Maybe I’ve grown callous from a career as a family physician. I hope not. Years of talking to people about their aches and pains, their bodily functions, their private feelings and fears might have made me so. I sense people’s shame and I respect their privacy. But I believe somethings need to be talked about and sometimes publicly. One of those is how we die.
The number of people dying from accidental prescription overdose deaths started climbing in 1999. We have all heard how the big drug companies started pushing their drugs on the medical profession in the mid 1990’s. It wasn’t until 2006 that a CDC data analyst saw some numbers and thought there might be a problem. Interestingly, there were also murmurings from state medical examiners that reinforced the impression. But the rate of deaths has only recently begun declining.
Some states have a medical examiner system, unlike Idaho where we have county coroners who are only responsible for their own jurisdiction. I have written before about the variation in Idaho’s county coroner death investigations. The Canyon County coroner only specified type of drug overdose death in 35% of death certificates. Next door Ada County specified 91%. There is little doubt Idaho has undercounted our problem.
But that is the official government system responsible for death investigation and reporting. I appreciate that some are looking to change the system.
But I wonder how the change in local reporting of deaths also might have contributed to the rise in accidental overdoses.
Some of you may remember when obituaries were written by the local newspapers. They were “reported”. I’m sure the youngest or newest reporter got the tedious and uncomfortable job of calling the family and doing some background on the recently deceased. It might have been mundane, but it would have required some sensitivity too. We all deserve that. I believe the profession of journalism has lost some sensitivity. But the balance of privacy, sensitivity and public awareness is the job of a journalist.
In my hometown paper the formula always included age and cause or manner of death. I noticed many times the death was referred to as “natural causes”, which I took to mean cancer, since back then, there was some shame associated with that dreaded disease. That has changed.
But that is truly a “manner of death”, since there are only five categories: natural, accidental, homicide, suicide, or indeterminate. I can appreciate skipping the details of “cause”. But sometimes the cause, say pneumonia or heart attack, was specified. I suppose this was sensitive.
The official report, the death certificate is required to be complete and detailed, but death certificates are not public record. They are shared with people who can demonstrate a need to know, like family or an estate agent. Life insurance companies demand a death certificate.
But in the early 2000’s many papers stopped reporting on deaths and obituaries became paid-for family written pieces. Most families don’t want to share such a tragedy as an accidental overdose or a suicide publicly. I can’t blame them. But it might have helped our communities have an earlier awareness of this wave of deaths.
I have asked some old newspaper guys and they explained this change with the simplest answer: money. Newspapers were being starved for revenue; Craigslist siphoned off the want ad revenue, online news depleted subscriptions, readership declined. They couldn’t afford to hire those young reporters and break them in on writing obituaries.
I really don’t know if more accidental overdose deaths would have been reported locally. Would the community benefit from knowing the young man died from an overdose? Would our awareness of the lethal effect of these drugs have made us a little less likely to demand them from our prescribers? It’s a sensitive question. We should all be a little more sensitive.