Drug overdose numbers often fuzzy in Michigan

Joel Kurth
The Detroit News

One person officially died of a drug overdose in Pontiac in 2013, according to state of Michigan records.

The next year, 56 people died in Pontiac after using drugs, according to a review of Oakland County autopsy records. At least six had needles or other paraphernalia in their arms or nearby.

The uptick isn’t necessarily from a massive spike in drug deaths. It was because, in Oakland County and several other counties in Michigan, dying after a drug bender doesn’t necessarily mean the cause of death is classified as an overdose.

“People who abuse drugs usually die of abuse rather than overdoses. It’s a word that’s commonly misapplied,” said Ljubisa Dragovic, Oakland County’s medical examiner.

Across Michigan, county medical examiners often have different standards about what constitutes a drug death or overdose. Most agree there’s a nationwide drug problem, caused largely by prescription painkillers and heroin, but state and local numbers on overdoses are often inconsistent and can make it difficult to identify problem areas.

“The data out there can be messy, which makes it hinder surveillance efforts about the problem” or confidence about decisions that are being made, said Dr. Amy Bohnert, a University of Michigan psychiatry professor who studies drug abuse.

This summer, for instance, Oakland County health and sheriff’s officials called a press conference to declare opiate abuse in the county an “epidemic” and outline steps to reduce deaths.

The announcement came months after state officials released a report, based on official death tallies, declaring Oakland County had one of the lowest rates of drug poisoning deaths in Michigan.

In Oakland County, Dragovic rules deaths as “overdoses” only if toxicology reports indicate lethal levels of drugs in systems. If it’s impossible to determine what delivered the fatal blow, causes of deaths are listed as undetermined, Dragovic said.

In Wayne County, similar deaths involving three or more drugs or alcohol are classified as “multiple drug intoxication.” Patty Roland, chief of operations for the Macomb County Medical Examiner Office, didn’t return three messages seeking clarification on her county’s standards.

“The term ‘overdose’ is incorrect,” Wayne County Medical Examiner Carl Schmidt wrote in an email.

“Many drug deaths are not due to a high concentration of a drug, but rather the enhancing effect of taking other drugs concurrently.”

Federal data indicate Oakland had 213 drug-related deaths in 2013, compared with 440 for Wayne County and 250 for Macomb County. Those tallies are from the Centers for Disease Control and Prevention, which scours death certificates.

Complicating matters is that that people in poor health are often on multiple painkillers.

Oakland County researched the issue recently and found that nearly a third, 324, of autopsies last year included positive tests for opiates, said Robert Gerds, administrator of the Medical Examiner’s Office.

In August, The Detroit News reviewed more than 50 autopsy reports linked to prescription drugs in Oakland County. Almost all involved multiple drugs, followed years of abuse and other health issues.