Sunday, April 26, 2015

News of TX overdose undercount bolsters 'Good Samaritan' bill

As the Texas Senate Criminal Justice Committee prepares to hear overdose prevention legislation (HB 225 by Guillen/Watson) on Tuesday, news comes that the state has dramatically and systematically undercounted overdose deaths in recent years.

The Houston Chronicle's Lise Olsen and the Austin Statesman's Mary Ann Roser this week (April 24) coauthored an important and impressive feature documenting how Texas dramatically undercounts overdose deaths, particularly those stemming from prescription opiates. "Overdose deaths from all drugs have skyrocketed nationwide in the last decade, outpacing even motor vehicle accident fatalities, according to the Centers for Disease Control and Prevention," they reported. But prescription opiods account for the largest source of the increase.
Last summer, Dr. David Lakey, then the Texas Department of State Health Services commissioner, told a Senate committee studying the problem that Texas has one of the nation's lowest prescription drug fatality rates and that his data showed deaths had peaked in 2006. But Lakey was referring only to deaths involving certain painkillers, not all prescription drugs. His report did not include information from medical examiners, who use drug screens to identify many more overdoses, according to a joint investigation by the Houston Chronicle and the Austin American-Statesman.

Only 622 deaths reported across Texas in 2013 were specifically blamed on opioids - mostly painkillers, based on death certificate data cited by Lakey's department.

But 798 prescription-drug related deaths were recorded by local medical examiners that year in just 17 of the state's 254 counties, the Chronicle and Statesman found. The newspapers found that medical examiner reports in Harris, Travis, Dallas, Tarrant and El Paso counties, as well as some smaller counties, attribute many more deaths to prescription drug overdoses than the state has counted in opioid overdoses.
The reporters determined that, "the state's method of tracking the problem undercounts deaths in every major county across Texas." E.g.:
In Travis County, which includes Austin, the state reported 17 deaths from prescription painkillers in its preliminary count of death certificates for 2013, but the administrator of the county's Medical Examiner's Office hand-counted 114 deaths involving all prescription drugs that year.

In Tarrant County, which includes Fort Worth, the medical examiner's office recorded 44 deaths in 2013 involving specific prescription drugs and another 57 fatalities from "mixed drugs." The state's count was 24 opioid overdoses.
Counties where justices of the peace determine cause of death instead of a medical examiner exacerbate the undercount. Some of that is because JPs are unqualified to make such a determination, while there are also economic incentives to undercount: "Many justices of the peace hail from counties with tight budgets, so there can be pressure to reduce the number of cases they send to a medical examiner for an autopsy."

The article mentioned legislation by Sen. Charles Schwertner "to better monitor patients who may be 'doctor shopping' for drugs." That bill passed the senate two weeks ago but has yet to be referred to committee in the House. But they failed to mention HB 225 by Guillen/Watson, which will be one of the first House bills taken up by the Senate Criminal Justice Committee when they hear the bill on Tuesday. That legislation would authorize use of the opiod antagonist naloxone (an antidote with no known side effects which is highly effective for heroin and many prescription pain medications) by first responders and adults with a prescription. It would also create a "Good Samaritan" provision - a defense to prosecution for people who call 911 in response to an overdose. (N.b., your correspondent supported HB 225 in the House on behalf of the Texas Criminal Justice Coalition.)

This joint feature from the Chronicle and Statesman makes the arguments for such overdose prevention legislation much more immediate and poignant. Since they didn't mention Guillen's Good Samaritan bill, I doubt the story was timed to benefit that legislation. But it's certainly a timely and helpful coincidence. For more background on HB 225, see recent coverage from NPR, prior Grits coverage and the House Research Organization report (pdf, p. 21) on the bill. MORE: See a brand new, detailed (88 page) fact sheet on precisely these topics from the Network for Public Health Law.

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