HARRISBURG – Everyone knows the state’s opioid crisis is bad. But how bad? Inconsistent reporting makes that a frustrating unknown.
State Sen. Gene Yaw, R-Lycoming County wants Pennsylvania to fix that. He has proposed legislation that would require more uniform standards and training and establish a tighter deadline for reporting drug deaths.
“Right now, they say that 15 people per day are dying from drug overdoses,” Yaw said. “We don’t know if that’s accurate. If it’s higher than that, maybe we should be investing more money” in fighting the drug crisis.
Pennsylvania law doesn’t require county coroners to alert the state about opioid overdose deaths. State health officials instead rely on data that coroners report to the federal government, including the Drug Enforcement Administration and the Centers for Disease Control.
The CDC calculated that there were 4,648 overdose deaths in Pennsylvania in 2016. The DEA put the death toll for the year at 4,642. Both estimates were about 5 percent lower than the overdose tally included in a report by the state coroners association. The coroners put the 2016 death count at 4,884.
Neither the CDC nor the DEA have released 2017 data yet.
The discrepancy between the federal data and the actual death toll could be more pronounced than that. A study published in the December edition of the American Journal of Preventive Medicine concluded that data based on death certificates was under-estimating deaths caused by heroin and opioids by 22-24 percent.
“Opioid mortality rate changes were considerably understated in Pennsylvania, Indiana, New Jersey, and Arizona, but dramatically overestimated in South Carolina, New Mexico, Ohio, Connecticut, Florida, and Kentucky,” according to a summary of the work by Christopher Ruhm, a researcher from the University of Virginia. “Increases in heroin death rates were understated in most states, and by large amounts in Pennsylvania, Indiana, New Jersey, Louisiana, and Alabama,” according to the summary.
The federal data under-report drug deaths because coroners don’t always include the drug information on the death certificates, his research found.
It’s a problem that officials in Pennsylvania became aware of during hearings on the drug crisis convened by the Center for Rural Pennsylvania, said Yaw, who is chairman of the Center for Rural Pennsylvania’s board of directors.
“Several presenters stated there is no uniformity in how heroin deaths are tracked. Sometimes, drug overdoses are listed legitimately as heart failure or are not reported as the actual cause of death to spare embarrassment to the family,” he said.
Yaw said that, as the University of Virginia researchers found, it’s not an issue confined to Pennsylvania. But it’s certainly an issue that could hamper the state’s efforts to adequately respond to the drug crisis, he said.
Yaw’s legislation, HB 419, is currently in the Senate health and human services committee. The bill would require coroners to notify the state Department of Health about each overdose death in their counties within five days after the coroner determines the cause of death. And it would require the Health Department to come up with uniform standards and training to make sure that all 67 coroners are reporting uniformly, he said.
J.J. Abbott, a spokesman for Gov. Tom Wolf said administration officials recognize the need to have accurate data.
"Governor Wolf recently announced the opioid data dashboard, which tracks important measures relative to opioid and heroin use, including overdoses. Accurate information allows law enforcement, health providers, and state policy makers to respond effectively and redistribute resources across the state to areas of greatest need," Abbott said. "Sen. Yaw’s legislation would ensure accurate and timely reporting. We are interested in working with Sen. Yaw and stakeholders to ensure that state has even more accurate and current data."
Coroners are taking their responsibilities in responding to the drug crisis seriously, said Lycoming County coroner Charles Kiessling, president of the Pennsylvania State Coroners Association.
“The coroners across PA are clearly at the frontlines of this opioid epidemic and have the most accurate information regarding drug deaths in our counties,” he said.
Kiessling said he doubts that any coroner would knowingly withhold information indicating that a person's death was caused by drugs.
"The family may not like it," he said. "But I don't know any coroner that would do that."
He said that the data being produced by his group is as accurate as the state's going to get.
"That's a valid number," he said.
While there is no law specifically requiring them to comply, the coroners are already being expected to provide a variety of data to a variety of different government agencies, Kiessling said. In addition, the coroners worry that they could run afoul of federal health information privacy laws if they turn over some of the overdose data, he said.
His group would like to see the state and federal government come up with a way to consolidate the reporting requirements, similar to the reporting system coroners use to notify the Department of Transportation about traffic deaths, he said.
“This is necessary to ease the burden on Coroner’s Offices who currently operate with minimal funding,” Kiessling said.
The coroners group has put the price tag of county coroners costs for investigating drug deaths at $30 million a year. That’s a cost that’s been borne by the counties, he said.
The coroners association plans to produce its own report again this year, said Kiessling.
“We are working on a 2017 report but I am not sure when we will have everyone’s drug death reports in,” Kiessling said. “Clearly, from what we are hearing, the numbers will again show a significant in nearly all counties and very few reducing their numbers.”
Susan Shanaman, an attorney for the coroners’ group, said she expects to have the reports from all of the coroners as soon as April.
Shananam said she’s sure the overdose death toll for 2017 will top 5,000.
Other estimates suggest it could go well beyond that milepost.
The CDC has indicated that in the 12-month period ending in September there were 5,545 overdose deaths in Pennsylvania.
John Finnerty reports from the Harrisburg Bureau for The Daily Item and other Pennsylvania newspapers owned by CNHI. Email him at firstname.lastname@example.org and follow him on Twitter @cnhipa.