Challenges with collecting new kinds of data on Clark County deaths in recent years have become more evident with the release of a statewide dashboard tracking unintentional overdose deaths within some Washington counties.
A deceased person’s housing status and whether an overdose was intentional or unintentional have been added to the list of data the Clark County Medical Examiner’s Office records in the last few years.
The information gleaned from collecting that data will be useful, alerting the community of what resources are needed and where, said staff of the Clark County Medical Examiner’s Office.
However, the data also has many limitations, including complications with how information is collected and the need for an abundance of evidence to prove the truth of the information.
“There are more limitations than there are mechanisms and systems to support really good consistent data collection and reporting across all of our systems,” Community Health Director Andrea Pruett said.
How it can be helpful
Clark County is one of the 13 Washington counties that have participated in a recently released statewide dashboard tracking unintentional overdoses.
The data are grouped together by two years, starting in 2019. The data on individual years for Clark County appears to be incomplete, with 2019 and 2022 missing.
Between 2019 and 2021, there were 144 confirmed unintentional overdoses in Clark County. Between 2020 and 2022, there were 156.
Pruett, who oversees the Medical Examiner’s Office, said the vast majority of fatal overdoses are considered accidental.
When staff notice an uptick in accidental overdoses, they can alert the community that more resources are needed, such as education and naloxone — a drug that can reverse opioid overdoses.
Mike Delay, a clinical supervisor at Columbia River Mental Health Services, said seeing an uptick in experienced drug users dying from overdoses might be a sign that a new type of substance is being supplied within the community — such as xylazine, a sedative commonly referred to as “Tranq” that doesn’t respond to naloxone because it’s not an opioid.
“So we might be seeing a sudden spike in unintentional overdoses as an indication that the supplied substance in our area has drastically changed, and we need to alter our harm reduction methodologies to address that,” Delay said.
According to Dr. Kevin Fischer, chief medical officer at Columbia River Mental Health Services, the organization’s most recent data indicates that Tranq is present in around 4 percent of the illicit fentanyl supply in the county.
Opioid data can also show whether there has been a spike in people attempting to commit suicide via overdosing, Pruett said.
“If we find that we see trends toward intentional deaths through use of illicit substances, that may signal a need for additional crisis services [and] support for primary prevention efforts,” Pruett said.
In July 2022, the county also began tracking the housing status of people at their time of death when statewide death certificate reporting began including a question about housing status. Previously, local homelessness providers were the only ones tracking the deaths of homeless people in Clark County.
The data will likely be released sometime next year, according to Marissa Armstrong, communications program coordinator for Clark County Public Health.
She said the data will help the county know what factors, such as weather or chronic health conditions, are causing the deaths of people without housing.
“Understanding those circumstances can help our community partners understand where resources and prevention efforts are needed to try and prevent some of these deaths,” Armstrong said.
Limitations
There are challenges in tracking this kind of information that can limit the data, according to Pruett.
For instance, a lack of evidence can make it difficult for the Medical Examiner’s Office to determine whether an overdose was intentional or unintentional.
“There has to be a preponderance of evidence available for the team to review in order to make a determination that the death was intentional,” she said.
That evidence can include written notes, texts or last conversations between friends and family.
“But even then, how much information that’s available to make those determinations is truly case by case,” Pruett said.
There are also complications with how housing status is recorded — a process done by many different people across different agencies.
The housing status of a person who has died from natural causes is often recorded by a physician or a funeral home. People can interpret housing statuses differently, like unhoused versus sheltered, which can affect the data, Armstrong said.
There’s also an “unknown” box on the death certificate, which unsure physicians could click and not look into the housing status further, Pruett said.
“That’s not just for here but anywhere in the state,” she said. “If someone has limited resources, and they can’t keep following the thread to try and really sort out if this person was housed or unhoused or in a shelter … there’s an unknown box.”
Another issue is collecting and reporting the data for the state over the years amongst staffing shortages.
“Time is short. Resources are scarce,” Pruett said. “There’s more work than there are staff to do it. And in these circumstances without oversight, incentive or clear understanding and direction tied to why folks do this across disciplines, it has impacts on the data and who even can say what those are.”
However, Pruett said it’s important to staff in Clark County that they gather this data about deaths to inform the community.
“We have started to collect the data, and then a goal would be to make iterative quality improvements,” she said.
