Lois Fingerhut, MA¹, Robert Anderson, PhD², Margaret Warner, PhD¹, and Ari Minino, MPH². (1) Office of Analysis, Epidemiology and Health Promotion, NCHS, 3311 Toledo Road, Hyattsville, MD 20782, 301-458-4213, lfingerhut@cdc.gov, (2) Division of Vital Statistics, NCHS, 3311 Toledo Road, Hyattsville, MD 20782

Background: The definitions of poisoning and the classification of substances involved in poisoning deaths are explored. Methods: Using 2001 national vital statistics data for the US, poisoning deaths are identified as the underlying external cause of injury death; the nature of injury for poisoning and toxic effects, and as the underlying cause of death classified to mental and behavioral disorders due to psychoactive substance use. Results: Of the 22,242 poisoning deaths defined by external cause only, 63% deaths were unintentional, 23% suicides, 13% as undetermined intent. Using the nature of injury poisoning codes, 25,807 deaths had a mention of a poison or toxic substance, and there were a total of 41,803 mentions of substances. For all underlying-cause poisoning deaths, an average of 1.7 total substances were listed per death. The type of drug mentioned as contributing to the death varied with intent of the death. Cocaine was more commonly listed than other narcotic drugs. In 2001, 1,931 deaths were classified to mental and behavioral disorders involving drugs and 6,627 deaths involving alcohol, increasing the number of deaths where alcohol was identified as the underlying cause by nearly 20 times, but not substantially changing the number of drug poisoning deaths. Implications: Death certificate wording determines whether a drug or alcohol-related death is assigned an underlying cause of poisoning or mental or behavioral disorder. Recommendations on formal definitions must follow broad-based discussions among communities of toxicologists, medical examiners, and injury epidemiologists.

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