The CDC cannot control local coroners, so it’s up to states and counties to improve overdose reporting practices. Although some of them have been doing so, the political incentives are not well-aligned. For example, if a state or county spends money on better recording of overdose deaths it will be “rewarded” by looking as if its opioid problem is getting worse.

More important, Ruhm’s research shows that the severity of the opioid epidemic is being underestimated. This makes it all the more urgent for the president and Congress to take significant steps to curb the worst public health disaster in decades.