{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T15:35:05Z","timestamp":1788536105451,"version":"build-2803163510"},"reference-count":20,"publisher":"SAGE Publications","issue":"4","license":[{"start":{"date-parts":[[2018,6,27]],"date-time":"2018-06-27T00:00:00Z","timestamp":1530057600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Public Health Rep"],"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>A complete and accurate count of the number of opioid-related overdose deaths is essential to properly allocate resources. We determined the rate of unintentional overdose deaths (non\u2013opioid-related, opioid-related, or unspecified) in the United States and by state from 1999 to 2015 and the possible effects of underreporting on national estimates of opioid abuse.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We abstracted unintentional drug overdose deaths ( International Classification of Diseases, 10th Revision, codes X40-X44) with contributory drug-specific T codes (T36.0-T50.9) from the Mortality Multiple Cause Micro-Data Files. We assumed that the proportion of unspecified overdose deaths that might be attributed to opioids would be the same as the proportion of opioid-related overdose deaths among all overdose deaths and calculated the number of deaths that could be reallocated as opioid-related for each state and year. We then added these reallocated deaths to the reported deaths to determine their potential effect on total opioid-related deaths.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>From 1999 to 2015, a total of 438\u2009607 people died from unintentional drug overdoses. Opioid-related overdose deaths rose 401% (from 5868 to 29\u2009383), non\u2013opioid-related overdose deaths rose 150% (from 3005 to 7505), and unspecified overdose deaths rose 220% (from 2255 to 29\u2009383). In 5 states (Alabama, Indiana, Louisiana, Mississippi, and Pennsylvania), more than 35% of unintentional overdose deaths were coded as unspecified. Our reallocation resulted in classifying more than 70\u2009000 unspecified overdose deaths as potential additional opioid-related overdose deaths.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>States may be greatly underestimating the effect of opioid-related overdose deaths because of incomplete cause-of-death reporting, indicating that the current opioid overdose epidemic may be worse than it appears.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/0033354918774330","type":"journal-article","created":{"date-parts":[[2018,6,27]],"date-time":"2018-06-27T03:01:31Z","timestamp":1530068491000},"page":"423-431","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":88,"title":["The Effect of Incomplete Death Certificates on Estimates of Unintentional Opioid-Related Overdose Deaths in the United States, 1999-2015"],"prefix":"10.1177","volume":"133","author":[{"given":"Jeanine M.","family":"Buchanich","sequence":"first","affiliation":[{"name":"Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lauren C.","family":"Balmert","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl E.","family":"Williams","sequence":"additional","affiliation":[{"name":"Office of the Medical Examiner of Allegheny County, Pittsburgh, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Donald S.","family":"Burke","sequence":"additional","affiliation":[{"name":"Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2018,6,27]]},"reference":[{"issue":"1","key":"bibr1-0033354918774330","first-page":"32","volume":"64","author":"Chen LH","year":"2015","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"bibr2-0033354918774330","first-page":"1","volume":"81","author":"Warner M","year":"2011","journal-title":"NCHS Data Brief"},{"key":"bibr3-0033354918774330","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2016.04.007"},{"key":"bibr4-0033354918774330","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2013.272"},{"issue":"39","key":"bibr5-0033354918774330","first-page":"849","volume":"63","author":"Rudd RA","year":"2014","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"bibr6-0033354918774330","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm6450a3"},{"key":"bibr7-0033354918774330","first-page":"1","volume":"273","author":"Hedegaard H","year":"2017","journal-title":"NCHS Data Brief"},{"key":"bibr8-0033354918774330","volume-title":"International Statistical Classification of Diseases and Related Health Problems","author":"World Health Organization","year":"2010"},{"key":"bibr9-0033354918774330","doi-asserted-by":"publisher","DOI":"10.1186\/s12963-016-0071-7"},{"key":"bibr10-0033354918774330","doi-asserted-by":"publisher","DOI":"10.23907\/2013.029"},{"key":"bibr11-0033354918774330","doi-asserted-by":"publisher","DOI":"10.1177\/003335491513000411"},{"key":"bibr12-0033354918774330","doi-asserted-by":"publisher","DOI":"10.1007\/s13181-013-0323-x"},{"key":"bibr13-0033354918774330","volume-title":"Mortality Multiple Cause Data Files","author":"National Center for Health Statistics","year":"1999"},{"key":"bibr14-0033354918774330","volume-title":"SAS\/STAT Version 9.4","author":"SAS Institute, Inc","year":"2013"},{"key":"bibr15-0033354918774330","author":"Ruhm CJ","journal-title":"Addiction"},{"key":"bibr16-0033354918774330","volume-title":"Medicolegal Death Investigation System: Workshop Summary","author":"Committee for the Workshop on the Medicolegal Death Investigation System","year":"2003"},{"key":"bibr17-0033354918774330","doi-asserted-by":"publisher","DOI":"10.5858\/2006-130-1274-MECAPH"},{"key":"bibr18-0033354918774330","volume-title":"Strengthening Forensic Science in the United States: A Path Forward","author":"Committee on Identifying the Needs of the Forensic Sciences Community, National Research Council","year":"2009"},{"key":"bibr19-0033354918774330","unstructured":"Sabel JC, Poel A, Tuazon E, Recommendations and Lessons Learned for Improved Reporting of Drug Overdose Deaths on Death Certificates. Atlanta, GA: Council of State and Territorial Epidemiologists; 2016. http:\/\/c.ymcdn.com\/sites\/www.cste.org\/resource\/resmgr\/PDFs\/PDFs2\/4_25_2016_FINAL-Drug_Overdos.pdf. Accessed March 2, 2018."},{"issue":"2","key":"bibr20-0033354918774330","doi-asserted-by":"crossref","first-page":"ii49","DOI":"10.1136\/ip.2006.012591","volume":"12","author":"Breidling MJ","year":"2006","journal-title":"Inj Prev"}],"container-title":["Public Health Reports\u00ae"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0033354918774330","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/0033354918774330","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/0033354918774330","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T09:34:36Z","timestamp":1777628076000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/0033354918774330"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,6,27]]},"references-count":20,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2018,7]]}},"alternative-id":["10.1177\/0033354918774330"],"URL":"https:\/\/doi.org\/10.1177\/0033354918774330","relation":{},"ISSN":["0033-3549","1468-2877"],"issn-type":[{"value":"0033-3549","type":"print"},{"value":"1468-2877","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,6,27]]}}}