Addressing data gaps in opioid overdose reporting: enhancing systems to protect vulnerable older adults

Abstract

While opioid overdoses impact Americans of all ages, the full extent of the impact of the evolving opioid crisis on older adults remains poorly understood due to significant gaps in data reporting. Inaccurate documentation of drug poisoning deaths—where opioids are often not listed as primary or secondary causes—obscures the real toll. Additionally, less is known about non-fatal overdoses due to inconsistent reporting and a lack of standardized data collection. To address these challenges, there is a need to reimagine data systems that link local, state, and federal sources to capture geographical risk factors. This article will reflect on current opioid overdose prevalence rates, discuss challenges in existing data solutions, and highlight novel attempts toward building better data systems to enhance our understanding of the risks for and effectiveness of different opioid prevention efforts. Texas A&M University's efforts in leveraging its data integration capabilities to link overdose events with specific interventions, utilizing diverse datasets to offer a more holistic view of the crisis and tailoring responses based on regional needs will serve as a case example. However, achieving optimal data systems will require further improvements, such as standardizing data across districts and enhancing interoperability between public health agencies. This coordinated effort, integrating geographical and demographic risk factors, will be essential to creating timely, accurate data systems that inform targeted interventions for persons of all ages and reduce direct and indirect impacts on older adults and their families.

Translational Significance.

This article highlights critical challenges in opioid overdose reporting and presents actionable solutions to improve surveillance and intervention strategies. By addressing data standardization, privacy concerns, and technological barriers, these findings support the development of a more integrated opioid monitoring system. The proposed solution, such as expanding real-time surveillance networks and enhancing data interoperability, offers translational potential by directly informing policy, public health initiatives, and clinical practices. Additionally, focusing on older adults ensures that vulnerable populations receive targeted interventions. Strengthening opioid data infrastructure will enable timely, evidence-based responses, ultimately will reduce opioid-related harm and improving population health outcomes.

The opioid crisis continues to devastate communities across the United States, affecting people across all age groups. However, older adults remain underrepresented in opioid-related data and policy discussions. Despite the rise in opioid-related hospitalizations and deaths in this demographic, current data systems fail to capture the scope of the issue comprehensively (Guy et al., 2017). The lack of robust and standardized data on opioid overdoses among older adults creates significant challenges for public health prevention efforts, intervention strategies, treatment access, screening practices, and clinical monitoring.

Accurate and timely data are critical for shaping public health responses and ensuring that resources are allocated where they are most needed. Without comprehensive data, it becomes difficult to identify trends in opioid misuse, implement targeted harm reduction programs, and allocate funding for intervention efforts (O’Donnell et al., 2017). Studies have indicated that inconsistencies in toxicology reporting and incomplete cause-of-death determinations lead to substantial underreporting of opioid-related fatalities (Hedegaard et al., 2017). Public health databases such as the National Vital Statistics System (NVSS) and the SUDORS provide valuable insights into overdose deaths, but gaps remain in non-fatal overdose tracking and data integration across healthcare systems (U.S. Centers for Disease Control and Prevention, 2024).

This gap in reporting also hinders the ability of healthcare providers to implement proactive screening and early intervention strategies that could mitigate overdose risks among older adults (Larochelle et al., 2019). Clinical monitoring, which relies on detailed patient histories and accurate prescription tracking, is also compromised when data on opioid misuse is incomplete or fragmented. Public health agencies, including the U.S. Centers for Disease Control and Prevention (CDC) and the Substance Abuse and Mental Health Services Administration (SAMHSA), have highlighted the need for improved data collection methods to track opioid-related morbidity and mortality across different demographics (SAMHSA, 2024). Furthermore, a lack of real-time overdose tracking limits the effectiveness of public health emergency responses, delaying crucial harm reduction measures such as naloxone distribution and emergency medical interventions (Evans et al., 2022).

As the opioid epidemic evolves, there is an urgent need to enhance data collection methods to provide a clearer picture of opioid-related morbidity and mortality among older populations. Enhanced interoperability between existing databases such as the CDC Wide-ranging ONline Data for Epidemiologic Research (WONDER), the Opioid Detection Mapping Application Program (ODMAP), and electronic health records (EHRs) could significantly improve real-time tracking and intervention efforts (Dasgupta et al., 2018). This article explores the gaps in opioid overdose reporting, discusses existing challenges, and highlights innovative strategies for improving surveillance and intervention for at-risk older adults. By addressing these data deficiencies, policymakers, healthcare providers, and public health officials can implement more effective strategies to prevent opioid-related harm in this vulnerable demographic.

What we know—or think we know about opioid overdosing among older adults

Despite the popular notion of substance misuse being a youth problem, it is an indirect or direct problem throughout life. Systematic data is significantly lacking on how older adults are affected by the opioid crisis, whether they are the person overdosing and/or are impacted by an overdose event in the family, and how this impacts resultant statistics (Mason et al., 2022). There is an outdated perception that older adults are overdosing on prescribed opioids, reflecting the first wave of the opioid epidemic (U.S. Centers for Disease Control and Prevention, 2024). Illicitly manufactured fentanyl is now the predominant drug in overdose deaths, especially among the younger populations (Tanz et al., 2022). Epidemiological surveillance data reveal an increasing risk of overdose deaths among older adults that quadrupled from 2020 to 2021 (Humphreys & Shover, 2023). Recent data (2021–2022) indicate drug overdose rates appear to be increasing among those 55–64 and 65 and older, while higher but decreasing in other age cohorts (Spencer et al., 2022). There are many unknowns due to incomplete data reporting, especially among the oldest cohorts.

Data deficiency in opioid overdose reporting

Accurate overdose surveillance is essential for developing effective prevention strategies. However, significant gaps persist in how opioid-related incidents are recorded, particularly among older adults. Primary challenges include inconsistent documentation of opioid-related deaths, limited tracking of non-fatal overdoses, and persistent stigma about drug users.

A significant issue is the inconsistent documentation of ­opioid-related deaths. Many death certificates fail to list opioids as either a primary or contributing cause of death, leading to an underestimation of opioid-related mortality among older adults (Hedegaard et al., 2017). Death certificates are often completed by medical examiners or coroners who may not have access to complete toxicology reports when filing. Primary care providers may also be required to complete death certificates and do so again without having access to pertinent medical circumstances. Worse yet, in rural states like Texas, a majority of the counties do not have access to medical personnel to complete death certificates and rely on local officials, such as the local justice of the peace, to complete this duty. This leads to inconsistencies in classification to exist across jurisdictions, with some states having more rigorous opioid screening protocols than others (Warner et al., 2021 ). Toxicology testing varies widely across states, further compounding the issue. In some jurisdictions, routine toxicology testing is not conducted even in cases of suspected overdose, leading to incomplete data collection and limiting the ability of policymakers to address the full extent of the crisis (Warner et al., 2021). According to Slavova et al. (2017), toxicology screening practices differ based on available resources, regional policies, and variations in forensic protocols, resulting in significant underreporting of opioid-related deaths. Moreover, not every state or region considers opioid overdose deaths a sentinel event, which means that such cases do not always prompt further investigation, limiting opportunities to collect critical public health data (Hall et al., 2008). The lack of national standardization in overdose death classification contributes to discrepancies in opioid-related mortality rates reported across different states (Ruhm, 2018).

Non-fatal opioid overdoses are another crucial yet often overlooked aspect of the opioid crisis, particularly among older adults (Lowder et al., 2020). As the U.S. population continues to age, there is a growing concern about the increasing number of older adults who are vulnerable to drug-related harms, including both non-fatal and fatal opioid overdoses. This demographic shift has significant public health implications, as aging individuals often experience chronic pain, polypharmacy, and physiological changes that heighten their susceptibility to substance use disorders and overdose risks. According to a study published in the Harm Reduction Journal, the prevalence of opioid-related harm among older adults has been rising, underscoring the need for age-specific interventions, harm reduction strategies, and healthcare policies aimed at mitigating these risks (Mason et al., 2022). Many individuals who experience non-fatal overdoses do not seek medical attention, and those who do may not have their overdose formally documented in public health records. Emergency department visits for opioid overdoses are inconsistently reported, with some hospitals failing to specify the involvement of opioids in their discharge records (Vivolo-Kantor et al., 2021). Another major challenge is the lack of centralized, real-time surveillance systems for tracking non-fatal overdoses. Unlike opioid-related deaths, which are recorded in mortality databases such as NVSS and SUDORS, non-fatal overdoses rely on fragmented reporting from emergency medical services (EMS), hospital records, and poison control centers (Walley et al., 2013). The inconsistency in reporting non-fatal overdoses results in a lack of data to assess the effectiveness of harm reduction programs, opioid prescribing regulations, and overdose prevention initiatives targeted at older adults (Bohnert & Ilgen, 2019).

In addition to the aforementioned issues, the stigma surrounding opioid use in older populations may contribute to underreporting. Older adults who survive an overdose may be reluctant to disclose opioid use due to fear of judgment or loss of access to pain management therapies (Guy et al., 2018). This reluctance further skews data collection efforts and creates challenges in designing interventions tailored to the unique needs of this demographic. Enhancing data-sharing agreements between healthcare providers, public health agencies, and law enforcement can improve the tracking of non-fatal overdoses and inform more effective prevention strategies (Faul et al., 2016).

Innovative data solutions for improved surveillance

To address these challenges, data systems must be restructured to provide comprehensive surveillance of opioid-related harms. Several initiatives are leading the way in closing data gaps and improving opioid overdose reporting. Federal and state agencies have taken steps to enhance surveillance through programs such as SUDORS under the CDC, which integrates medical examiner and toxicology reports to provide more granular overdose data (O’Donnell et al., 2017). However, more states must adopt and expand this system to include additional demographic insights, particularly risk factors specific to older adults. Similarly, CDC WONDER aggregates mortality and morbidity data but lacks interoperability with local health departments, limiting its real-time effectiveness in overdose prevention efforts (Rudd et al., 2016).

Real-time or near real-time overdose detection tools like ODMAP, developed by the High Intensity Drug Trafficking Area (HIDTA) program, provide near real-time surveillance of overdose events (Overdose Detection Mapping Application Program, 2022). Public health officials can effectively tailor interventions by identifying geographic overdose hotspots. Some states have begun integrating ODMAP with emergency medical services (EMS) data to improve the responsiveness of harm reduction programs and naloxone distribution efforts.

Figure 1 represents the current and available data capabilities that employ rudimentary geospatial references based on tabular data. This representation provides increased insight relative to hotspots and demographic information. It is a superior representation to bar graphs currently used to demonstrate aggregation of the volume of overdose events in a particular state or geographic area; however, this visual interpretation does not immediately allow the user to evaluate the opioid overdose risk of older adult populations, and it is not apparent how the representation or data would be used to intentional provide targeted interventions to a selected population.

Figure 1.

Representation of opioid overdose hotspots in areas with older adult populations in Texas to include naloxone distribution sites with limited geospatial reference (based on real-world simulation).

Texas A&M University (TAMU) has pioneered efforts in linking overdose events with specific intervention programs by leveraging advanced data analytics. By incorporating public health data, law enforcement reports, and healthcare utilization statistics, TAMU’s model provides a more holistic view of opioid risk factors among older adults. Such approaches allow policymakers to tailor interventions based on regional needs, ensuring more effective prevention and treatment strategies (Texas A&M University, 2023). A comprehensive geographic representation that integrates real-time and near real-time data with rich geospatial insights—including opioid overdose events, older adult demographic density, socioeconomic status, epidemiological risk factors, high-risk environments, population density, and healthcare system accessibility—provides a superior analytical framework for targeted intervention and ­decision-making. By leveraging advanced spatial intelligence, public health officials can pinpoint overdose hotspots, predict emerging outbreaks, and optimize resource allocation for harm reduction strategies such as naloxone distribution and treatment accessibility. The integration of predictive analytics enables proactive intervention by identifying communities at heightened risk, improving response times, and guiding policy decisions based on data-driven insights. This holistic geospatial approach enhances the effectiveness of public health strategies, supports equitable distribution of healthcare resources, and strengthens long-term prevention efforts in combating the opioid crisis. Figure 2 represents a rich representation based on synthetic and notional data on the vulnerability aspects of a community, in this case, Harris County, Texas, with a composite representation of factors to include socioeconomic status, minority status, household and transportation, epidemiological factors, healthcare system factors, high-risk environment factors, density of elevated health risk individuals to include density of population over the age of 65 to construct a general an index that is associated with elevated risk. Indicated on the map are naloxone distribution sites as blue triangles, dense older adult population areas represented by orange transparent circles, and red dots representing fatal opioid overdose events that occurred in the designated time range for the target population, which is older adults for this representation.

Figure 2.

Representation of data integration of vulnerability factors with synthetic data representing opioid overdose events in notional population catchment areas using Mapbox Open StreetMap and Surgo Ventures Vulnerability Index.

Challenges and recommendations for strengthening opioid data systems

The opioid crisis remains a significant public health challenge, and the ability to track, analyze, and respond to overdose incidents in real time is critical to saving lives. However, despite advancements in overdose monitoring and response efforts, several obstacles hinder the development of a fully integrated opioid overdose reporting system. These challenges—lack of standardization, privacy concerns, and technological barriers—result in fragmented data collection, delays in public health interventions, and missed opportunities for prevention. To address these issues, strategic solutions must be implemented, including standardized overdose documentation, expanded surveillance networks, improved data interoperability, enhanced technological investments, and a specific focus on older adults affected by opioid misuse.

One of the most challenging obstacles to a comprehensive overdose reporting system is the lack of standardization in how states and local jurisdictions collect and report overdose data. Variability in toxicology testing, cause-of-death classification, and overdose determination prevents the formation of a unified national dataset (Dasgupta et al., 2018). Some jurisdictions may underreport opioid-involved overdoses due to inconsistent data collection methods, while others may lack clear protocols for recording opioid-related hospital visits. These discrepancies limit the ability of researchers and policymakers to conduct comparative analyses, hindering the development of effective interventions. Establishing national standards for opioid overdose documentation is critical to improving data accuracy and reliability. Implementing uniform toxicology testing protocols in all suspected overdose cases will ensure consistent identification of opioid involvement (Rudd et al., 2016). Additionally, requiring healthcare providers and medical examiners to follow standardized guidelines for recording opioid use in medical records and death certificates will enhance the quality of overdose data. Public health agencies can produce more reliable statistics by enforcing clear documentation requirements, allowing data-driven decision-making and targeted intervention efforts.

While health data privacy regulations are crucial in protecting patient confidentiality, they also create significant barriers to effective data sharing between public health agencies, hospitals, and law enforcement. The Health Insurance Portability and Accountability Act (HIPAA) and similar regulations often prevent the timely exchange of overdose-related data, delaying interventions and limiting the ability of stakeholders to track emerging trends (Gostin et al., 2017). Additionally, concerns about data security and the potential misuse of personal health information have further impeded efforts to develop a fully integrated overdose reporting system.

Facilitating better collaboration among public health agencies, hospitals, and law enforcement through improved data interoperability can address these challenges. Establishing secure, privacy-compliant data-sharing agreements and integrating health information exchange (HIE) systems will allow for the responsible and efficient exchange of overdose data. Enhanced interoperability between electronic health records (EHRs) and public health databases can streamline overdose reporting, enabling a more comprehensive and real-time understanding of the crisis (Dasgupta et al., 2018). Policymakers should work to create frameworks that balance patient privacy with the urgent need for timely data sharing in overdose prevention efforts.

Many local health departments, particularly in rural and underfunded areas, lack the infrastructure to implement real-time overdose tracking tools. Outdated data management systems, insufficient funding, and limited technical expertise hinder the ability of these departments to collect and analyze data effectively (Wheeler et al., 2015). Without access to advanced surveillance technologies, public health agencies experience delays in identifying overdose hotspots, preventing rapid deployment of emergency response teams, and harm reduction resources. Increasing federal and state funding for technological upgrades in local health departments is necessary to improve data collection and integration capabilities. Providing grants for implementing real-time surveillance tools, such as geographic information systems (GIS) mapping and artificial intelligence-driven analytics, can significantly enhance overdose tracking efforts. Additionally, investing in workforce training programs will ensure that healthcare and public health professionals can effectively utilize new technologies. By equipping all jurisdictions with the necessary digital tools, policymakers can reduce reporting delays and improve public health responses.

The absence of real-time overdose surveillance hinders the ability of first responders and public health officials to react quickly to overdose spikes. Many regions lack the necessary systems to track overdoses as they occur, resulting in missed opportunities for intervention. Without real-time monitoring, public health agencies cannot efficiently allocate resources, such as naloxone distribution and treatment services, to areas experiencing overdose surges. Expanding real-time overdose surveillance networks, such as ODMAP, can facilitate immediate responses to overdose incidents (Wolff et al., 2022). ODMAP allows first responders, law enforcement, and public health officials to input and access overdose data in real-time, enabling rapid deployment of emergency interventions. Increasing the adoption of these programs across all states will enhance coordination between agencies and improve the efficiency of overdose response efforts. Additionally, integrating these surveillance systems with hospital and EMS data will provide a more comprehensive picture of overdose trends, further strengthening prevention strategies.

While much of the focus on the opioid crisis has been directed toward younger populations, opioid misuse among older adults is a growing concern that has received insufficient attention. Older individuals are at an increased risk of opioid-related harm due to age-related changes in drug metabolism, polypharmacy, and higher rates of chronic pain management with opioids. However, research on opioid misuse and overdose trends among older adults remains limited, leading to gaps in age-specific prevention and intervention strategies (Hedegaard et al., 2017).

Encouraging targeted studies on opioid misuse among older populations is essential for informing age-specific intervention programs. Research should focus on identifying risk factors unique to older adults, such as interactions with other medications, cognitive impairment, and barriers to accessing addiction treatment. Policymakers should integrate older adults into overdose prevention initiatives, ensuring that harm reduction strategies—such as naloxone distribution and opioid prescribing guidelines—are tailored to their needs. Additionally, healthcare providers should receive training on recognizing and addressing opioid misuse in aging populations, helping to bridge the current knowledge gap in clinical practice.

Conclusion

The opioid crisis is a complex public health challenge that demands robust data systems to develop effective interventions. Addressing significant gaps in overdose reporting, especially among older adults, will enhance our understanding of opioid-­related risks and improve prevention efforts. Overcoming challenges such as a lack of standardization, data-sharing barriers, technological limitations, and inadequate real-time surveillance requires a comprehensive approach. Implementing standardized documentation practices, expanding real-time surveillance networks, improving data interoperability, increasing funding for technological upgrades, and prioritizing research on older adults will strengthen opioid monitoring systems and lead to more effective interventions.

A more responsive and accurate reporting system can be built by integrating real-time surveillance tools and leveraging innovative university-led initiatives like those at Texas A&M. Prescription Drug Monitoring Programs (PDMPs), which track metrics such as individual prescription opioid total daily volume, dosing, and co-prescribing patterns of other controlled substances, represent a critical yet underutilized data source. When integrated with GIS, PDMP data can support the construction of community- or region-specific risk profiles, enabling precise identification of high-risk prescribing patterns and populations. This integration would support earlier interventions, improve allocation of harm reduction resources, and contribute to predictive modeling efforts aimed at preventing overdose events. Fostering collaboration among local, state, and federal agencies will further enhance the coordination of overdose prevention strategies. Strengthening opioid data infrastructure will enable targeted interventions that reduce overdose fatalities and mitigate the broader impact of opioid misuse, particularly among vulnerable populations such as older adults and their families.

Funding

None declared.

Conflict of interest

M. Ory served as a co-editor for the special issue, in which this article is published, but was not involved in the review or decision for the article.

Data availability

This article does not report data, and therefore the pre-­registration and data availability requirements are not applicable.