A Comparison of Florida Medical Examiners’ Reports and Death Certificates for Specific Drug Related Overdose Deaths

Death certificates are a source of information on deaths caused by specific drugs. However, the completeness of such information has been questioned. This study compared counts in the Florida Medical Examiner Commission's drug related death reporting system (ME) with those from death certificates (DC) for overdose deaths involving selected drugs during 2005-2008 to assess the completeness of death certificate information. DC data indicated 2,401 deaths with benzodiazepines as a cause, 2,182 for cocaine, 2,055 for methadone, and 416 for heroin. The ratios of ME deaths to DC deaths were 1.19 (95% CI 1.13-1.26) for benzodiazepines, 1.38 (95% CI 1.31-1.46) for cocaine, 1.37 (95% CI 1.29-1.44) for methadone, and 0.96 (95% CI 0.83-1.09) for heroin. For each drug, ratios were similar for unintentional (accidental), suicide, and undetermined intent deaths. Ratios varied across the 24 ME districts, but few districts reported significantly fewer deaths in the ME system than in the DC system. Results suggest that surveillance based on death certificate data underestimates specific drug caused deaths as counted by medical examiners in a state with multiple, independent medical examiners. Death certificate data might therefore underestimate drug overdose mortality nationwide.