Dr. Tom Frieden and a number of other CDC experts have put together an excellent public health grand rounds about the epidemic of drug overdoses in the U.S, which is driven mainly by a five fold increase in prescription drug deaths. The situation is in fact substantially worse than the official data reflect, for two reasons.
If you feel as a living voter that you get slow service from government, consider the dead: It takes 3-4 years for cause of death data to work its way from county coroners to states to the federal government. The frightening numbers in this presentation are snapshots from 2007 and 2008. Unless we assume that prescription drug overdose deaths magically stopped their rapid ascent at that time, they have probably increased to the point that they are today the leading cause of accidental death in the United States.
Further, many states don’t invest sufficiently in determining cause of death. For gunshot wounds and car accidents, death determination is typically obvious, but it costs money to do the proper toxicology for assessment of overdose death. In cases where someone has died of, say, a combination of alcohol, tranquilizers and pain killers, many a coroner will detect the alcohol and count it as an alcohol overdose, full stop. Other prescription drug deaths are mistakenly recorded as accidents (e.g., falling down a flight a stairs while intoxicated) or strokes.
When I was on the drug policy making side of the table, the slowness of the data on drug deaths drove me crazy. I remember asking in exasperation if we waited three years to report death data because we just wanted to be really, really sure that the person was in fact deceased. The data problems may seem esoteric until one realizes that not only do they hamper understanding of the current situation, but they also prevent us from figuring out how to respond effectively: We won’t be able to tell if anti-overdose death initiatives now underway (naloxone distribution, prescription monitoring, prescription takeback days, addiction treatment expansion, what have you) are making a difference until 2014 or 2015.
It definitely does not seem like it should take ~3 years to get this data together at the federal level, even though it is generated at the county level and responsibility for record keeping lies at the state level.
Is the main driver for this just that the process for collecting the data is old and fails to take advantage of technology that is easily available now? Or is there some other driver?
What would it take to get more timely data? Does anyone have the funding?
In Florida we have a yearly medical examiner’s report: http://www.fdle.state.fl.us/Content/getdoc/742e2162-c1de-4ecd-bce4-857a32c6f42e/2009-Drug-Report.aspx
It took us some time and effort to put this together statewide, but now we have reliable data each year. The report does not just identify the cause of death, but also the drugs that were present. Prescription drug overdoses kill 7 Floridians every day.
I imagine a lot of others here have more experience in this than me, but from what I’ve seen and read, it is folly to think “technology” is an easy solution. So many agencies have bit the dust on this, repeatedly in some cases. The FBI, the LAUSD, probably lots of other school districts. California’s court system is currently in the throes. If it were easy, it would be happening.
I’m not saying this shouldn’t be done, just that it’s hard and I totally understand why it usually doesn’t happen.
If the data is stale and no good, why the dickens are we giving technocrats so much power over what we choose to ingest in our bodies when they can only speculate and guess as to the alleged harms?
The arguments for a lot of our drug policies would be weak even if the policymakers had good data. But without good data, we are just making policy based on whatever their moral opinions are.
Those failures you mention NGC (and yes, there are many) are usually a function of who is running the project, who the stakeholders are, and their interests. It’s rarely the true technical details that cause issues.
So to clarify my question, who has what interests that keep the NVSS reporting process from getting sped up?
David: I don’t think the problem is that people want slow data, but that there is no adverse consequence for slow data and no reward for timely data. In the face of a public health crisis it seems reasonable to me for the federal government to give state health departments a bonus payment for gathering and filing their death data more quickly and then let each state work out how to do that (rather than trying to micromanage a standardized process from Washington).
Dilan, five years ago the numbers were bad, and getting worse. (I wouldn’t call death-certificate data “speculation” or “guessing,” though as Keith notes they may undercount the problem.)
Why do you expect newer data to show that suggest a less urgent need for better controls? I would have thought that a pile of corpses would count as fairly good evidence that some people’s decisions about what to ingest could do with a little technocratic interference.
I’ll bet this would be the wrong time to bring up the safety, versatility, and efficacy of medicinal cannabis. Yeah, that’s what I thought.
From your earlier posts, I take it attempts to prevent people from abusing opiates by mixing them with acetaminophen are responsible for most of these overdose deaths, since Tylenol is deadly at fairly small doses. So, are you calling for wider availability of opiates, unmixed with acetaminophen?
Ragout: The opiates themselves suppress respiration and can lead to overdose, so it is not just the hepatoxicity of acetaminophen in combination products that is the problem. Rescheduling hydrocodone to Schedule II could reduce deaths…but as with other possible steps we would not know for sure for years.
Mark:
That’s way oversimplified. The only thing that is certain with drug laws is they are huge impositions on individual freedom.
Now on the other side, nobody disputes that some illegal drugs, like alcohol and tobacco, are very dangerous. (Some others are not.)
But as alcohol and tobacco indicate, mere dangerousness isn’t a sufficient justification for laws. The laws have to be shown to work and to work without causing huge secondary effects.
And if we don’t have good data that our laws are actually working, that leaves the moral judgments of our policymakers as the basis of our policymakers.
So since our policymakers love to drink but think smoking pot is immoral, that’s the policy we get.
What most people don’t know is that 85% of all abuse is through recreational use by teens, and accidental use by toddlers. Also, more than 98% of all homes DO NOT LOCK up their prescription medications. Forget millions of dollars of research then grantee’s spending another 3 years analyzing the data - buy a safe and lock up your meds. It really is that easy - the grantee’s don’t want to admit it because it does away with a paycheck - but i rather tsave lives, than wastefuil research jobs.