Opioid database coming, but it depends on good data from coroners

by Steve Brawner (BRAWNERSTEVE@MAC.COM) 341 views 

The state of Arkansas is using an almost $1 million Department of Justice grant to create a statewide database for opioid abuse and deaths, but the system will depend on the voluntary compliance of 75 county coroners.

The $999,979 grant over three years is helping the state create a comprehensive data repository system allowing law enforcement, health care professionals, policymakers and others to better track those opioid incidents. It was awarded last September to the Arkansas Drug Director’s Office, with the Arkansas Foundation for Medical Care serving as a subrecipient. AFMC is creating the database.

Arkansas Drug Director Kirk Lane said he hopes the database is available for use within the next 3-6 months. The grant money also will be used for training.

The information will be available for viewing by participating agencies, but it won’t be a public website. How much information will be publicly available remains to be seen.

The various stakeholders held their first collaborative meeting Wednesday (July 17) at the Arkansas Association of Counties.

Lane said before the meeting that the state needs to know the extent of its opioid problem. Arkansas has the nation’s second highest opioid prescribing rate. Records indicate that 416 people died from a drug overdose in 2017, but that number probably is inaccurately low because of the disparities in how county coroners report deaths. Numbers for 2018 are not yet available.

“Right now, we’re pouring 2019 resources, dollars and manpower into 2016 and 2017 statistics, and that doesn’t work,” he said. “We need to do a better job in how we bring these databases together.”

The grant will allow the state to create a real-time database with information such as overdose deaths and administrations of naloxone, a drug that can save the life of an opioid overdose victim. Lane said there are 30 nonfatal overdoses for every fatal one. Having good data will allow the state to use other grants to target resources where they will be most effective. Good data makes Arkansas more competitive against other states when those grants are offered. And it will provide accurate information to courts during civil litigation cases.

Gina Redford, manager for AFMC’s analytic services, said AFMC has identified data sources and purchased geospatial software to build the database. About 10-12 people are involved.

The system will depend on the state’s 75 coroners and their deputies providing accurate information. Those coroners have not had a standardized system of determining and reporting deaths until now.

An online MDI Log provides that opportunity and will be used to populate the new database. But Kevin Cleghorn, Saline County coroner and president of the Arkansas Coroners’ Association, said only 42-43 coroners are using the free tool.

The association has been encouraging others to make the change, and some have.

“We’re very well received, but again there are some that just, ‘I’ve been doing it the way I’ve been doing it for so many years, and I’m not going to change,’” he said.

He said a number of new coroners were elected in November, and the association has experienced “massive growth” in the last six months. Fifty-one counties are active members of the association.

But one county’s coroner can’t even access the system because he doesn’t have a computer and doesn’t have county funding to pay for one. Cleghorn said part of the grant potentially could be used to purchase a mobile digital device for him.

Seventy-three of the state’s coroners are elected, while two are appointed. Some are part-time. Cleghorn said they do not have to undergo any training and can’t be made to do so because they are constitutional officers.

“It could be just XYZ off the street corner that just happens to be the most popular person in the county,” he said. “They win the election, and now they determine the cause and manner of the death in that county. That’s why we emphasize tremendously the education program in the state of Arkansas.”

However, under Act 238 passed by legislators this year, deputy coroners must obtain Arkansas medicolegal death investigation certification before January 2021.

Because of the system’s voluntary nature, Cleghorn said the database “will be flawed to a certain degree. We may miss one or two counties … but our goal before this is over with, our goal is to have all 75 counties on board with the MDI Log.”

Another challenge to overcome: AFMC’s Redford said small-town coroners can face pressure from families who want an opioid death classified as a heart attack because it doesn’t have a stigma.

Asked about that happening, Cleghorn said, “I can’t comment on that. I will say that is not the way that we teach. We don’t teach sugarcoating anything.”

Cleghorn’s Saline County office maintains case files for each of the county’s 800-900 deaths annually. He has two full-time deputies and six part-time ones.

He said a close family friend lost a son, 27, to an opioid overdose at 2 a.m. Wednesday morning. The death occurred in Saline County, but the young man was transported to a Pulaski County hospital, so Cleghorn’s office did not work the case.

“We see things that no man should ever have to see in a lot of cases,” he said.

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