Background Kentucky (Ky) had the 2^nd highest DOF rate in the U.S. in 2012 (25/100,000) mainly due to prescription drug (PD) overdose (PDO). In response, Ky enacted comprehensive PDO prevention laws. The law evaluation required death certificates (DCs) with accurate drug overdose data.

Methods In KY, DCs are completed by elected county coroners. In 2011, 30% of the Ky DCs did not list any drugs contributing to DOFs, underestimating the burden of PDO deaths. DOF reporting based on a DC data alone didn’t allow monitoring of PDO by specific drugs and identifying sources of diversion.

Results To improve the completeness of DOF data Ky enacted a law in 2013 (KRS72.026) requiring the coroners to test for controlled substances postmortem if a cause of death was not clearly established; the toxicology testing is performed by an accredited national laboratory, and is paid by the Kentucky Medical Examiner Office (MEO). KY’s Chief Medical Examiner reviews all of the test results, and follows up with a review of DCs, and consultation with coroners on a case-by-case basis. Two years after law implementation, there is a significant increase in completeness of DOF data. To further improve the quality of DOF data, the MEO expanded coroners’ education and supplemented autopsy reports with DC cause of death completion suggestions. The OME and Ky Injury Prevention and Research Centre expanded the KyDOF surveillance, incorporating DC, death investigation, autopsy, toxicology, and prescription drug monitoring data. New epi tools were introduced to analyse the comprehensive KyDOF data. Data showed the PDO prevention laws contributed to better prescribing and decreased diversion of historically abused medications (e.g., oxycodone, alprazolam); and identified heroin and fentanyl (mostly illicitly manufactured) as emerging drugs of abuse.

Conclusions Quality DOF data are critical to inform targeted policy interventions and evaluate effectiveness.