Overdose Deaths, Manner of Death, and the Meaning of “Homicide”
Under common law and everyday understanding, “homicide” describes a death that occurs at the hands of another person. That is, someone else’s actions caused the death — regardless of whether the act was intentional or malicious. Yet in U.S. forensic-medical practice, guided by frameworks such as those promulgated by the National Association of Medical Examiners (NAME), many poisoning and overdose deaths — even when another party supplied or administered the drug — are certified as “accidents,” not homicides, provided there is no clear evidence of intent to kill.
According to NAME’s death-certification guidance, death due to poisoning is labelled “accident” when there is “little or no evidence that the injury or poisoning occurred with intent to harm or cause death.” CDC+1 In practice, many fatal overdoses are thus certified as unintentional, even though another person may have supplied the substance or otherwise contributed to the death.
But if a death truly occurs because of another person’s act, classifying it as “accident” appears to invert the common-sense definition of homicide. This mismatch between causation (someone else caused the death) and forensic-medical classification (unintentional accident) can lead to significant distortions in how society, public health, and the legal system treat overdose fatalities.
The Scale of Overdose Deaths and the Prevalence of “Accident” Classifications
Overdose deaths have become a major cause of mortality in the United States. According to the most recent estimates from the Centers for Disease Control and Prevention (CDC), there were an estimated 107,543 drug overdose deaths in 2023 — marking a modest 3% decrease from 2022, but still reflecting a decades-long surge in mortality. CDC Blogs+1
When it comes to how these overdose deaths are classified, the vast majority are designated as unintentional (accidents). For instance, the CDC’s death-certificate coding shows that among drug poisoning deaths in 2023, 92.6% were unintentional, 4.4% suicides, 2.8% undetermined intent, and less than 1.0% homicides. NCBI+1
More granular data from a national medical examiner and coroner survey reinforce this pattern: in a 2022 survey, 88% of accepted overdose cases were classified as accidents; only 1.2% were classified as homicides. nflis.deadiversion.usdoj.gov
Given the sheer volume — over one hundred thousand overdose deaths per year — these statistics imply that tens of thousands of people die annually from overdoses that are legally and medically classified as “accidents,” even when third parties may have been involved in supplying or administering the lethal substance.
Inconsistency Between Cause and Manner: A Logical Tension
This practice raises a fundamental conceptual tension. On one hand: causation. If someone other than the decedent supplied or administered the toxic drug, then “death at the hands of another” — in ordinary moral and linguistic terms — has occurred. On the other hand: forensic classification. Because the supplying or administering party did not necessarily intend death, the manner-of-death label becomes “accident.”
Thus, a decedent’s death may be causally attributable to another person’s act, yet the official record treats it as a non-homicide. In doing so, the classification divorces factual causation from the legal/forensic label.
This logic is institutionalized. As noted by a detailed critique from defense advocates, medical certification of a “manner of death” as “accident” does not preclude legal prosecution for homicide or manslaughter under appropriate statutes; but the inverse is also true — certifying overdose deaths as accidents effectively removes the vast majority of fatal overdoses from the class of deaths that might trigger homicide-style scrutiny. NACDL+2NAAG+2
Moreover, the determination of manner often relies less on objective, reproducible scientific criteria than on contextual information (e.g., witness statements, scene investigation, knowledge of drug source, etc.). Such subjectivity can lead to inconsistent or biased outcomes. A recent analysis in the legal-medical literature argues that manner-of-death classifications may reflect contextual, non-scientific influences, which undermines their reliability. American Bar Association+1
As the report by the National Academies of Sciences, Engineering, and Medicine outlines, in some high-profile cases, re-examinations have overturned manner-of-death determinations — certifying deaths earlier labeled “accidental” as homicides, or vice versa. NAP
Legal and Public-Health Implications
The consequences of this classification disconnect are nontrivial.
- Criminal justice and accountability: If overdose deaths are nearly always labeled “accident,” it becomes far less likely that suppliers or distributors of lethal drugs will face homicide or manslaughter charges. While certification as “accident” does not legally preclude prosecution, in practice it significantly reduces the likelihood. NACDL+1 In the context of the ongoing opioid crisis, this may blunt one of the few legal tools available for holding accountable those who profit from or facilitate fatal drug use.
Public health surveillance and policy: Death classification affects how data are collected, reported, and interpreted. If tens of thousands of overdose deaths are consistently classified as accidents, the scope and nature of drug deaths may be underappreciated in public-health statistics, or mischaracterized in ways that obscure underlying systemic issues (e.g., supply-side responsibility versus user error). The authors of a recent review note that reliance on death certificates and coding systems (like the International Classification of Diseases, Tenth Revision / ICD-10) may “not tell the whole story — or even the right story” about drug-involved deaths. WMP LLC+1
Transparency and public trust: When manner-of-death classifications appear logically inconsistent (e.g., someone dies because another person supplied them a poison, yet it’s labelled “accident”) it undermines faith in the impartiality and scientific integrity of medicolegal death investigation systems. As institutions like the National Academies have observed, inconsistent or inaccurate death certifications hinder both public-health planning and legal accountability. NAP+1
By Larry Hatfield
Victim Advocate
Research Specialist
