Questions linger over fatal overdose statistics
A recent bout of drug overdoses — two of which were fatal — in Northern Chautauqua County was enough to dash some hopes that the heroin epidemic was somehow turning a corner.
The episode, which led to the arrests of six individuals in Hanover last month, was also a reminder that heroin remains a deadly, day-to-day threat in the county and that a proper accounting of its victims is a must.
Earlier this year, the OBSERVER reported on the county’s struggles with keeping track of fatal heroin- and opioid-related overdoses, a challenge, which according to county Health Commissioner Christine Schuyler, is the result of a “complicated, inadequate and inconsistent system.”
“I feel that an age-old conflict between politicians, law enforcement, the medical profession and coroners has led us to where we are now,” Schuyler said. “There is such variability in death investigations and certifications across counties and states in this country that no real comparisons can be made between anyone.”
Unlike Erie County, which has a designated medical examiner’s office, Chautauqua County has four coroners appointed by the County Legislature.
If there is an indication of drugs in the deceased individual’s body or if an autopsy is required, the body is sent to Erie County or another facility, where toxicology results could take months to return, and the chances of confusing or inaccurate data collection more likely.
Overdose deaths can also be linked to medical conditions or accidents brought on or exacerbated by drugs, rather than the drugs themselves. For instance, a person’s death may be attributed to a respiratory failure or blunt force trauma, even though heroin was an underlying factor.
Schuyler said the New York State Department of Health added a check box to death certificates regarding whether or not tobacco use contributed to the death. Perhaps at some point, she said, something similar will happen with other substances.
Warren Riles, chief coroner in Chautauqua County, pushed back on some of these claims, insisting contributing factors such as heroin are included on death certificates.
For instance, he said, if heroin was a contributing factor to a fatal vehicle crash, it would be listed as such on the death certificate and the county would still count it as a heroin overdose. The death certificates are then sent to the legislative clerk’s office in Mayville.
“We send in a report every three months and they total everything up from the four coroners,” he said. “That’s how they determine how many natural deaths we’ve had and drug overdose cases and so on.”
Riles said roughly 20-30 bodies are given toxicologies every year. Some death certificates may read “undetermined” cause of death until toxicology results return; at which point, they’re amended.
“We’re not witholding anything that we’re involved in … there would be no reason for us to do that,” Riles said.
Between January and April, the county health department has recorded eight opioid overdose deaths, four of which involved heroin. More than 20 overdoses were recorded in 2016.
The New York State Department of Health recorded 15 opioid overdoses in the county, seven of which involved heroin and six involved opioid painkillers, in 2015. There were 14 opioid overdoses, eight involving heroin and seven involving painkillers, in 2014.
Between January and September 2016, there were 52 outpatient emergency department visits due to opioid overdoses.
In 2015, there were a total of 68 outpatient visits and 17 hospitalizations. In 2014, there were a total of 56 outpatient visits and 20 hospitalizations.
According to the Centers for Disease Control and Prevention, heroin-related overdose deaths have more than quadrupled since 2010. From 2014 to 2015, heroin overdose death rates increased by 20.6 percent, with nearly 13,000 people dying in 2015.