In one Pennsylvania county, heroin overdoses are now called homicides.
Lycoming County Coroner Charles Kiessling told PennLive.com that he has started listing homicide as the manner of death in cases where heroin was the cause.
"If you are selling heroin to someone and they die, isn't that homicide?" he said.
Kiessling told the news outlet that calling such deaths accidental downplays their severity.
"If you are dealing drugs you are a murderer," he said. "You may not know who you are killing."
A coroner's ruling of homicide specifies a manner of death and does not necessarily lead to homicide charges. And not all Pennsylvania coroners are rushing to deem such deaths homicides.
In Delaware County, heroin overdoses are typically ruled as accidental deaths, unless there is evidence of circumstances like a person being forced to take the drug against his will, said Leslie Jones, an investigator with the county medical examiner's office.
"The death certificates usually say accident," she said.
Coroners list a person's manner of death as natural, accident, suicide, homicide or undetermined. The National Association of Medical Examiner says homicide should be used to designate a death from "a volitional act committed by another person to cause fear, harm or death," according to a Centers for Disease Control and Prevention handbook, which adds: "Intent to cause death is a common element but is not required for classification as homicide.''
In a handful of cases around the Philadelphia region in recent years, alleged dealers have been charged with providing heroin that led to deadly overdoses, though such prosecutions are relatively rare.
Overdose fatality rates in Pennsylvania increased by a factor of 14 between 1979 and 2014, according to a recent data analysis by University of Pittsburgh researchers.
"Heroin abuse is truly ubiquitous," a Drug Enforcement Administration report on drug-related overdose deaths in Pennsylvania, released in November, noted in its key findings.
The report found that heroin was the drug most commonly found in victims of fatal overdoses. That was true statewide, where heroin was detected in 52 percent of people who died from drug overdoses, and in Philadelphia its surrounding counties. In Philadelphia, for instance, heroin was present in 349 of the 655 victims of fatal overdoses in 2014, the report said.