Facts & Statistics

The Truth Behind the Numbers.

Advocating for the Classification of Homicides on Death Certificates

Coroner Charles E. Kiessling said it is time to stop “dancing around the issue” and “call it what it is.”
He now lists homicide as the manner of death on death certificates in cases where heroin has been determined to be the cause.

“If you are selling heroin to someone and they die, isn’t that homicide?” he asked.

The manner-of-death section of the death certificate was introduced in 1910 to collect accurate data identifying threats to public safety and to guide public-health policy, research priorities, and funding decisions.

1. Purpose of Manner-of-Death Classification

Common Position

The National Association of Medical Examiners classifies impaired-driving fatalities and drug poisoning deaths as accidents when there is a perceived lack of intent to kill.

Truth

This classification contradicts both investigative reality and public-health purpose.

In the United States, more than 90–92% of drug poisoning deaths are classified as unintentional (“accidents”), while less than 1% are classified as homicides.
In 2023, approximately 107,500 people died from drug poisoning, making it one of the leading causes of death for Americans ages 18–44.
Provisional 2024 data still shows ~80,000 drug poisoning deaths, despite a modest decline—demonstrating the crisis remains severe and ongoing.

These deaths are frequently the result of another person’s choice and actions, including the distribution of lethal substances or impaired operation of vehicles. Law-enforcement investigations regularly identify criminal behavior, yet death certificates often fail to reflect this reality. Misclassification undermines prevention, accountability, and public trust.

Common Position

Medical examiners often avoid using the term “poison”, believing it may be misconstrued as a legal conclusion or could initiate criminal investigations.

Truth

Death certificates are legal documents, and accuracy—not convenience—must be the priority.

The term “drug poisoning” is the medically accurate cause of death.
The continued use of the non-medical term “overdose” obscures the presence of toxic, adulterated, or unexpectedly lethal substances, particularly fentanyl.
Synthetic opioids, primarily fentanyl, are now involved in the vast majority of drug poisoning deaths, often without the victim’s knowledge.

Avoiding accurate terminology does not protect the medical examiner—it suppresses legitimate investigations and prevents the death certificate from fulfilling its public-health purpose.

Truth

The manner-of-death section exists to identify preventable threats to public safety. Labeling homicides as accidents defeats the reason death certificates exist.

Truth

A Medical Examiner’s default classification of drug poisoning deaths as “accidents” creates the false impression that these deaths are random or unavoidable. In reality, they are driven by predictable, human-caused actions, including drug distribution and impaired operation of vehicles.

2. Classification of Deaths

Common Position

Fentanyl poisoning and impaired-driving deaths are classified as “accidents” due to lack of intent.

Truth

By definition, a homicide is any death caused by the actions of another person, regardless of intent.

Medical Examiner guidance explicitly states that intent is not required for a homicide classification.
Despite this, nearly all fentanyl poisoning deaths remain classified as accidents—even when another person supplied the lethal substance.

This contradiction between definition and practice distorts national mortality data.

3. Concerns About Criminal Investigations

Common Position

Medical examiners avoid homicide classifications to prevent triggering prosecutions.

Truth

Misclassification does the opposite—it prevents investigations from ever beginning.

Over the past decade, more than half a million Americans have died from drug poisoning.
Only a small fraction of these deaths have resulted in prosecutions related to distribution or delivery of lethal substances.
When a death is labeled an “accident,” law enforcement is often never notified, evidence is not preserved, and accountability is lost.

Calling a death an accident protects offenders—not victims.

4. Guidelines vs. Standards

Common Position

Recommendations are viewed as optional guidelines rather than mandatory standards for individual certifiers.

Truth

These guidelines explicitly allow medical examiners to classify deaths as homicides when circumstances warrant it. Certifiers already have the authority to do so but rarely exercise it in drug poisoning or impaired-driving cases.

5. Traffic Fatalities and Negligence

Common Position

Impaired-driving fatalities are often certified as accidents.

Truth

Impaired-driving deaths are homicides.

In 2023, 12,429 people died in alcohol-impaired driving crashes.
Alcohol impairment accounts for approximately 30–32% of all U.S. traffic fatalities.
That is one impaired-driving death every 42 minutes.

These deaths meet the definition of homicide: death caused by another person’s actions.

6. Discretion of Medical Examiners

Common Position

Medical examiners have discretion to classify deaths as homicides.

Truth

That discretion is rarely used.

Instead, certifiers default to outdated conventions to maintain consistency, even when accuracy is sacrificed. The result is systemic undercounting of homicides caused by drug poisoning and impaired driving.

7. Autopsy vs. Scene Investigation

Common Position

Autopsies provide the best information for manner-of-death determinations.

Truth

Autopsies show how someone died—not who caused the death.

Accurate determinations require:

Scene evidence
Witness statements
Investigative findings
Toxicology context
Law-enforcement conclusions

Ignoring investigative context leads directly to misclassification.

8. Changing the Classification

Common Position

Medical examiners can amend death certificates when new information emerges.

Truth

In practice, changes are rare—even when courts later rule a death a homicide.

Medical Examiner documents explicitly allow homicide classification when warranted, yet revisions almost never occur in drug poisoning or impaired-driving deaths.

9. Impact on Data Validity

Common Position

Reclassification would undermine historical data.

Truth

Decades of misclassification have already undermined data validity.

Mislabeling drug poisoning and impaired-driving deaths as accidents has distorted public-health priorities, research conclusions, and funding decisions.
Correcting classifications going forward does not require revising past records—only acknowledging that previous methodology was flawed.

10. Public Misconceptions

Common Position

Drug poisoning deaths are viewed as self-inflicted accidents.

Truth

Victims do not consent to ingesting lethal or adulterated substances.

Most drug poisoning deaths involve unknown potency, contamination, or substitution, particularly with fentanyl. Responsibility lies with the circumstances and actors that caused the exposure—not the victim.

Common Position

Lack of intent means the death was an accident.

Truth

“Accident” ignores misconduct.

Driving while impaired or distributing toxic substances is foreseeably dangerous behavior. Labeling these deaths as accidents creates a false presumption of innocence and allows preventable violence to continue unchecked.