TY - JOUR T1 - Overcoming the limitations of ‘accident’ as a manner of death for drug overdose mortality: case for a death certificate checkbox JF - Injury Prevention JO - Inj Prev SP - 375 LP - 378 DO - 10.1136/injuryprev-2020-043830 VL - 27 IS - 4 AU - Ian R H Rockett AU - Eric D Caine AU - Hilary S Connery AU - Kurt B Nolte Y1 - 2021/08/01 UR - http://injuryprevention.bmj.com/content/27/4/375.abstract N2 - 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. ER -