths doesn’t make up nearly half of all re­ported drug over­dose deaths. For ex­am­ple, in 2014, Arkansas re­ported that 163 of 405 over­dose deaths were tied to pre­scrip­tion opi­oids — not nearly the cor­rect ra­tio of what in­ves­ti­ga­tors are see­ing in the lab, Chan­nell ex­plained.

In other bodies sent to the lab, those that weren’t over­doses, “some form of pre­scrip­tion opi­oids were found on­board,” he said.

In­com­plete data kept Arkansas from be­ing in­cluded in a new re­port that found opi­oid-in­volved deaths rose be­tween 2015 and 2016, re­gard­less of vic­tims’ age, race and sex. The study, re­leased March 29 by the fed­eral Na­tional Cen­ter for In­jury Preven­tion and Con­trol, looked at fa­tal over­dose in­for­ma­tion from 31 states and Wash­ing­ton, D.C.

Re­searchers relied on drug over­dose deaths noted in a data­base called the Na­tional Vi­tal Sta­tis­tics Sys­tem, which is

main­tained by the U.S. Cen­ters for Dis­ease Con­trol and Preven­tion.

Re­searchers ex­am­ined only states that sub­mit­ted re­li­able data on drug-in­volved deaths. To be in­cluded in the re­port, 80 per­cent of a state’s drug over­dose death cer­tifi­cates had to name at least one spe­cific drug in 2015 and 2016. Arkansas did not meet that stan­dard.

A 2015 Pub­lic Health Re­ports ar­ti­cle also found that drug over­doses re­main un­der­re­ported across the coun­try.

In about 25 per­cent of drug over­dose cases na­tion­ally, death cer­tifi­cates did not in­clude a spe­cific drug. In­stead, cause of death was at­trib­uted to “other and un­spec­i­fied drugs,” the ar­ti­cle found.

States with cen­tral­ized med­i­cal ex­am­iner sys­tems were much more likely to have more de­tailed in­for­ma­tion on drug over­dose deaths, ac­cord­ing to the re­port.

In Arkansas, the sys­tem isn’t cen­tral­ized. The Crime Lab doesn’t han­dle all over­dose in­ves­ti­ga­tions; many are han­dled by county coro­ners.

Those elected coro­ners of­ten don’t have med­i­cal back­grounds. State law doesn’t re­quire it. The law re­quires only that coro­ners be at least 18 years old, reg­is­tered vot­ers, live in the county served and lack felony ar­rests.

That means coro­ners’ re­ports are “not as thor­ough as they could be,” said Kevin Cleghorn, pres­i­dent of the Arkansas Coro­ner’s As­so­ci­a­tion.

For in­stance, Cleghorn said, some­one might have died from car­diac ar­rest, but a coro­ner might fail to note that the heart at­tack was in­duced by opi­oid use. Or mul­ti­ple drugs are found in some­one’s sys­tem, like a ben­zo­di­azepene such as Xanax, in ad­di­tion to an opi­oid, but only the ben­zo­di­azepene’s pres­ence is doc­u­mented.

Some cer­tifi­cates for drug over­dose deaths fail to in­clude any spe­cific drug in­for­ma­tion, he added.

Cleghorn also be­lieves that deaths stem­ming from opi­oid mis­use, such as traf­fic wrecks or heart at­tacks, aren’t be­ing noted in med­i­cal re­ports.

Arkansas is one of 14 states that does not have spe­cific train­ing re­quire­ments for coro­ners, yet coro­ners can ac­cess crime scenes in­volv­ing deaths, is­sue sub­poe­nas, han­dle tox­i­col­ogy sam­ples and de­ter­mine causes of death.

Free med­i­cal and death-in­ves­ti­ga­tion train­ing have been avail­able to the state’s coro­ners and their deputies since 2014.

Un­der a 2017 law, “cer­ti­fied coro­ners” are en­ti­tled to salary in­creases. These coro­ners must com­plete the death-in­ves­ti­ga­tion train­ing.

Only 69 of at least 325 coro­ners or deputy coro­ners have com­pleted the state course thus far.

Eigh­teen Arkansas coro­ners are cer­ti­fied through the Amer­i­can Board of Medi­cole­gal Death In­ves­ti­ga­tors. Board cer­ti­fi­ca­tion goes to coro­ners with “ba­sic knowl­edge and demon­strated pro­fi­ciency in the stan­dards of prac­tice” to con­duct com­pe­tent death in­ves­ti­ga­tions and those with at least 640 hours of death-in­ves­ti­ga­tion ex­pe­ri­ence.

Skip­ping such train­ing cre­ates dis­par­i­ties in coro­ner re­port­ing across the state, Cleghorn said.

“Un­til you know what you’re truly fac­ing, you can’t re­ally know what to do,” he said. “How do you coun­ter­act it, how do you fight it, if you don’t know what the true enemy is?

“That is what these drugs are — they’re our enemy. They’re killing our peo­ple.”

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