Unspecified drug overdose deaths and state policy changes

Abstract

Background: A lack of standardization in death investigation procedures is associated with a significant undercounting of opioid‑related
overdoses in the United States. Because overdose fatality statistics are often used to allocate federal and state funding, inaccuracies can worsen
the gap between actual and needed death investigation resources. Aims and Objectives: This case study examines Indiana’s legislative efforts
to improve toxicology surveillance and its impact on county coroners. Materials and Methods: First, the proportion of unspecified overdose
deaths were examined by comparing Indiana and the United States using CDC WONDER data from 2016-2020. Second, we surveyed Indiana
coroners’ offices on their perceptions of the law’s requirements, available resources, and barriers to compliance. Results: We first describe
fatal overdose trends in Indiana from 2016 to 2020, noting its overall improvement in identifying opioid‑related deaths. Next, we present
results from a survey of 30 coroners’ offices, focusing on their perceptions of the requirements, available resources, and barriers to compliance.
Finally, we consider successes and areas of improvement. Conclusion: This case study highlights the importance of state efforts to improve
toxicology surveillance, especially in decentralized county coroner systems.