Rockett: change the way we categorize overdoses

“Accidental” drug deaths often result from self-harm

MORGANTOWN, W.Va. – A large proportion of so-called accidental drug overdose deaths are probably due to suicide or other self-directed violence, suggests an essay by a panel of international experts led by Ian Rockett, Ph.D., professor of epidemiology in the West Virginia University School of Public Health. “Confronting Death from Drug Self-Intoxication (DDSI): Prevention through a Better Definition,” appears in the October 16 online edition of the American Journal of Public Health.

In achieving consensus on a controversial and divisive topic, Dr. Rockett’s team – comprised of epidemiologists, psychiatrists, emergency physicians, sociologists, a health economist, a philosopher, medical examiners, and forensic pathologists – coined a new concept called “death from drug self-intoxication,” or DDSI. The basis for this concept is that drug-intoxication deaths frequently result from self-harming behavior, even if the circumstances don’t meet the high standards required for medical examiners and coroners to classify them as suicides as distinct from accidents.

The DDSI category would recognize that many people who die from deliberate self-intoxication exhibited self-destructiveness or indifference or ambivalence towards life, even when they did not intend to die. The team agreed that without comprehensive consideration of such deaths as suicide or due to other self-directed violence, we are left with a misleading picture that greatly impedes prevention, explained Rockett.

“Use of a DDSI category by epidemiologists and public health practitioners would avoid problems in appropriately characterizing high-risk populations for a self-administered drug death and designing effective interventions, which stem from them having to use the current manner-of-death categories of suicide, accident, and undetermined intent,” Rockett said.

The multidisciplinary team suggested accounting for DDSI could be implemented if the Centers for Disease Control and Prevention’s (CDC) National Violent Death Reporting System collected data on all poisoning deaths and not just those officially classified as suicide, homicide, or undetermined intent. Nationally, 80 percent of poisoning deaths are classified as accidents. The DDSI category would include all drug-intoxication deaths from suicide and most currently categorized as an accident or undetermined intent.

“The enormous surge in the poisoning death rate in the United States during the 21st century points to a major failure in prevention,” Rockett explained. “Approximately 90 percent of these poisoning deaths are from use, abuse, and misuse of pharmaceuticals and other drugs.”

Rockett’s hope is that prevention strategies aimed at reducing these drug deaths would improve through a clearer definition of the problem and become more proactive than those aimed at preventing accidental or unintentional drug deaths.

To read the full text of the team’s essay, visit: