For years, Nebraska has maintained one of the lowest drug overdose death rates in the U.S.
It’s a point of pride among state leaders, who have cited the numbers when debating — and often defeating — drug policy proposals, including a proposed needle exchange program in 2024.
Just one problem: Nebraska’s lowest-in-the-nation drug death rate is likely false.
The state has long undercounted drug deaths, say state officials, public health researchers, treatment workers and a new Flatwater Free Press analysis of Centers for Disease Control data showing that Nebraska’s nonfatal overdose rate and its death rate simply don’t match up.
For example, emergency departments in Nebraska, Montana and Texas all reported the same rate of nonfatal overdoses in 2023. But Montanans and Texans died of overdoses at double the rate of Nebraskans.
The reason for the discrepancy might be straightforward: Other states rely on medical examiners to determine cause of death, while Nebraska leaves that job to county attorneys whose primary job is to prosecute crimes. Many haven’t reported a drug death in years, even decades.
The undercounting — long suspected by some public health officials — extends to both rural areas and Nebraska’s cities.
“It’s clear that there’s underreporting based on our existing systems, and that’s unfortunate because everything we do depends on understanding what’s going on in the community,” said Dr. Ali Khan, dean of the University of Nebraska Medical Center’s College of Public Health.
Why it matters
The undercounting likely costs the state millions of dollars in federal funding meant to treat addiction and prevent overdoses in the first place. Over the past decade, Nebraska received the lowest per-person dollar amount from the federal Center for Substance Abuse Treatment in the entire country.
The undercounting can distort the reality of Nebraska’s drug-use problem, influencing policy and funding decisions at the state level. In recent years, the Legislature has cut $15 million from the state’s behavioral health budget, failed to legalize syringe exchange programs and stalled efforts to enhance penalties for drug-involved deaths.
For grieving families seeking answers, the system can inflict more heartache. That’s because county attorneys have broad discretion about when to order an autopsy.
Linette Cocchiarella sought answers following the death of her 23-year-old son, Derrek, who struggled with drug addiction. The county attorney initially declined to perform an autopsy, ruling his death was from “natural causes.” Linette pressed for answers, kicking off a long, frustrating and painful process.
“It was rough … I always thought their job was to advocate for the dead person,” Linette said. “And I didn’t feel like Derrek was being advocated for at all.”
