Accurate identification of opioid overdose deaths using coronial data

Roxburgh, Amanda, Pilgrim, Jennifer L., Hall, Wayne D., Burns, Lucinda and Degenhardt, Louisa (2018) Accurate identification of opioid overdose deaths using coronial data. Forensic Science International, 287 40-46. doi:10.1016/j.forsciint.2018.03.032


Author Roxburgh, Amanda
Pilgrim, Jennifer L.
Hall, Wayne D.
Burns, Lucinda
Degenhardt, Louisa
Title Accurate identification of opioid overdose deaths using coronial data
Journal name Forensic Science International   Check publisher's open access policy
ISSN 1872-6283
0379-0738
Publication date 2018-06-01
Sub-type Article (original research)
DOI 10.1016/j.forsciint.2018.03.032
Open Access Status Not yet assessed
Volume 287
Start page 40
End page 46
Total pages 7
Place of publication E Park, Shannon, Clare Ireland
Publisher Elsevier Ireland
Language eng
Abstract Defining drug-related mortality is complex as these deaths can include a wide range of diseases and circumstances. This paper outlines a method to identify deaths that are directly due to fatal opioid toxicity (i.e. overdose), utilising coronial data.

The National Coronial Information System (NCIS), an online coronial database containing information on all deaths that are reported to a coroner in Australia, is used to develop methods to more accurately identify opioid overdose deaths. The NCIS contains demographic information, Medical Cause of Death, and associated documentation on toxicology, clinical and police investigations.

Identifying overdose deaths using the coroner determined Medical Cause of Death provided greater capture, and specificity, of opioid overdose deaths. Distinguishing morphine from heroin-related deaths presented challenges, requiring analysis of clinical and investigative information in addition to toxicology results. One-quarter of the deaths attributed to morphine were recorded to heroin as a result of further investigation. There was also some underestimation of codeine-related deaths. Access to clinical and investigative information also yields important information in relation to comorbid conditions among these decedents, such as history of chronic pain, substance use issues and mental health problems.

Reliance on toxicology results alone leads to an underestimate of heroin-related deaths. Differentiating between heroin and pharmaceutical opioid (e.g. morphine) overdose deaths has important public health and policy implications, particularly in relation to prescribing practices and development of a strategic response. Understanding comorbidities among these decedents is also important in efforts to reduce preventable causes of death such as opioid overdose.
Formatted abstract
Introduction: Defining drug-related mortality is complex as these deaths can include a wide range of diseases and circumstances. This paper outlines a method to identify deaths that are directly due to fatal opioid toxicity (i.e. overdose), utilising coronial data.

Materials and methods: The National Coronial Information System (NCIS), an online coronial database containing information on all deaths that are reported to a coroner in Australia, is used to develop methods to more accurately identify opioid overdose deaths. The NCIS contains demographic information, Medical Cause of Death, and associated documentation on toxicology, clinical and police investigations.

Results: Identifying overdose deaths using the coroner determined Medical Cause of Death provided greater capture, and specificity, of opioid overdose deaths. Distinguishing morphine from heroin-related deaths presented challenges, requiring analysis of clinical and investigative information in addition to toxicology results. One-quarter of the deaths attributed to morphine were recorded to heroin as a result of further investigation. There was also some underestimation of codeine-related deaths. Access to clinical and investigative information also yields important information in relation to comorbid conditions among these decedents, such as history of chronic pain, substance use issues and mental health problems.

Conclusions: Reliance on toxicology results alone leads to an underestimate of heroin-related deaths. Differentiating between heroin and pharmaceutical opioid (e.g. morphine) overdose deaths has important public health and policy implications, particularly in relation to prescribing practices and development of a strategic response. Understanding comorbidities among these decedents is also important in efforts to reduce preventable causes of death such as opioid overdose.
Keyword Heroin
Opioid overdose deaths
Pharmaceutical opioids
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: UQ Centre for Clinical Research Publications
HERDC Pre-Audit
Centre for Youth Substance Abuse Research Publications
 
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Created: Wed, 11 Apr 2018, 10:02:12 EST