The opioid abuse epidemic in the United States may already be bad enough by leading to 91 overdose deaths every day. The total number of opioid-related deaths, however, may still be underestimated and a few cases may be missed because of how deaths are reported, according to a new study from the Centers for Disease Control and Prevention.

Minnesota-based CDC field officer Dr. Victoria Hall, speaking at the annual Epidemic Intelligence Service Conference, revealed that more than half of opioid-related deaths in her state from 2006 to 2015 had not been captured in total numbers.

Are Opioids Involved In These Deaths?

"While my research cannot speak to what percent we are underestimating, we know we are missing cases. It does seem like it is almost an iceberg of an epidemic,” Hall warned, citing the case of a middle-aged man’s sudden death listing only pneumonia on record and not his long-term opioid treatment for back pain.

The team led by Hall studied death records within the state health department’s Unexplained Death surveillance system for the said period. Minnesota has maintained the system unlike other states in order to track emerging diseases, especially for deaths with no clear explanation.

Given evidence that opioid users and abusers are at a greater risk for pneumonia, the team searched for deaths from the condition as well as other infectious disorders to see whether opioids might play a factor.

Here’s what they found: Of the 1,676 deaths fitting their criteria, 3.5 percent demonstrated proof of opioid use. Such 59 deaths had not been on the radar of the state’s opioid surveillance.

In addition, 22 of those cases involved toxic opioid levels.

Opioids Can Kill Anyone

The dead varied in status and categories: they ranged from 16 to 32 years old, and 53 percent were women. Adults from every age or ethnicity were captured, whether they lived in an urban or rural location.

Of the 59 deaths, pneumonia was present in 32. Hall said that deaths that involve such infectious conditions can be complicated by the presence of opioids in one’s body. At high levels, opioids can affect the immune system and dampen infection-fighting immune cells as well as antibody response, she added.

Opioids also have a sedative effect that can affect breathing, making the patient breathe more shallowly, slower, and with less likelihood of coughing. Thus, plenty of matter could settle in one’s lungs.

The expert recommended public health officials to work with medical examiners to ensure that death certificates are completely coded, or else the full scope of the opioid or another epidemic will be missed.

Hall insisted that opioids aren’t just a Minnesota problem. In other states like Virginia, for instance, the rising death toll from drug overdose has been widely reported, implicating the use of synthetic opioids such as heroin and the prescription drug fentanyl.

Health officials noted that Virginia had a 38 percent increase in drug overdose from 2015 to last year, with synthetic opioids playing a crucial role in it.

A study from March noted that opioid dependence can start as early as the first five days of use.

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