{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,8]],"date-time":"2026-01-08T07:04:14Z","timestamp":1767855854107,"version":"3.49.0"},"reference-count":21,"publisher":"American Public Health Association","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Am J Public Health"],"published-print":{"date-parts":[[2018,12]]},"abstract":"<jats:p> Objectives. To demonstrate the severity of undercounting opioid-involved deaths in a local jurisdiction with a high proportion of unspecified accidental poisoning deaths. <\/jats:p><jats:p> Methods. We matched toxicology data to vital records for all accidental poisoning deaths (n\u2009=\u20091238) in Marion County, Indiana, from January 2011 to December 2016. From vital records, we coded cases as opioid involved, specified other substance, or unspecified. We extracted toxicology data on opioid substances for unspecified cases, and we have reported corrected estimates of opioid-involved deaths after accounting for toxicology findings. <\/jats:p><jats:p> Results. Over a 6-year period, 57.7% of accidental overdose deaths were unspecified and 34.2% involved opioids. Toxicology data showed that 86.8% of unspecified cases tested positive for an opioid. Inclusion of toxicology results more than doubled the proportion of opioid-involved deaths, from 34.2% to 86.0%. <\/jats:p><jats:p> Conclusions. Local jurisdictions may be undercounting opioid-involved overdose deaths to a considerable degree. Toxicology data can improve accuracy in identifying opioid-involved overdose deaths. <\/jats:p><jats:p> Public Health Implications. Mandatory toxicology testing and enhanced training for local coroners on standards for death certificate reporting are needed to improve the accuracy of local monitoring of opioid-involved accidental overdose deaths. <\/jats:p>","DOI":"10.2105\/ajph.2018.304683","type":"journal-article","created":{"date-parts":[[2018,10,25]],"date-time":"2018-10-25T19:56:45Z","timestamp":1540497405000},"page":"1682-1687","source":"Crossref","is-referenced-by-count":28,"title":["Identifying Unreported Opioid Deaths Through Toxicology Data and Vital Records Linkage: Case Study in Marion County, Indiana, 2011\u20132016"],"prefix":"10.2105","volume":"108","author":[{"given":"Evan M.","family":"Lowder","sequence":"first","affiliation":[{"name":"Evan M. Lowder and Bradley R. Ray are with the School of Public and Environmental Affairs, Indiana University\u2013Purdue University Indianapolis, Indianapolis. At the time of this study, Philip Huynh and Dennis P. Watson were with the Center for Health Engagement and Equity Research, Department of Social and Behavioral Sciences, Indiana University Richard M. Fairbanks School of Public Health, Indiana University\u2013Purdue University. Alfarena Ballew is with the Marion County Coroner\u2019s Office, Indianapolis."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bradley R.","family":"Ray","sequence":"additional","affiliation":[{"name":"Evan M. Lowder and Bradley R. Ray are with the School of Public and Environmental Affairs, Indiana University\u2013Purdue University Indianapolis, Indianapolis. At the time of this study, Philip Huynh and Dennis P. Watson were with the Center for Health Engagement and Equity Research, Department of Social and Behavioral Sciences, Indiana University Richard M. Fairbanks School of Public Health, Indiana University\u2013Purdue University. Alfarena Ballew is with the Marion County Coroner\u2019s Office, Indianapolis."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philip","family":"Huynh","sequence":"additional","affiliation":[{"name":"Evan M. Lowder and Bradley R. Ray are with the School of Public and Environmental Affairs, Indiana University\u2013Purdue University Indianapolis, Indianapolis. At the time of this study, Philip Huynh and Dennis P. Watson were with the Center for Health Engagement and Equity Research, Department of Social and Behavioral Sciences, Indiana University Richard M. Fairbanks School of Public Health, Indiana University\u2013Purdue University. Alfarena Ballew is with the Marion County Coroner\u2019s Office, Indianapolis."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alfarena","family":"Ballew","sequence":"additional","affiliation":[{"name":"Evan M. Lowder and Bradley R. Ray are with the School of Public and Environmental Affairs, Indiana University\u2013Purdue University Indianapolis, Indianapolis. At the time of this study, Philip Huynh and Dennis P. Watson were with the Center for Health Engagement and Equity Research, Department of Social and Behavioral Sciences, Indiana University Richard M. Fairbanks School of Public Health, Indiana University\u2013Purdue University. Alfarena Ballew is with the Marion County Coroner\u2019s Office, Indianapolis."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dennis P.","family":"Watson","sequence":"additional","affiliation":[{"name":"Evan M. Lowder and Bradley R. Ray are with the School of Public and Environmental Affairs, Indiana University\u2013Purdue University Indianapolis, Indianapolis. At the time of this study, Philip Huynh and Dennis P. Watson were with the Center for Health Engagement and Equity Research, Department of Social and Behavioral Sciences, Indiana University Richard M. Fairbanks School of Public Health, Indiana University\u2013Purdue University. Alfarena Ballew is with the Marion County Coroner\u2019s Office, Indianapolis."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"844","reference":[{"key":"bib1","volume-title":"Drug Overdose Deaths in the United States, 1999\u20132016","author":"Hedegaard H","year":"2017"},{"key":"bib2","doi-asserted-by":"publisher","DOI":"10.1111\/add.14144"},{"key":"bib4","volume-title":"ICD-10: International Statistical Classification of Diseases and Related Health Problems, Tenth Revision","year":"2011"},{"key":"bib6","doi-asserted-by":"publisher","DOI":"10.1007\/s13181-013-0323-x"},{"key":"bib7","doi-asserted-by":"publisher","DOI":"10.23907\/2013.029"},{"key":"bib9","volume-title":"Medical Examiners and Coroners\u2019 Offices, 2004","author":"Hickman MJ","year":"2007"},{"key":"bib10","doi-asserted-by":"publisher","DOI":"10.1186\/s12963-016-0071-7"},{"key":"bib11","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2017.06.009"},{"key":"bib12","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2017.304253"},{"key":"bib15","doi-asserted-by":"publisher","DOI":"10.1007\/s12024-016-9780-2"},{"key":"bib16","doi-asserted-by":"publisher","DOI":"10.1016\/j.forsciint.2011.11.007"},{"key":"bib17","doi-asserted-by":"publisher","DOI":"10.23907\/2015.055"},{"key":"bib19","doi-asserted-by":"publisher","DOI":"10.1177\/003335491513000411"},{"key":"bib20","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2017.04.004"},{"key":"bib21","volume-title":"Drug Overdose Deaths in Kentucky, 2000\u20132015","author":"Akers D","year":"2016"},{"key":"bib22","doi-asserted-by":"publisher","DOI":"10.1093\/jat\/bky017"},{"key":"bib23","doi-asserted-by":"publisher","DOI":"10.1081\/CLT-58950"},{"key":"bib24","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4637.2011.01132.x"},{"key":"bib25","doi-asserted-by":"publisher","DOI":"10.23907\/2017.009"},{"key":"bib26","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMp1615145"},{"key":"bib27","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2014.07.017"}],"container-title":["American Journal of Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/ajph.aphapublications.org\/doi\/pdf\/10.2105\/AJPH.2018.304683","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,5,10]],"date-time":"2022-05-10T00:35:47Z","timestamp":1652142947000},"score":1,"resource":{"primary":{"URL":"https:\/\/ajph.aphapublications.org\/doi\/full\/10.2105\/AJPH.2018.304683"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,12]]},"references-count":21,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2018,12]]}},"alternative-id":["10.2105\/AJPH.2018.304683"],"URL":"https:\/\/doi.org\/10.2105\/ajph.2018.304683","relation":{},"ISSN":["0090-0036","1541-0048"],"issn-type":[{"value":"0090-0036","type":"print"},{"value":"1541-0048","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,12]]}}}