In Reply Dr Nestadt raises 3 concerns regarding our analysis of trends in the intent of overdose deaths involving opioids.1 His first concern is that suicides may have been misclassified. A prior estimate assumed that because 26.5% of opioid overdose visits to the emergency department were classified as intentional, 20% to 30% of opioid overdose deaths were also intentional.2 Our findings, which were based on the National Vital Statistics System, revealed that in 2017, 4.0% of overdose deaths involving opioids were certified as suicides, 5.4% were certified as undetermined intent, and 90.6% were unintentional. One reason that a larger percentage of nonfatal than fatal opioid overdoses are intentional may be that intentional opioid overdoses are less often fatal than unintentional opioid overdoses ...
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", language="en", issn="0098-7484", doi="10.1001/jama.2020.1458", url="http://dx.doi.org/10.1001/jama.2020.1458" }