As epidemiologist for the North Carolina Office of the Chief Medical Examiner in Raleigh, North Carolina, Bloomberg Fellow Alison Miller tracks all deaths investigated in the state, including suspected overdoses. They made up more than half of North Carolina autopsies conducted from March 2017, when the medical examiner system began tracking them, through the end of 2017.

Watching the state’s rate of opioid deaths rise has stoked Alison’s interest in what it will take to stem the tide. We sat down with her to talk about the difficulty of quantifying the epidemic, what she hopes to gain as an MPH candidate at the Johns Hopkins Bloomberg School of Public Health, and the huge stumbling block presented by stigma.

Alison Miller

As the epidemiologist for the medical examiner system in your state, what is one of the biggest problems you see in how we handle addiction and overdose?

What people really want to know is how many people are dying from overdose and what drugs are involved. Right now we have a turnaround-time issue because we’re overwhelmed by the number of deaths and the complexity of the cases. It can take a while to perform toxicology testing, which is necessary to accurately certify the cause and manner of death and finalize the autopsy report. Without this information, it’s challenging for public health partners to understand the magnitude of the problem, project trends and focus harm reduction efforts, such as naloxone distribution, to counties being hit the hardest. 

That’s probably the greatest problem we’re facing. Though people can rely on data from emergency medical service systems and emergency departments to track non-fatal overdoses, only the medical examiner system can provide drug-specific data on fatal overdoses. It’s important to understand what drugs are involved in overdoses so prevention efforts can be targeted effectively. You usually can’t get that information from emergency departments or death certificates.

What are you most looking forward to as a Bloomberg fellow? 

I’m most excited to learn more about implementing evidence-based policies. I’ve been providing data to inform public health initiatives and efforts, and now I want to be on the other side of it. 

I’m very excited by all the people in the initiative that have experience with policy development and implementation. I can learn from them. Eventually, I would love to work at the National Institute on Drug Abuse to translate research on addiction into policies that expand access to medication-assisted treatment. 

Ultimately, I plan to go for a PhD in health policy, but I’ll continue to advocate for medical examiner data as an essential resource to inform public health prevention efforts. 

Where do you see the U.S. moving in its response to addiction and overdose?

My hope is that we will move toward more harm-reduction approaches and that people will open their minds to increasing funding for syringe-exchange programs and opening safe consumption spaces to help address the epidemic. 

I hope we begin to treat people who use drugs with respect and compassion. I think that’s really critical because stigmatization is such a huge problem. It prevents the public from considering all harm-reduction approaches and expanding access to medication-assisted treatment, and it keeps people from seeking treatment. I think “detox” and abstinence from drugs have been prioritized because medication-assisted treatment has been stigmatized. I have seen so many deaths that could have been prevented if methadone or buprenorphine had been available. It’s also important that we change our perception of addiction as a moral weakness so we can address related problems without criminalization.