What's the most deadly drug in Michigan? It's "unspecified."
There is an epidemic of drug use in Michigan, and in the rest of the country, involving a class of drugs called opiates – think Vicodin, Oxycontin or heroin.
In Michigan, at least 3,000 people have died from these drugs since 2005. But even that number doesn’t tell the whole story. The actual number of deaths is likely much higher.
How much higher? We don't actually know.
Dr. Sue Min Oh is an epidemiologist with the Michigan Department of Health and Human Services. Last year, she put together a report on what’s led to the rise in drug overdose deaths in Michigan. And in that report is a line graph that charts the number of deaths over time from each kind of drug.
And there’s one line – a yellow line – that’s been above all the others since 2007.
I asked Dr. Oh about that line.
"The drug that kills the most people in Michigan right now is 'unspecified'?"
"Yeah," she said, nodding. "It is really unspecified."
From 2009 to 2012, more than a third of the drug overdose deaths in Michigan were attributed to "unspecified." That’s more than 1,600 deaths in those years alone.
Unspecified isn’t a drug I’ve ever heard of. I asked how Dr. Oh interprets that as a public health expert.
"The data came from death certificate files," she says, "which is the record that medical examiner or coroner write up … based on their death investigation."
In Michigan, county agencies handle these reports. There is a county medical examiner, or a county coroner who’s responsible for carrying out autopsies to find out what caused a drug overdose death.
Why does it matter which drug it was?
Gregory Davis is a county medical examiner in Alabama, and former director of the National Association of Medical Examiners.
"The federal government uses information from death certificates to help determine in what way it should apportion resources for investigation whether it’s in research or whether it’s programs that would try to prevent deaths as a public health measure," Davis says.
Davis wrote a position paper for the National Association of Medical Examiners, calling for more specificity on records for drug overdose deaths.
But Michigan’s data have been becoming less specific over time. The number of deaths chalked up to “unspecified” drugs is rising.
"So I would have hoped that that would not be the case," Davis told me. "But the position paper is just that. It’s the position of the National Association of Medical Examiners, it’s our recommendation as best practice, but we have no means of enforcing that people follow these best practices.
I called up the administrator for the medical examiner’s office in one of those counties. Robert Herds is in Oakland County.
"Maybe if they want to do the research, they need to come out with some guidelines to tighten that up," Herds says.
The reason Oakland County doesn’t specify which drugs are responsible for the overdoses boils down to an honest scientific disagreement between its chief medical examiner and the official position of the National Association of Medical Examiners. Basically, I was told, the body’s reaction to drugs is complex. Often there are interactions, especially with alcohol or other drugs. So instead of pinpointing it, Oakland and other counties just leave it unspecified.
What that means for those trying to understand Michigan’s drug problem, though, is that we just don’t have great information. What we can say from the statistics we do have is that at least 3,000 people in Michigan have died with some kind of opiate in their system since 2005. It’s likely those drugs have contributed to many more deaths. But how many? That’s unspecified.