State Policy Approaches to Improve Drug Overdose Death Data

June 14, 2018|10:05 a.m.| ASTHO Staff

Interventions for the opioid epidemic, such as deploying naloxone kits, promoting safer prescribing, increasing access to medication-assisted treatment, coordinating public awareness campaigns, and implementing harm reduction approaches, depend on timely, high-quality, comprehensive data. This data is necessary to determine where to target these interventions and to whom, how and when they should be delivered, and what specific environments, systems, behaviors, beliefs, and attitudes they should address. The data required for these interventions often includes information that is collected for death certificates and results from the investigations of drug overdose deaths by medical examiners and coroners.

Earlier this year, ASTHO released a report on a meeting involving death investigation and overdose death surveillance professionals. The report summarizes their perspectives on key strategies, priorities, and feasible actions for improving the quality of drug data on death certificates. Six overarching themes emerged from these discussions, including:

Mortality Data Systems: Improve interoperability between mortality data systems, update essential mortality data systems, improve access to medical data, and plan for a coordinated data architecture that pulls data from multiple sectors and systems.

Postmortem Toxicology: Address the timeliness, quality, and reporting process for postmortem toxicology results, and address funding gaps for coroners and medical examiners to complete appropriate toxicology testing.

Training and Education: Develop and offer training and education to coroners and medical examiners about the importance of drug specificity on the death certificate, how to complete the death certificate, and related issues.

Guidance on Filling Out the Death Certificate: Develop and disseminate guidance for the death investigation and death certification processes as they relate to drug overdose deaths.

Verification of Fact of Death: Develop a mechanism to provide an official certification of death that would be available for next of kin for administrative purposes, but doesn’t include medical information.

Coordination of Medicolegal Death Investigation: Enhance federal- and state-level coordination of work related to coroners, medical examiners, and other medicolegal death investigation stakeholders.

Throughout the year, ASTHO has also tracked state legislation related to the investigation and reporting of drug overdose deaths. Many of these legislative proposals and new laws relate directly to the themes listed above. Below is a categorization and brief summary of the bills and laws that ASTHO tracked this year.

Investigating and Reporting Opioid Overdose Deaths

In March, Indiana’s governor signed a bill (SB 139) enhancing the county coroner’s role in investigating overdose deaths. Under the new law, whenever a county coroner reasonably suspects a drug overdose as the cause of death, the coroner is to review and obtain information from the state’s prescription drug monitoring program, perform certain testing on the decedent, report the test results to the state department of health, and provide notice of the decedent's death and any information about the drug involved to the department. The law also stipulates that for the next fiscal year, the costs of the overdose investigations will be covered by the state’s coroners training and continuing education fund.

In Virginia and Illinois, bills related to investigating and reporting overdose death were also introduced. Companion bills SB 804 and HB 134 in Virginia would have required the state’s chief medical examiner to report overdose deaths to the state health agency within 120 hours of an investigation’s finding. Neither bill advanced beyond its originating legislative chamber. In Illinois, a bill (HB 4331) to require coroners and hospitals to report certain opioid overdose death information (e.g., the decedent’s age, gender, race, and county of residence) to the state health department passed the House chamber. An Indiana bill (SB 215) to require a hospital to provide a coroner and a coroner to provide a medical examiner with a complete set of the decedent’s health records was also introduced but did not pass.

Coordination and Guidance

In New Jersey, a bill (S 976) was passed to establish a new office of the chief state medical examiner with authority over and supervision of the state’s medical examiner system. The new office will be responsible for equipping and funding all the state’s medical examiner offices as well as establishing operating and performance standards and death investigation procedures for medical examiners in the state.

Funding and Compensation

In Illinois and Mississippi, bills were introduced that would add funding for death investigations and increase the compensation for medical examiners. Such increases can alleviate the financial burden some localities are experiencing from the high number of overdose death investigations and help retain qualified medical examiners to perform the investigations. Illinois’ HB 5831 would have authorized a grant to the Macon County Coroner for conducting the autopsies of suspected overdose deaths. In Mississippi, HB 759, a bill to increase the salaries of certain county officials, included compensation increases for county medical examiners, deputy medical examiners, and deputy medical examiner investigators.

Obtaining quality and complete data on drug overdose deaths helps to ensure that proper, successful public health interventions are deployed in addressing the opioid crisis. As state legislatures develop policies related to the collection of this key data, such as the laws summarized above, ASTHO will track them and continue to inform our members and stakeholders of their impact.