PT  - JOURNAL ARTICLE
AU  - Ian R H Rockett
AU  - Eric D Caine
AU  - Hilary S Connery
AU  - Kurt B Nolte
TI  - Overcoming the limitations of ‘accident’ as a manner of death for drug overdose mortality: case for a death certificate checkbox
AID  - 10.1136/injuryprev-2020-043830
DP  - 2021 Aug 01
TA  - Injury Prevention
PG  - 375--378
VI  - 27
IP  - 4
4099  - http://injuryprevention.bmj.com/content/27/4/375.short
4100  - http://injuryprevention.bmj.com/content/27/4/375.full
SO  - Inj Prev2021 Aug 01; 27
AB  - Collectively, the epidemic increases in the United States of opioid-related deaths and suicides during the first two decades of the 21st century have exposed shortcomings in current forensic and epidemiological approaches for determining and codifying manner of death—a vital function fulfilled by medical examiners, coroners and nosologists—the foundation for the National Violent Death Reporting System (NVDRS), an incident-based surveillance system providing individual-level information on decedent characteristics, manner, cause and circumstances of suicide, homicide and other violent injury deaths. Drug intoxication deaths are generally classified as ‘accidents’ or unintentional, a fundamental mischaracterisation; most arose from repetitive self-harm behaviours related to substance acquisition and misuse. Moreover, given the burden of affirmative evidence required to determine suicide, many of these ‘accidents’ likely reflected unrecognised intentional acts—that is, suicides. Addition of a simple checkbox for self-injury mortality on the death certificate would enrich the National Death Index and NVDRS, and in turn, inform prevention and clinical research, and enhance the evaluation of prevention programmes and therapeutic regimens.