{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T17:40:43Z","timestamp":1786642843457,"version":"build-2736575974"},"reference-count":40,"publisher":"BMJ","funder":[{"DOI":"10.13039\/100000026","name":"National Institute on Drug Abuse","doi-asserted-by":"publisher","award":["R21DA059189"],"award-info":[{"award-number":["R21DA059189"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Inj Prev"],"accepted":{"date-parts":[[2026,7,30]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Both suicides and unintentional drug overdose deaths have risen dramatically over the last two decades in the USA. However, the classification of death manner intent can be a challenge for death investigators in drug poisoning deaths. This study assessed whether county death investigation system type was a predictive factor in the likelihood of \u2018undetermined\u2019 intent death classifications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This study examines the association between undetermined intent classifications and death investigation systems among drug poisoning deaths in the USA. With novel data from the Centres for Disease Control and Prevention and from the State Unintentional Drug Overdose Reporting System in nine states, we used logistic regression models to analyse whether county coroner systems were differentially associated with \u2018undetermined\u2019 intent death classifications as compared with county medical examiner systems.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>County coroner systems were associated with increased odds of undetermined intent classifications in drug poisoning deaths as compared with county medical examiner systems (OR: 1.79; 95% CI 1.43 to 2.27). Even after a full set of county and individual decedent controls, the association remained (adjusted OR: 1.60; 95% CI 1.25 to 2.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Future work should examine ways to identify suicides in drug poisoning deaths, as the consequences of misclassification echo forward into data used for prevention. The type of death investigation system may be an important factor in how drug poisoning deaths are classified.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/ip-2025-046028","type":"journal-article","created":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T17:20:17Z","timestamp":1786641617000},"page":"ip-2025-046028","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Association between undetermined intent death classification and county death investigation system for drug poisoning deaths in nine US jurisdictions"],"prefix":"10.1136","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9743-8441","authenticated-orcid":false,"given":"Alexander","family":"Lundberg","sequence":"first","affiliation":[{"name":"Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"George Jay","family":"Unick","sequence":"additional","affiliation":[{"name":"School of Social Work, University of Maryland, Baltimore, Baltimore, Maryland, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle M.","family":"Mccarthy","sequence":"additional","affiliation":[{"name":"Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5609-3718","authenticated-orcid":false,"given":"Sarah B.","family":"Welch","sequence":"additional","affiliation":[{"name":"Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kena","family":"Noland","sequence":"additional","affiliation":[{"name":"Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-3654-9884","authenticated-orcid":false,"given":"Katie","family":"Lawler","sequence":"additional","affiliation":[{"name":"Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6524-1532","authenticated-orcid":false,"given":"Maryann","family":"Mason","sequence":"additional","affiliation":[{"name":"Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6261-3254","authenticated-orcid":false,"given":"Lori","family":"Post","sequence":"additional","affiliation":[{"name":"Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0459-4945","authenticated-orcid":false,"given":"Susan T.","family":"Parker","sequence":"additional","affiliation":[{"name":"Emergency Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,8,13]]},"reference":[{"key":"2026081310201295000_ip-2025-046028v1.1","doi-asserted-by":"crossref","first-page":"291","DOI":"10.1097\/PHH.0000000000001161","article-title":"Opioids and Suicide: Opportunities for Comprehensive Prevention","volume":"26","author":"Ranade","year":"2020","journal-title":"J Public Health Manag Pract"},{"key":"2026081310201295000_ip-2025-046028v1.2","doi-asserted-by":"crossref","first-page":"1233","DOI":"10.2105\/AJPH.2017.303863","article-title":"Deciphering Suicide and Other Manners of Death Associated with Drug Intoxication: A Centers for Disease Control and Prevention Consultation Meeting Summary","volume":"107","author":"Stone","year":"2017","journal-title":"Am J Public Health"},{"key":"2026081310201295000_ip-2025-046028v1.3","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-10-1"},{"key":"2026081310201295000_ip-2025-046028v1.4","doi-asserted-by":"crossref","first-page":"986","DOI":"10.1017\/S0950268810002840","article-title":"Death investigation systems and disease surveillance","volume":"139","author":"McGowan","year":"2011","journal-title":"Epidemiol Infect"},{"key":"2026081310201295000_ip-2025-046028v1.5","doi-asserted-by":"publisher","DOI":"10.23907\/2013.029"},{"key":"2026081310201295000_ip-2025-046028v1.6","doi-asserted-by":"crossref","first-page":"ii49","DOI":"10.1136\/ip.2006.012591","article-title":"Variability of undetermined manner of death classification in the US","volume":"12 Suppl 2","author":"Breiding","year":"2006","journal-title":"Inj Prev"},{"key":"2026081310201295000_ip-2025-046028v1.7","doi-asserted-by":"crossref","unstructured":"Spencer MR , Garnett M , Mini\u00f1o AM . 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