Drug Poisoning:

Trends and Current StatusUS, England & Wales, Canada

Lois A. FingerhutUS, National Center for Health Statistics

Clare GriffithsUK, Office of National Statistics

Kathryn WilkinsCanada, Statistics Canada

• ICD-9 vs ICD-10

• Underlying cause: external cause codes (X & Y codes)

• Multiple cause: T codes for substances

• Mental health “F” codes

•Nondependent abuse

•Dependent abuse

•Alcohol intoxication (not included here)

• Adverse effects codes (not included here)

Definitional issues: Drug poisoning mortality

ICD-9 vs ICD-10Substance selection

• ICD-9 underlying cause codes for poisoning more specific than ICD-10 codes

• ICD-10, to get specific substances

• Literals from the death certificate

•Code the multiple cause data

ICD mortality coding by country

ICD-9-UCOD

ICD-10-UCOD

Substance-specific

England and Wales

1990-2000

2001-2002 Literals from text files

Canada 1990-1999

2000-2002 From under-lying cause

United States

1990- 1998

1999-2002 Multiple cause coding

ICD ‘definitions’ of drug poisoningICD-10

Nondependent abuse of drugs 305.2-.9 F11-16, 18-19 (not .2)

Dependent abuse 304 F11-16,18-19(.2)

Unintentional E850-E858 X40-X44

Suicide E950(.0-5) X60-X64

Undetermined E980(.0-.5) Y10-Y14

Homicide E962.0 X85

[Alcohol intoxication 305.0 F10.0]

ICD-9

Drug poisoning death rates: US, 2002

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

Under15

15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

Death

s p

er

100,0

00 p

op Unintentional

Suicide

Undetermined

DAD

NDAD

Drug poisoning deaths, ages 35-54

2

9

3

9 8

51

29

61

33

29

15

11

24

13

2

0

10

20

30

40

50

60

70

Canada 99-02 E&W 93-02 US 99-02

Perc

en

t o

f all

dru

g d

eath

s

Dependent AbuseNon-dependent abuseUnintentionalSuicideUndetermined

Drug poisoning death rates,males 35-54 years

1

10

100

1990 1992 1994 1996 1998 2000 2002

Dea

ths

per

100

,000

po

pu

lati

on

US

Canada

E&W

Drug poisoning death rates, males, 25-34 years

1

10

100

1990 1992 1994 1996 1998 2000 2002

Death

s p

er

100,0

00 p

op

ula

tio

n

E&W

US

Canada

Drug poisoning death rates, females, 35-54 years

1

10

100

1990 1992 1994 1996 1998 2000 2002

Death

s p

er

100,0

00 p

op

ula

tio

n

E&W

US

Canada

Abuse-related (mental health codes)

death rates, males 35-54 years

0.01

0.1

1

10

1990 1992 1994 1996 1998 2000 2002

Dea

ths

per

100,

000

pop

Canada nondep abuse Canada depend abuse E&W nondep abuseE&W depend abuse US nondep abuse US depend abuse

Canada: Leading substance categories based on underlying

cause of death: No further specificity available

1)Opiates and related narcotics

2)Tranquilizers and other psychotropic agents

3)Local anaesthetics (includes cocaine)

England & Wales: Leading specified substances mentioned in drug deaths for

those 35-54 years: [not ICD coded]: 1993-2002

1) Antidepressants (23%)

2) Paracetamol (22%)

3) Heroin/morphine (17%)

4) Methadone (9%)

5) Benzodiazepines (7%)

US: Leading specified substances mentioned in drug deaths for those 35-54

years: 20021. Cocaine T40.5: 25%

2. Other specified opioids T40.2: 21%

3. Antidepressants T43.0-T43.2: 11%

4. Alcohol T51: 11%

5. Carbon Monoxide T58: 8%

6. Heroin T40.1: 10%

7. Benzodiazepines T42.4: 9%

8. Methadone T40.3 10%

Next Steps

• Recommend adding certain ICD codes from Mental and Behavioral Disorders (F10-F19) to classification of poisoning deaths

•Nondependent abuse?

•Dependent abuse?

•Alcohol intoxication?

• Drug status- legal/illegal use

•International variation- a topic to be researched….

Questions…

•Lois A Fingerhut: US NCHS

LFingerhut@cdc.gov

•Clare Griffiths UK ONS

Clare.Griffiths@ons.gsi.gov.uk

•Kathryn Wilkins Canada Statistics Canada

Kathryn.Wilkins@statcan.ca