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Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosures
Puja Seth PhD Alana Vivolo-Kantor PhD MPH and Julie ODonnell PhD MPH have disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce healthcare goods and services
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosures
All plannersmanagers hereby state that they or their spouselife partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months
The following plannersmanagers have the following to disclose- Kelly J Clark MD MBA FASAM DFAPA ndash
Consulting fees Braeburn Indivior
Rx Summit wwwNationalRxDrugAbuseSummitorg
Learning Objectives
Describe the process to develop CDC and state case definitions
Identify patterns of recent nonfatal heroin and opioid drug overdoses across 12 states
Identify drugs involved in deaths and circumstances precipitating the deaths based on data
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
Puja Seth PhDAlana Vivolo-Kantor PhD
Julie OrsquoDonnell PhD
Division of Unintentional Injury PreventionCenters for Disease Control and Prevention
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Puja Seth PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Goals
Describe CDCrsquos new opioid overdose surveillance program Discuss how rapidly available data can be used to inform
overdose response and prevention efforts Overview of emergency department and emergency medical
services data for use in tracking opioid overdose trends Describe the development of case definitions for opioid and
heroin overdose in emergency department and emergency medical services data
Overview of data available for fatal opioid overdoses and associated risk factors and its use in informing prevention and response recommendations
Rx Summit wwwNationalRxDrugAbuseSummitorg
Opioid Overdoses Treated in Emergency Departments
Vivolo-Kantor AM Seth P Gladden RM Mattson CL Baldwin GT Kite-Powell A Coletta MA Vital Signs Trends in Emergency Department Visits for Suspected Opioid Overdoses mdash United States July 2016ndashSeptember 2017(httpswwwcdcgovmmwrvolumes67wrmm6709e1htm) MMWR Morb Mortal Wkly Rep201867
Rx Summit wwwNationalRxDrugAbuseSummitorg
Vivolo-Kantor AM Seth P Gladden RM Mattson CL Baldwin GT Kite-Powell A Coletta MA Vital Signs Trends in Emergency Department Visits for Suspected Opioid Overdoses mdash United States July 2016ndashSeptember 2017(httpswwwcdcgovmmwrvolumes67wrmm6709e1htm) MMWR Morb Mortal Wkly Rep201867
Rx Summit wwwNationalRxDrugAbuseSummitorg
2000 Rapid Increase in Drug Overdose Death Rates by County
SOURCE NCHS Data Visualization Gallery
Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery
2005 Rapid Increase in Drug Overdose Death Rates by County
Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery
2010 Rapid Increase in Drug Overdose Death Rates by County
Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery
2016 Rapid Increase in Drug Overdose Death Rates by County
Rx Summit wwwNationalRxDrugAbuseSummitorg
RISE IN OPIOID DEATHS
Overlapping Entangled but Distinct Epidemics
Natural and semi-synthetic opioidslike oxycodone or hydrocodone
Methadone
Heroin
SOURCE National Vital Statistics System Mortality File
Dea
ths
per 1
000
00 p
opul
atio
n
Rx Summit wwwNationalRxDrugAbuseSummitorg
CDCrsquos Pillars on Opioids Conducting surveillance and research
Building state local and tribal prevention efforts
Supporting healthcare providers and health systems
Partnering with public safety officials
Encouraging consumers to make safe choices about opioids raising awareness about prescription opioid misuse and overdose
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS) 12 states funded in September 2016 20 additional states and the
District of Columbia funded in September 2017 (through September 2019)
Strategy One Increase timeliness of non-fatal opioid overdose reporting- Use syndromic surveillance to establish an early warning system to
detect sharp increases or decreases in non-fatal opioid overdoses - Three indicators suspected all-drug opioid and heroin
Alaska California Connecticut Delaware DC Florida Georgia Illinois Indiana Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Nevada New Hampshire New Jersey New Mexico North Carolina Ohio Oklahoma Pennsylvania Rhode Island Tennessee Utah Vermont Virginia Washington West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS) Strategy Two Increase timeliness of fatal opioid overdose
reporting- Capture detailed information on toxicology death scene
investigations and other risk factors that may be associated with a fatal overdose
Strategy Three widespread dissemination- Rapidly disseminate surveillance findings to key stakeholders
working to prevent or respond to opioid overdoses
ESOOS program expansion in September 2017- At least 60 for comprehensive toxicology testing for opioid-
involved deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
Funded ESOOS states
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS)
Nonfatal Opioid Overdoses Reported
Quarterly
Emergency Department Visits EMS Transports
Fatal Opioid Overdoses Reported within 8 months
of death
Death CertificatesMEC reports
Toxicology reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
Next Two Presentationshellip
The Utilization of Emergency Department Syndromic Surveillance and Emergency Medical Services Data to Monitor Nonfatal Opioid Overdoses ndash Dr Alana Vivolo-Kantor
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System ndash Dr Julie OrsquoDonnell
Rx Summit wwwNationalRxDrugAbuseSummitorg
The utilization of emergency department syndromic surveillance
and emergency medical services data to monitor nonfatal opioid
overdosesPresenter Alana Vivolo-Kantor PhD
Behavioral ScientistCenters for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Julie OrsquoDonnell R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Alana Vivolo-Kantor PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Why Emergency Department and Emergency Medical Service Data for Surveillance
Need- Identify areas experiencing rapid increases in opioid overdoses to
inform responses- More quickly identify promising practices to reduce opioid overdoses
Proven utility to public health and scalable- Local jurisdictions already using it to track and respond to drug
overdoses- Findings from Epi-Aid investigations and collaborative work with states- Leverage existing state and national resources (BioSenseESSENCE)
Action at local and national level- Track quarterly trends across the nation to inform national policy- Improve more rapid local and state public health response
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our Philosophy
Focus on detecting change- Pushing system by looking at trend data over quarters- Some jurisdictions may be able to get and report preliminary
burden estimates
Jurisdiction-driven definitions will outperform national definitions- Local flexibility enhances quality and utility by accounting for large
variance in text entries and coding
National guidance- National definition will provide a good starting place- Guidance to encourage common conceptual definition (eg no
withdrawaldetox) and learn from previous work
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our approach
Non-fatal overdoses
Emergency Department
Near real-time ED collection (ie
syndromic ESSENCE)
Case-level or aggregate data shared
through ESSENCE (BioSense) or directly
with CDC
DischargeBilling Data
Case-level or aggregate data shared
directly with CDC
Emergency Medical Services
Case-level or aggregate data shared
directly with CDC
Includes breakdown by
sex age group and county of residence
Raceethnicity is optional
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency Department Data
Two sources- Near real-time syndromic data (visit information within 24-48 hours)- Lagged hospital billing or claims data (usually within 3-4 weeks)
Different variables used- Discharge diagnosis codes (eg ICD-10-CM) ndash available in billing
data and sometimes in syndromic- Free text fields (eg chief complaint provided by Doctor) ndash
available only in syndromic
Rx Summit wwwNationalRxDrugAbuseSummitorg
Case definitions for suspected overdose
If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED) and free text fields such as chief complaint or triage notes
- Free text searches use common terms slang and misspellings (eg herion instead of heroin)
If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED)
Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency medical services data
Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on
the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)
Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following
Naloxone administration)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Challenges in EMS data
Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp
v340)
Different case definitions in different versions
Missing data feeds
Not all EMS agencies share data
Varying time frame in when data is received- lt24 hours to 6 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Data submission process
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample quality control report
ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)
TOTAL ED VISITS (AGE)
1XX 2017 1 ED Visits mismatch 98287 98309
2XX 2017 2 ED Visits mismatch 98195 98230
3XX 2017 3 ED Visits mismatch 99167 99205
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample site report
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results All drug (11 sites)
0
10
20
30
40
50
60
70
80
90
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d al
l dru
g ov
erdo
se ra
tes
by
100
00 E
D v
isits
Quarter year
-2000
-1000
000
1000
2000
3000
4000
5000
6000
7000
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Opioid (11 sites)
0
5
10
15
20
25
30
35
40
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Heroin (11 sites)
0
5
10
15
20
25
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-15
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Column1 | Any opioid | Natural and semi-synthetic opioid analgesic | Methadone | Synthetic opioid analgesic excluding methadone | Heroin | ||||||
1999 | 1 | 03 | 03 | 07 | |||||||
21 | 1 | 04 | 03 | 07 | |||||||
2001 | 24 | 12 | 05 | 03 | 06 | ||||||
32 | 15 | 08 | 04 | 07 | |||||||
2003 | 35 | 17 | 1 | 05 | 07 | ||||||
39 | 18 | 13 | 06 | 06 | |||||||
2005 | 43 | 19 | 15 | 06 | 07 | ||||||
51 | 23 | 18 | 09 | 07 | |||||||
2007 | 54 | 27 | 18 | 07 | 08 | ||||||
57 | 3 | 16 | 08 | 1 | |||||||
2009 | 59 | 31 | 15 | 1 | 11 | ||||||
62 | 35 | 15 | 1 | 1 | |||||||
2011 | 66 | 37 | 14 | 08 | 14 | ||||||
67 | 35 | 12 | 08 | 19 | |||||||
2013 | 74 | 35 | 11 | 1 | 27 | ||||||
86 | 38 | 11 | 18 | 34 | |||||||
2015 | 104 | 39 | 1 | 31 | 41 | ||||||
133 | 44 | 1 | 62 | 49 |
1999 | 1999 | 1999 | 1999 | ||||
1 | 04 | 03 | 07 | ||||
2001 | 2001 | 2001 | 2001 | ||||
15 | 08 | 04 | 07 | ||||
2003 | 2003 | 2003 | 2003 | ||||
18 | 13 | 06 | 06 | ||||
2005 | 2005 | 2005 | 2005 | ||||
23 | 18 | 09 | 07 | ||||
2007 | 2007 | 2007 | 2007 | ||||
3 | 16 | 08 | 1 | ||||
2009 | 2009 | 2009 | 2009 | ||||
35 | 15 | 1 | 1 | ||||
2011 | 2011 | 2011 | 2011 | ||||
35 | 12 | 08 | 19 | ||||
2013 | 2013 | 2013 | 2013 | ||||
38 | 11 | 18 | 34 | ||||
2015 | 2015 | 2015 | 2015 | ||||
44 | 1 | 62 | 49 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosures
Puja Seth PhD Alana Vivolo-Kantor PhD MPH and Julie ODonnell PhD MPH have disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce healthcare goods and services
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosures
All plannersmanagers hereby state that they or their spouselife partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months
The following plannersmanagers have the following to disclose- Kelly J Clark MD MBA FASAM DFAPA ndash
Consulting fees Braeburn Indivior
Rx Summit wwwNationalRxDrugAbuseSummitorg
Learning Objectives
Describe the process to develop CDC and state case definitions
Identify patterns of recent nonfatal heroin and opioid drug overdoses across 12 states
Identify drugs involved in deaths and circumstances precipitating the deaths based on data
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
Puja Seth PhDAlana Vivolo-Kantor PhD
Julie OrsquoDonnell PhD
Division of Unintentional Injury PreventionCenters for Disease Control and Prevention
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Puja Seth PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Goals
Describe CDCrsquos new opioid overdose surveillance program Discuss how rapidly available data can be used to inform
overdose response and prevention efforts Overview of emergency department and emergency medical
services data for use in tracking opioid overdose trends Describe the development of case definitions for opioid and
heroin overdose in emergency department and emergency medical services data
Overview of data available for fatal opioid overdoses and associated risk factors and its use in informing prevention and response recommendations
Rx Summit wwwNationalRxDrugAbuseSummitorg
Opioid Overdoses Treated in Emergency Departments
Vivolo-Kantor AM Seth P Gladden RM Mattson CL Baldwin GT Kite-Powell A Coletta MA Vital Signs Trends in Emergency Department Visits for Suspected Opioid Overdoses mdash United States July 2016ndashSeptember 2017(httpswwwcdcgovmmwrvolumes67wrmm6709e1htm) MMWR Morb Mortal Wkly Rep201867
Rx Summit wwwNationalRxDrugAbuseSummitorg
Vivolo-Kantor AM Seth P Gladden RM Mattson CL Baldwin GT Kite-Powell A Coletta MA Vital Signs Trends in Emergency Department Visits for Suspected Opioid Overdoses mdash United States July 2016ndashSeptember 2017(httpswwwcdcgovmmwrvolumes67wrmm6709e1htm) MMWR Morb Mortal Wkly Rep201867
Rx Summit wwwNationalRxDrugAbuseSummitorg
2000 Rapid Increase in Drug Overdose Death Rates by County
SOURCE NCHS Data Visualization Gallery
Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery
2005 Rapid Increase in Drug Overdose Death Rates by County
Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery
2010 Rapid Increase in Drug Overdose Death Rates by County
Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery
2016 Rapid Increase in Drug Overdose Death Rates by County
Rx Summit wwwNationalRxDrugAbuseSummitorg
RISE IN OPIOID DEATHS
Overlapping Entangled but Distinct Epidemics
Natural and semi-synthetic opioidslike oxycodone or hydrocodone
Methadone
Heroin
SOURCE National Vital Statistics System Mortality File
Dea
ths
per 1
000
00 p
opul
atio
n
Rx Summit wwwNationalRxDrugAbuseSummitorg
CDCrsquos Pillars on Opioids Conducting surveillance and research
Building state local and tribal prevention efforts
Supporting healthcare providers and health systems
Partnering with public safety officials
Encouraging consumers to make safe choices about opioids raising awareness about prescription opioid misuse and overdose
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS) 12 states funded in September 2016 20 additional states and the
District of Columbia funded in September 2017 (through September 2019)
Strategy One Increase timeliness of non-fatal opioid overdose reporting- Use syndromic surveillance to establish an early warning system to
detect sharp increases or decreases in non-fatal opioid overdoses - Three indicators suspected all-drug opioid and heroin
Alaska California Connecticut Delaware DC Florida Georgia Illinois Indiana Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Nevada New Hampshire New Jersey New Mexico North Carolina Ohio Oklahoma Pennsylvania Rhode Island Tennessee Utah Vermont Virginia Washington West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS) Strategy Two Increase timeliness of fatal opioid overdose
reporting- Capture detailed information on toxicology death scene
investigations and other risk factors that may be associated with a fatal overdose
Strategy Three widespread dissemination- Rapidly disseminate surveillance findings to key stakeholders
working to prevent or respond to opioid overdoses
ESOOS program expansion in September 2017- At least 60 for comprehensive toxicology testing for opioid-
involved deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
Funded ESOOS states
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS)
Nonfatal Opioid Overdoses Reported
Quarterly
Emergency Department Visits EMS Transports
Fatal Opioid Overdoses Reported within 8 months
of death
Death CertificatesMEC reports
Toxicology reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
Next Two Presentationshellip
The Utilization of Emergency Department Syndromic Surveillance and Emergency Medical Services Data to Monitor Nonfatal Opioid Overdoses ndash Dr Alana Vivolo-Kantor
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System ndash Dr Julie OrsquoDonnell
Rx Summit wwwNationalRxDrugAbuseSummitorg
The utilization of emergency department syndromic surveillance
and emergency medical services data to monitor nonfatal opioid
overdosesPresenter Alana Vivolo-Kantor PhD
Behavioral ScientistCenters for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Julie OrsquoDonnell R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Alana Vivolo-Kantor PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Why Emergency Department and Emergency Medical Service Data for Surveillance
Need- Identify areas experiencing rapid increases in opioid overdoses to
inform responses- More quickly identify promising practices to reduce opioid overdoses
Proven utility to public health and scalable- Local jurisdictions already using it to track and respond to drug
overdoses- Findings from Epi-Aid investigations and collaborative work with states- Leverage existing state and national resources (BioSenseESSENCE)
Action at local and national level- Track quarterly trends across the nation to inform national policy- Improve more rapid local and state public health response
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our Philosophy
Focus on detecting change- Pushing system by looking at trend data over quarters- Some jurisdictions may be able to get and report preliminary
burden estimates
Jurisdiction-driven definitions will outperform national definitions- Local flexibility enhances quality and utility by accounting for large
variance in text entries and coding
National guidance- National definition will provide a good starting place- Guidance to encourage common conceptual definition (eg no
withdrawaldetox) and learn from previous work
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our approach
Non-fatal overdoses
Emergency Department
Near real-time ED collection (ie
syndromic ESSENCE)
Case-level or aggregate data shared
through ESSENCE (BioSense) or directly
with CDC
DischargeBilling Data
Case-level or aggregate data shared
directly with CDC
Emergency Medical Services
Case-level or aggregate data shared
directly with CDC
Includes breakdown by
sex age group and county of residence
Raceethnicity is optional
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency Department Data
Two sources- Near real-time syndromic data (visit information within 24-48 hours)- Lagged hospital billing or claims data (usually within 3-4 weeks)
Different variables used- Discharge diagnosis codes (eg ICD-10-CM) ndash available in billing
data and sometimes in syndromic- Free text fields (eg chief complaint provided by Doctor) ndash
available only in syndromic
Rx Summit wwwNationalRxDrugAbuseSummitorg
Case definitions for suspected overdose
If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED) and free text fields such as chief complaint or triage notes
- Free text searches use common terms slang and misspellings (eg herion instead of heroin)
If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED)
Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency medical services data
Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on
the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)
Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following
Naloxone administration)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Challenges in EMS data
Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp
v340)
Different case definitions in different versions
Missing data feeds
Not all EMS agencies share data
Varying time frame in when data is received- lt24 hours to 6 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Data submission process
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample quality control report
ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)
TOTAL ED VISITS (AGE)
1XX 2017 1 ED Visits mismatch 98287 98309
2XX 2017 2 ED Visits mismatch 98195 98230
3XX 2017 3 ED Visits mismatch 99167 99205
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample site report
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results All drug (11 sites)
0
10
20
30
40
50
60
70
80
90
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d al
l dru
g ov
erdo
se ra
tes
by
100
00 E
D v
isits
Quarter year
-2000
-1000
000
1000
2000
3000
4000
5000
6000
7000
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Opioid (11 sites)
0
5
10
15
20
25
30
35
40
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Heroin (11 sites)
0
5
10
15
20
25
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-15
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Column1 | Any opioid | Natural and semi-synthetic opioid analgesic | Methadone | Synthetic opioid analgesic excluding methadone | Heroin | ||||||
1999 | 1 | 03 | 03 | 07 | |||||||
21 | 1 | 04 | 03 | 07 | |||||||
2001 | 24 | 12 | 05 | 03 | 06 | ||||||
32 | 15 | 08 | 04 | 07 | |||||||
2003 | 35 | 17 | 1 | 05 | 07 | ||||||
39 | 18 | 13 | 06 | 06 | |||||||
2005 | 43 | 19 | 15 | 06 | 07 | ||||||
51 | 23 | 18 | 09 | 07 | |||||||
2007 | 54 | 27 | 18 | 07 | 08 | ||||||
57 | 3 | 16 | 08 | 1 | |||||||
2009 | 59 | 31 | 15 | 1 | 11 | ||||||
62 | 35 | 15 | 1 | 1 | |||||||
2011 | 66 | 37 | 14 | 08 | 14 | ||||||
67 | 35 | 12 | 08 | 19 | |||||||
2013 | 74 | 35 | 11 | 1 | 27 | ||||||
86 | 38 | 11 | 18 | 34 | |||||||
2015 | 104 | 39 | 1 | 31 | 41 | ||||||
133 | 44 | 1 | 62 | 49 |
1999 | 1999 | 1999 | 1999 | ||||
1 | 04 | 03 | 07 | ||||
2001 | 2001 | 2001 | 2001 | ||||
15 | 08 | 04 | 07 | ||||
2003 | 2003 | 2003 | 2003 | ||||
18 | 13 | 06 | 06 | ||||
2005 | 2005 | 2005 | 2005 | ||||
23 | 18 | 09 | 07 | ||||
2007 | 2007 | 2007 | 2007 | ||||
3 | 16 | 08 | 1 | ||||
2009 | 2009 | 2009 | 2009 | ||||
35 | 15 | 1 | 1 | ||||
2011 | 2011 | 2011 | 2011 | ||||
35 | 12 | 08 | 19 | ||||
2013 | 2013 | 2013 | 2013 | ||||
38 | 11 | 18 | 34 | ||||
2015 | 2015 | 2015 | 2015 | ||||
44 | 1 | 62 | 49 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosures
All plannersmanagers hereby state that they or their spouselife partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months
The following plannersmanagers have the following to disclose- Kelly J Clark MD MBA FASAM DFAPA ndash
Consulting fees Braeburn Indivior
Rx Summit wwwNationalRxDrugAbuseSummitorg
Learning Objectives
Describe the process to develop CDC and state case definitions
Identify patterns of recent nonfatal heroin and opioid drug overdoses across 12 states
Identify drugs involved in deaths and circumstances precipitating the deaths based on data
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
Puja Seth PhDAlana Vivolo-Kantor PhD
Julie OrsquoDonnell PhD
Division of Unintentional Injury PreventionCenters for Disease Control and Prevention
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Puja Seth PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Goals
Describe CDCrsquos new opioid overdose surveillance program Discuss how rapidly available data can be used to inform
overdose response and prevention efforts Overview of emergency department and emergency medical
services data for use in tracking opioid overdose trends Describe the development of case definitions for opioid and
heroin overdose in emergency department and emergency medical services data
Overview of data available for fatal opioid overdoses and associated risk factors and its use in informing prevention and response recommendations
Rx Summit wwwNationalRxDrugAbuseSummitorg
Opioid Overdoses Treated in Emergency Departments
Vivolo-Kantor AM Seth P Gladden RM Mattson CL Baldwin GT Kite-Powell A Coletta MA Vital Signs Trends in Emergency Department Visits for Suspected Opioid Overdoses mdash United States July 2016ndashSeptember 2017(httpswwwcdcgovmmwrvolumes67wrmm6709e1htm) MMWR Morb Mortal Wkly Rep201867
Rx Summit wwwNationalRxDrugAbuseSummitorg
Vivolo-Kantor AM Seth P Gladden RM Mattson CL Baldwin GT Kite-Powell A Coletta MA Vital Signs Trends in Emergency Department Visits for Suspected Opioid Overdoses mdash United States July 2016ndashSeptember 2017(httpswwwcdcgovmmwrvolumes67wrmm6709e1htm) MMWR Morb Mortal Wkly Rep201867
Rx Summit wwwNationalRxDrugAbuseSummitorg
2000 Rapid Increase in Drug Overdose Death Rates by County
SOURCE NCHS Data Visualization Gallery
Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery
2005 Rapid Increase in Drug Overdose Death Rates by County
Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery
2010 Rapid Increase in Drug Overdose Death Rates by County
Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery
2016 Rapid Increase in Drug Overdose Death Rates by County
Rx Summit wwwNationalRxDrugAbuseSummitorg
RISE IN OPIOID DEATHS
Overlapping Entangled but Distinct Epidemics
Natural and semi-synthetic opioidslike oxycodone or hydrocodone
Methadone
Heroin
SOURCE National Vital Statistics System Mortality File
Dea
ths
per 1
000
00 p
opul
atio
n
Rx Summit wwwNationalRxDrugAbuseSummitorg
CDCrsquos Pillars on Opioids Conducting surveillance and research
Building state local and tribal prevention efforts
Supporting healthcare providers and health systems
Partnering with public safety officials
Encouraging consumers to make safe choices about opioids raising awareness about prescription opioid misuse and overdose
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS) 12 states funded in September 2016 20 additional states and the
District of Columbia funded in September 2017 (through September 2019)
Strategy One Increase timeliness of non-fatal opioid overdose reporting- Use syndromic surveillance to establish an early warning system to
detect sharp increases or decreases in non-fatal opioid overdoses - Three indicators suspected all-drug opioid and heroin
Alaska California Connecticut Delaware DC Florida Georgia Illinois Indiana Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Nevada New Hampshire New Jersey New Mexico North Carolina Ohio Oklahoma Pennsylvania Rhode Island Tennessee Utah Vermont Virginia Washington West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS) Strategy Two Increase timeliness of fatal opioid overdose
reporting- Capture detailed information on toxicology death scene
investigations and other risk factors that may be associated with a fatal overdose
Strategy Three widespread dissemination- Rapidly disseminate surveillance findings to key stakeholders
working to prevent or respond to opioid overdoses
ESOOS program expansion in September 2017- At least 60 for comprehensive toxicology testing for opioid-
involved deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
Funded ESOOS states
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS)
Nonfatal Opioid Overdoses Reported
Quarterly
Emergency Department Visits EMS Transports
Fatal Opioid Overdoses Reported within 8 months
of death
Death CertificatesMEC reports
Toxicology reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
Next Two Presentationshellip
The Utilization of Emergency Department Syndromic Surveillance and Emergency Medical Services Data to Monitor Nonfatal Opioid Overdoses ndash Dr Alana Vivolo-Kantor
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System ndash Dr Julie OrsquoDonnell
Rx Summit wwwNationalRxDrugAbuseSummitorg
The utilization of emergency department syndromic surveillance
and emergency medical services data to monitor nonfatal opioid
overdosesPresenter Alana Vivolo-Kantor PhD
Behavioral ScientistCenters for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Julie OrsquoDonnell R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Alana Vivolo-Kantor PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Why Emergency Department and Emergency Medical Service Data for Surveillance
Need- Identify areas experiencing rapid increases in opioid overdoses to
inform responses- More quickly identify promising practices to reduce opioid overdoses
Proven utility to public health and scalable- Local jurisdictions already using it to track and respond to drug
overdoses- Findings from Epi-Aid investigations and collaborative work with states- Leverage existing state and national resources (BioSenseESSENCE)
Action at local and national level- Track quarterly trends across the nation to inform national policy- Improve more rapid local and state public health response
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our Philosophy
Focus on detecting change- Pushing system by looking at trend data over quarters- Some jurisdictions may be able to get and report preliminary
burden estimates
Jurisdiction-driven definitions will outperform national definitions- Local flexibility enhances quality and utility by accounting for large
variance in text entries and coding
National guidance- National definition will provide a good starting place- Guidance to encourage common conceptual definition (eg no
withdrawaldetox) and learn from previous work
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our approach
Non-fatal overdoses
Emergency Department
Near real-time ED collection (ie
syndromic ESSENCE)
Case-level or aggregate data shared
through ESSENCE (BioSense) or directly
with CDC
DischargeBilling Data
Case-level or aggregate data shared
directly with CDC
Emergency Medical Services
Case-level or aggregate data shared
directly with CDC
Includes breakdown by
sex age group and county of residence
Raceethnicity is optional
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency Department Data
Two sources- Near real-time syndromic data (visit information within 24-48 hours)- Lagged hospital billing or claims data (usually within 3-4 weeks)
Different variables used- Discharge diagnosis codes (eg ICD-10-CM) ndash available in billing
data and sometimes in syndromic- Free text fields (eg chief complaint provided by Doctor) ndash
available only in syndromic
Rx Summit wwwNationalRxDrugAbuseSummitorg
Case definitions for suspected overdose
If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED) and free text fields such as chief complaint or triage notes
- Free text searches use common terms slang and misspellings (eg herion instead of heroin)
If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED)
Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency medical services data
Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on
the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)
Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following
Naloxone administration)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Challenges in EMS data
Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp
v340)
Different case definitions in different versions
Missing data feeds
Not all EMS agencies share data
Varying time frame in when data is received- lt24 hours to 6 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Data submission process
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample quality control report
ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)
TOTAL ED VISITS (AGE)
1XX 2017 1 ED Visits mismatch 98287 98309
2XX 2017 2 ED Visits mismatch 98195 98230
3XX 2017 3 ED Visits mismatch 99167 99205
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample site report
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results All drug (11 sites)
0
10
20
30
40
50
60
70
80
90
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d al
l dru
g ov
erdo
se ra
tes
by
100
00 E
D v
isits
Quarter year
-2000
-1000
000
1000
2000
3000
4000
5000
6000
7000
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Opioid (11 sites)
0
5
10
15
20
25
30
35
40
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Heroin (11 sites)
0
5
10
15
20
25
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-15
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Column1 | Any opioid | Natural and semi-synthetic opioid analgesic | Methadone | Synthetic opioid analgesic excluding methadone | Heroin | ||||||
1999 | 1 | 03 | 03 | 07 | |||||||
21 | 1 | 04 | 03 | 07 | |||||||
2001 | 24 | 12 | 05 | 03 | 06 | ||||||
32 | 15 | 08 | 04 | 07 | |||||||
2003 | 35 | 17 | 1 | 05 | 07 | ||||||
39 | 18 | 13 | 06 | 06 | |||||||
2005 | 43 | 19 | 15 | 06 | 07 | ||||||
51 | 23 | 18 | 09 | 07 | |||||||
2007 | 54 | 27 | 18 | 07 | 08 | ||||||
57 | 3 | 16 | 08 | 1 | |||||||
2009 | 59 | 31 | 15 | 1 | 11 | ||||||
62 | 35 | 15 | 1 | 1 | |||||||
2011 | 66 | 37 | 14 | 08 | 14 | ||||||
67 | 35 | 12 | 08 | 19 | |||||||
2013 | 74 | 35 | 11 | 1 | 27 | ||||||
86 | 38 | 11 | 18 | 34 | |||||||
2015 | 104 | 39 | 1 | 31 | 41 | ||||||
133 | 44 | 1 | 62 | 49 |
1999 | 1999 | 1999 | 1999 | ||||
1 | 04 | 03 | 07 | ||||
2001 | 2001 | 2001 | 2001 | ||||
15 | 08 | 04 | 07 | ||||
2003 | 2003 | 2003 | 2003 | ||||
18 | 13 | 06 | 06 | ||||
2005 | 2005 | 2005 | 2005 | ||||
23 | 18 | 09 | 07 | ||||
2007 | 2007 | 2007 | 2007 | ||||
3 | 16 | 08 | 1 | ||||
2009 | 2009 | 2009 | 2009 | ||||
35 | 15 | 1 | 1 | ||||
2011 | 2011 | 2011 | 2011 | ||||
35 | 12 | 08 | 19 | ||||
2013 | 2013 | 2013 | 2013 | ||||
38 | 11 | 18 | 34 | ||||
2015 | 2015 | 2015 | 2015 | ||||
44 | 1 | 62 | 49 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Learning Objectives
Describe the process to develop CDC and state case definitions
Identify patterns of recent nonfatal heroin and opioid drug overdoses across 12 states
Identify drugs involved in deaths and circumstances precipitating the deaths based on data
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
Puja Seth PhDAlana Vivolo-Kantor PhD
Julie OrsquoDonnell PhD
Division of Unintentional Injury PreventionCenters for Disease Control and Prevention
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Puja Seth PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Goals
Describe CDCrsquos new opioid overdose surveillance program Discuss how rapidly available data can be used to inform
overdose response and prevention efforts Overview of emergency department and emergency medical
services data for use in tracking opioid overdose trends Describe the development of case definitions for opioid and
heroin overdose in emergency department and emergency medical services data
Overview of data available for fatal opioid overdoses and associated risk factors and its use in informing prevention and response recommendations
Rx Summit wwwNationalRxDrugAbuseSummitorg
Opioid Overdoses Treated in Emergency Departments
Vivolo-Kantor AM Seth P Gladden RM Mattson CL Baldwin GT Kite-Powell A Coletta MA Vital Signs Trends in Emergency Department Visits for Suspected Opioid Overdoses mdash United States July 2016ndashSeptember 2017(httpswwwcdcgovmmwrvolumes67wrmm6709e1htm) MMWR Morb Mortal Wkly Rep201867
Rx Summit wwwNationalRxDrugAbuseSummitorg
Vivolo-Kantor AM Seth P Gladden RM Mattson CL Baldwin GT Kite-Powell A Coletta MA Vital Signs Trends in Emergency Department Visits for Suspected Opioid Overdoses mdash United States July 2016ndashSeptember 2017(httpswwwcdcgovmmwrvolumes67wrmm6709e1htm) MMWR Morb Mortal Wkly Rep201867
Rx Summit wwwNationalRxDrugAbuseSummitorg
2000 Rapid Increase in Drug Overdose Death Rates by County
SOURCE NCHS Data Visualization Gallery
Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery
2005 Rapid Increase in Drug Overdose Death Rates by County
Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery
2010 Rapid Increase in Drug Overdose Death Rates by County
Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery
2016 Rapid Increase in Drug Overdose Death Rates by County
Rx Summit wwwNationalRxDrugAbuseSummitorg
RISE IN OPIOID DEATHS
Overlapping Entangled but Distinct Epidemics
Natural and semi-synthetic opioidslike oxycodone or hydrocodone
Methadone
Heroin
SOURCE National Vital Statistics System Mortality File
Dea
ths
per 1
000
00 p
opul
atio
n
Rx Summit wwwNationalRxDrugAbuseSummitorg
CDCrsquos Pillars on Opioids Conducting surveillance and research
Building state local and tribal prevention efforts
Supporting healthcare providers and health systems
Partnering with public safety officials
Encouraging consumers to make safe choices about opioids raising awareness about prescription opioid misuse and overdose
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS) 12 states funded in September 2016 20 additional states and the
District of Columbia funded in September 2017 (through September 2019)
Strategy One Increase timeliness of non-fatal opioid overdose reporting- Use syndromic surveillance to establish an early warning system to
detect sharp increases or decreases in non-fatal opioid overdoses - Three indicators suspected all-drug opioid and heroin
Alaska California Connecticut Delaware DC Florida Georgia Illinois Indiana Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Nevada New Hampshire New Jersey New Mexico North Carolina Ohio Oklahoma Pennsylvania Rhode Island Tennessee Utah Vermont Virginia Washington West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS) Strategy Two Increase timeliness of fatal opioid overdose
reporting- Capture detailed information on toxicology death scene
investigations and other risk factors that may be associated with a fatal overdose
Strategy Three widespread dissemination- Rapidly disseminate surveillance findings to key stakeholders
working to prevent or respond to opioid overdoses
ESOOS program expansion in September 2017- At least 60 for comprehensive toxicology testing for opioid-
involved deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
Funded ESOOS states
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS)
Nonfatal Opioid Overdoses Reported
Quarterly
Emergency Department Visits EMS Transports
Fatal Opioid Overdoses Reported within 8 months
of death
Death CertificatesMEC reports
Toxicology reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
Next Two Presentationshellip
The Utilization of Emergency Department Syndromic Surveillance and Emergency Medical Services Data to Monitor Nonfatal Opioid Overdoses ndash Dr Alana Vivolo-Kantor
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System ndash Dr Julie OrsquoDonnell
Rx Summit wwwNationalRxDrugAbuseSummitorg
The utilization of emergency department syndromic surveillance
and emergency medical services data to monitor nonfatal opioid
overdosesPresenter Alana Vivolo-Kantor PhD
Behavioral ScientistCenters for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Julie OrsquoDonnell R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Alana Vivolo-Kantor PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Why Emergency Department and Emergency Medical Service Data for Surveillance
Need- Identify areas experiencing rapid increases in opioid overdoses to
inform responses- More quickly identify promising practices to reduce opioid overdoses
Proven utility to public health and scalable- Local jurisdictions already using it to track and respond to drug
overdoses- Findings from Epi-Aid investigations and collaborative work with states- Leverage existing state and national resources (BioSenseESSENCE)
Action at local and national level- Track quarterly trends across the nation to inform national policy- Improve more rapid local and state public health response
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our Philosophy
Focus on detecting change- Pushing system by looking at trend data over quarters- Some jurisdictions may be able to get and report preliminary
burden estimates
Jurisdiction-driven definitions will outperform national definitions- Local flexibility enhances quality and utility by accounting for large
variance in text entries and coding
National guidance- National definition will provide a good starting place- Guidance to encourage common conceptual definition (eg no
withdrawaldetox) and learn from previous work
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our approach
Non-fatal overdoses
Emergency Department
Near real-time ED collection (ie
syndromic ESSENCE)
Case-level or aggregate data shared
through ESSENCE (BioSense) or directly
with CDC
DischargeBilling Data
Case-level or aggregate data shared
directly with CDC
Emergency Medical Services
Case-level or aggregate data shared
directly with CDC
Includes breakdown by
sex age group and county of residence
Raceethnicity is optional
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency Department Data
Two sources- Near real-time syndromic data (visit information within 24-48 hours)- Lagged hospital billing or claims data (usually within 3-4 weeks)
Different variables used- Discharge diagnosis codes (eg ICD-10-CM) ndash available in billing
data and sometimes in syndromic- Free text fields (eg chief complaint provided by Doctor) ndash
available only in syndromic
Rx Summit wwwNationalRxDrugAbuseSummitorg
Case definitions for suspected overdose
If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED) and free text fields such as chief complaint or triage notes
- Free text searches use common terms slang and misspellings (eg herion instead of heroin)
If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED)
Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency medical services data
Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on
the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)
Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following
Naloxone administration)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Challenges in EMS data
Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp
v340)
Different case definitions in different versions
Missing data feeds
Not all EMS agencies share data
Varying time frame in when data is received- lt24 hours to 6 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Data submission process
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample quality control report
ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)
TOTAL ED VISITS (AGE)
1XX 2017 1 ED Visits mismatch 98287 98309
2XX 2017 2 ED Visits mismatch 98195 98230
3XX 2017 3 ED Visits mismatch 99167 99205
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample site report
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results All drug (11 sites)
0
10
20
30
40
50
60
70
80
90
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d al
l dru
g ov
erdo
se ra
tes
by
100
00 E
D v
isits
Quarter year
-2000
-1000
000
1000
2000
3000
4000
5000
6000
7000
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Opioid (11 sites)
0
5
10
15
20
25
30
35
40
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Heroin (11 sites)
0
5
10
15
20
25
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-15
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Column1 | Any opioid | Natural and semi-synthetic opioid analgesic | Methadone | Synthetic opioid analgesic excluding methadone | Heroin | ||||||
1999 | 1 | 03 | 03 | 07 | |||||||
21 | 1 | 04 | 03 | 07 | |||||||
2001 | 24 | 12 | 05 | 03 | 06 | ||||||
32 | 15 | 08 | 04 | 07 | |||||||
2003 | 35 | 17 | 1 | 05 | 07 | ||||||
39 | 18 | 13 | 06 | 06 | |||||||
2005 | 43 | 19 | 15 | 06 | 07 | ||||||
51 | 23 | 18 | 09 | 07 | |||||||
2007 | 54 | 27 | 18 | 07 | 08 | ||||||
57 | 3 | 16 | 08 | 1 | |||||||
2009 | 59 | 31 | 15 | 1 | 11 | ||||||
62 | 35 | 15 | 1 | 1 | |||||||
2011 | 66 | 37 | 14 | 08 | 14 | ||||||
67 | 35 | 12 | 08 | 19 | |||||||
2013 | 74 | 35 | 11 | 1 | 27 | ||||||
86 | 38 | 11 | 18 | 34 | |||||||
2015 | 104 | 39 | 1 | 31 | 41 | ||||||
133 | 44 | 1 | 62 | 49 |
1999 | 1999 | 1999 | 1999 | ||||
1 | 04 | 03 | 07 | ||||
2001 | 2001 | 2001 | 2001 | ||||
15 | 08 | 04 | 07 | ||||
2003 | 2003 | 2003 | 2003 | ||||
18 | 13 | 06 | 06 | ||||
2005 | 2005 | 2005 | 2005 | ||||
23 | 18 | 09 | 07 | ||||
2007 | 2007 | 2007 | 2007 | ||||
3 | 16 | 08 | 1 | ||||
2009 | 2009 | 2009 | 2009 | ||||
35 | 15 | 1 | 1 | ||||
2011 | 2011 | 2011 | 2011 | ||||
35 | 12 | 08 | 19 | ||||
2013 | 2013 | 2013 | 2013 | ||||
38 | 11 | 18 | 34 | ||||
2015 | 2015 | 2015 | 2015 | ||||
44 | 1 | 62 | 49 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
Puja Seth PhDAlana Vivolo-Kantor PhD
Julie OrsquoDonnell PhD
Division of Unintentional Injury PreventionCenters for Disease Control and Prevention
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Puja Seth PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Goals
Describe CDCrsquos new opioid overdose surveillance program Discuss how rapidly available data can be used to inform
overdose response and prevention efforts Overview of emergency department and emergency medical
services data for use in tracking opioid overdose trends Describe the development of case definitions for opioid and
heroin overdose in emergency department and emergency medical services data
Overview of data available for fatal opioid overdoses and associated risk factors and its use in informing prevention and response recommendations
Rx Summit wwwNationalRxDrugAbuseSummitorg
Opioid Overdoses Treated in Emergency Departments
Vivolo-Kantor AM Seth P Gladden RM Mattson CL Baldwin GT Kite-Powell A Coletta MA Vital Signs Trends in Emergency Department Visits for Suspected Opioid Overdoses mdash United States July 2016ndashSeptember 2017(httpswwwcdcgovmmwrvolumes67wrmm6709e1htm) MMWR Morb Mortal Wkly Rep201867
Rx Summit wwwNationalRxDrugAbuseSummitorg
Vivolo-Kantor AM Seth P Gladden RM Mattson CL Baldwin GT Kite-Powell A Coletta MA Vital Signs Trends in Emergency Department Visits for Suspected Opioid Overdoses mdash United States July 2016ndashSeptember 2017(httpswwwcdcgovmmwrvolumes67wrmm6709e1htm) MMWR Morb Mortal Wkly Rep201867
Rx Summit wwwNationalRxDrugAbuseSummitorg
2000 Rapid Increase in Drug Overdose Death Rates by County
SOURCE NCHS Data Visualization Gallery
Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery
2005 Rapid Increase in Drug Overdose Death Rates by County
Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery
2010 Rapid Increase in Drug Overdose Death Rates by County
Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery
2016 Rapid Increase in Drug Overdose Death Rates by County
Rx Summit wwwNationalRxDrugAbuseSummitorg
RISE IN OPIOID DEATHS
Overlapping Entangled but Distinct Epidemics
Natural and semi-synthetic opioidslike oxycodone or hydrocodone
Methadone
Heroin
SOURCE National Vital Statistics System Mortality File
Dea
ths
per 1
000
00 p
opul
atio
n
Rx Summit wwwNationalRxDrugAbuseSummitorg
CDCrsquos Pillars on Opioids Conducting surveillance and research
Building state local and tribal prevention efforts
Supporting healthcare providers and health systems
Partnering with public safety officials
Encouraging consumers to make safe choices about opioids raising awareness about prescription opioid misuse and overdose
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS) 12 states funded in September 2016 20 additional states and the
District of Columbia funded in September 2017 (through September 2019)
Strategy One Increase timeliness of non-fatal opioid overdose reporting- Use syndromic surveillance to establish an early warning system to
detect sharp increases or decreases in non-fatal opioid overdoses - Three indicators suspected all-drug opioid and heroin
Alaska California Connecticut Delaware DC Florida Georgia Illinois Indiana Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Nevada New Hampshire New Jersey New Mexico North Carolina Ohio Oklahoma Pennsylvania Rhode Island Tennessee Utah Vermont Virginia Washington West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS) Strategy Two Increase timeliness of fatal opioid overdose
reporting- Capture detailed information on toxicology death scene
investigations and other risk factors that may be associated with a fatal overdose
Strategy Three widespread dissemination- Rapidly disseminate surveillance findings to key stakeholders
working to prevent or respond to opioid overdoses
ESOOS program expansion in September 2017- At least 60 for comprehensive toxicology testing for opioid-
involved deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
Funded ESOOS states
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS)
Nonfatal Opioid Overdoses Reported
Quarterly
Emergency Department Visits EMS Transports
Fatal Opioid Overdoses Reported within 8 months
of death
Death CertificatesMEC reports
Toxicology reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
Next Two Presentationshellip
The Utilization of Emergency Department Syndromic Surveillance and Emergency Medical Services Data to Monitor Nonfatal Opioid Overdoses ndash Dr Alana Vivolo-Kantor
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System ndash Dr Julie OrsquoDonnell
Rx Summit wwwNationalRxDrugAbuseSummitorg
The utilization of emergency department syndromic surveillance
and emergency medical services data to monitor nonfatal opioid
overdosesPresenter Alana Vivolo-Kantor PhD
Behavioral ScientistCenters for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Julie OrsquoDonnell R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Alana Vivolo-Kantor PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Why Emergency Department and Emergency Medical Service Data for Surveillance
Need- Identify areas experiencing rapid increases in opioid overdoses to
inform responses- More quickly identify promising practices to reduce opioid overdoses
Proven utility to public health and scalable- Local jurisdictions already using it to track and respond to drug
overdoses- Findings from Epi-Aid investigations and collaborative work with states- Leverage existing state and national resources (BioSenseESSENCE)
Action at local and national level- Track quarterly trends across the nation to inform national policy- Improve more rapid local and state public health response
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our Philosophy
Focus on detecting change- Pushing system by looking at trend data over quarters- Some jurisdictions may be able to get and report preliminary
burden estimates
Jurisdiction-driven definitions will outperform national definitions- Local flexibility enhances quality and utility by accounting for large
variance in text entries and coding
National guidance- National definition will provide a good starting place- Guidance to encourage common conceptual definition (eg no
withdrawaldetox) and learn from previous work
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our approach
Non-fatal overdoses
Emergency Department
Near real-time ED collection (ie
syndromic ESSENCE)
Case-level or aggregate data shared
through ESSENCE (BioSense) or directly
with CDC
DischargeBilling Data
Case-level or aggregate data shared
directly with CDC
Emergency Medical Services
Case-level or aggregate data shared
directly with CDC
Includes breakdown by
sex age group and county of residence
Raceethnicity is optional
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency Department Data
Two sources- Near real-time syndromic data (visit information within 24-48 hours)- Lagged hospital billing or claims data (usually within 3-4 weeks)
Different variables used- Discharge diagnosis codes (eg ICD-10-CM) ndash available in billing
data and sometimes in syndromic- Free text fields (eg chief complaint provided by Doctor) ndash
available only in syndromic
Rx Summit wwwNationalRxDrugAbuseSummitorg
Case definitions for suspected overdose
If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED) and free text fields such as chief complaint or triage notes
- Free text searches use common terms slang and misspellings (eg herion instead of heroin)
If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED)
Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency medical services data
Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on
the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)
Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following
Naloxone administration)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Challenges in EMS data
Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp
v340)
Different case definitions in different versions
Missing data feeds
Not all EMS agencies share data
Varying time frame in when data is received- lt24 hours to 6 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Data submission process
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample quality control report
ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)
TOTAL ED VISITS (AGE)
1XX 2017 1 ED Visits mismatch 98287 98309
2XX 2017 2 ED Visits mismatch 98195 98230
3XX 2017 3 ED Visits mismatch 99167 99205
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample site report
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results All drug (11 sites)
0
10
20
30
40
50
60
70
80
90
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d al
l dru
g ov
erdo
se ra
tes
by
100
00 E
D v
isits
Quarter year
-2000
-1000
000
1000
2000
3000
4000
5000
6000
7000
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Opioid (11 sites)
0
5
10
15
20
25
30
35
40
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Heroin (11 sites)
0
5
10
15
20
25
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-15
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Column1 | Any opioid | Natural and semi-synthetic opioid analgesic | Methadone | Synthetic opioid analgesic excluding methadone | Heroin | ||||||
1999 | 1 | 03 | 03 | 07 | |||||||
21 | 1 | 04 | 03 | 07 | |||||||
2001 | 24 | 12 | 05 | 03 | 06 | ||||||
32 | 15 | 08 | 04 | 07 | |||||||
2003 | 35 | 17 | 1 | 05 | 07 | ||||||
39 | 18 | 13 | 06 | 06 | |||||||
2005 | 43 | 19 | 15 | 06 | 07 | ||||||
51 | 23 | 18 | 09 | 07 | |||||||
2007 | 54 | 27 | 18 | 07 | 08 | ||||||
57 | 3 | 16 | 08 | 1 | |||||||
2009 | 59 | 31 | 15 | 1 | 11 | ||||||
62 | 35 | 15 | 1 | 1 | |||||||
2011 | 66 | 37 | 14 | 08 | 14 | ||||||
67 | 35 | 12 | 08 | 19 | |||||||
2013 | 74 | 35 | 11 | 1 | 27 | ||||||
86 | 38 | 11 | 18 | 34 | |||||||
2015 | 104 | 39 | 1 | 31 | 41 | ||||||
133 | 44 | 1 | 62 | 49 |
1999 | 1999 | 1999 | 1999 | ||||
1 | 04 | 03 | 07 | ||||
2001 | 2001 | 2001 | 2001 | ||||
15 | 08 | 04 | 07 | ||||
2003 | 2003 | 2003 | 2003 | ||||
18 | 13 | 06 | 06 | ||||
2005 | 2005 | 2005 | 2005 | ||||
23 | 18 | 09 | 07 | ||||
2007 | 2007 | 2007 | 2007 | ||||
3 | 16 | 08 | 1 | ||||
2009 | 2009 | 2009 | 2009 | ||||
35 | 15 | 1 | 1 | ||||
2011 | 2011 | 2011 | 2011 | ||||
35 | 12 | 08 | 19 | ||||
2013 | 2013 | 2013 | 2013 | ||||
38 | 11 | 18 | 34 | ||||
2015 | 2015 | 2015 | 2015 | ||||
44 | 1 | 62 | 49 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Puja Seth PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Goals
Describe CDCrsquos new opioid overdose surveillance program Discuss how rapidly available data can be used to inform
overdose response and prevention efforts Overview of emergency department and emergency medical
services data for use in tracking opioid overdose trends Describe the development of case definitions for opioid and
heroin overdose in emergency department and emergency medical services data
Overview of data available for fatal opioid overdoses and associated risk factors and its use in informing prevention and response recommendations
Rx Summit wwwNationalRxDrugAbuseSummitorg
Opioid Overdoses Treated in Emergency Departments
Vivolo-Kantor AM Seth P Gladden RM Mattson CL Baldwin GT Kite-Powell A Coletta MA Vital Signs Trends in Emergency Department Visits for Suspected Opioid Overdoses mdash United States July 2016ndashSeptember 2017(httpswwwcdcgovmmwrvolumes67wrmm6709e1htm) MMWR Morb Mortal Wkly Rep201867
Rx Summit wwwNationalRxDrugAbuseSummitorg
Vivolo-Kantor AM Seth P Gladden RM Mattson CL Baldwin GT Kite-Powell A Coletta MA Vital Signs Trends in Emergency Department Visits for Suspected Opioid Overdoses mdash United States July 2016ndashSeptember 2017(httpswwwcdcgovmmwrvolumes67wrmm6709e1htm) MMWR Morb Mortal Wkly Rep201867
Rx Summit wwwNationalRxDrugAbuseSummitorg
2000 Rapid Increase in Drug Overdose Death Rates by County
SOURCE NCHS Data Visualization Gallery
Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery
2005 Rapid Increase in Drug Overdose Death Rates by County
Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery
2010 Rapid Increase in Drug Overdose Death Rates by County
Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery
2016 Rapid Increase in Drug Overdose Death Rates by County
Rx Summit wwwNationalRxDrugAbuseSummitorg
RISE IN OPIOID DEATHS
Overlapping Entangled but Distinct Epidemics
Natural and semi-synthetic opioidslike oxycodone or hydrocodone
Methadone
Heroin
SOURCE National Vital Statistics System Mortality File
Dea
ths
per 1
000
00 p
opul
atio
n
Rx Summit wwwNationalRxDrugAbuseSummitorg
CDCrsquos Pillars on Opioids Conducting surveillance and research
Building state local and tribal prevention efforts
Supporting healthcare providers and health systems
Partnering with public safety officials
Encouraging consumers to make safe choices about opioids raising awareness about prescription opioid misuse and overdose
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS) 12 states funded in September 2016 20 additional states and the
District of Columbia funded in September 2017 (through September 2019)
Strategy One Increase timeliness of non-fatal opioid overdose reporting- Use syndromic surveillance to establish an early warning system to
detect sharp increases or decreases in non-fatal opioid overdoses - Three indicators suspected all-drug opioid and heroin
Alaska California Connecticut Delaware DC Florida Georgia Illinois Indiana Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Nevada New Hampshire New Jersey New Mexico North Carolina Ohio Oklahoma Pennsylvania Rhode Island Tennessee Utah Vermont Virginia Washington West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS) Strategy Two Increase timeliness of fatal opioid overdose
reporting- Capture detailed information on toxicology death scene
investigations and other risk factors that may be associated with a fatal overdose
Strategy Three widespread dissemination- Rapidly disseminate surveillance findings to key stakeholders
working to prevent or respond to opioid overdoses
ESOOS program expansion in September 2017- At least 60 for comprehensive toxicology testing for opioid-
involved deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
Funded ESOOS states
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS)
Nonfatal Opioid Overdoses Reported
Quarterly
Emergency Department Visits EMS Transports
Fatal Opioid Overdoses Reported within 8 months
of death
Death CertificatesMEC reports
Toxicology reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
Next Two Presentationshellip
The Utilization of Emergency Department Syndromic Surveillance and Emergency Medical Services Data to Monitor Nonfatal Opioid Overdoses ndash Dr Alana Vivolo-Kantor
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System ndash Dr Julie OrsquoDonnell
Rx Summit wwwNationalRxDrugAbuseSummitorg
The utilization of emergency department syndromic surveillance
and emergency medical services data to monitor nonfatal opioid
overdosesPresenter Alana Vivolo-Kantor PhD
Behavioral ScientistCenters for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Julie OrsquoDonnell R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Alana Vivolo-Kantor PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Why Emergency Department and Emergency Medical Service Data for Surveillance
Need- Identify areas experiencing rapid increases in opioid overdoses to
inform responses- More quickly identify promising practices to reduce opioid overdoses
Proven utility to public health and scalable- Local jurisdictions already using it to track and respond to drug
overdoses- Findings from Epi-Aid investigations and collaborative work with states- Leverage existing state and national resources (BioSenseESSENCE)
Action at local and national level- Track quarterly trends across the nation to inform national policy- Improve more rapid local and state public health response
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our Philosophy
Focus on detecting change- Pushing system by looking at trend data over quarters- Some jurisdictions may be able to get and report preliminary
burden estimates
Jurisdiction-driven definitions will outperform national definitions- Local flexibility enhances quality and utility by accounting for large
variance in text entries and coding
National guidance- National definition will provide a good starting place- Guidance to encourage common conceptual definition (eg no
withdrawaldetox) and learn from previous work
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our approach
Non-fatal overdoses
Emergency Department
Near real-time ED collection (ie
syndromic ESSENCE)
Case-level or aggregate data shared
through ESSENCE (BioSense) or directly
with CDC
DischargeBilling Data
Case-level or aggregate data shared
directly with CDC
Emergency Medical Services
Case-level or aggregate data shared
directly with CDC
Includes breakdown by
sex age group and county of residence
Raceethnicity is optional
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency Department Data
Two sources- Near real-time syndromic data (visit information within 24-48 hours)- Lagged hospital billing or claims data (usually within 3-4 weeks)
Different variables used- Discharge diagnosis codes (eg ICD-10-CM) ndash available in billing
data and sometimes in syndromic- Free text fields (eg chief complaint provided by Doctor) ndash
available only in syndromic
Rx Summit wwwNationalRxDrugAbuseSummitorg
Case definitions for suspected overdose
If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED) and free text fields such as chief complaint or triage notes
- Free text searches use common terms slang and misspellings (eg herion instead of heroin)
If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED)
Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency medical services data
Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on
the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)
Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following
Naloxone administration)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Challenges in EMS data
Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp
v340)
Different case definitions in different versions
Missing data feeds
Not all EMS agencies share data
Varying time frame in when data is received- lt24 hours to 6 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Data submission process
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample quality control report
ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)
TOTAL ED VISITS (AGE)
1XX 2017 1 ED Visits mismatch 98287 98309
2XX 2017 2 ED Visits mismatch 98195 98230
3XX 2017 3 ED Visits mismatch 99167 99205
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample site report
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results All drug (11 sites)
0
10
20
30
40
50
60
70
80
90
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d al
l dru
g ov
erdo
se ra
tes
by
100
00 E
D v
isits
Quarter year
-2000
-1000
000
1000
2000
3000
4000
5000
6000
7000
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Opioid (11 sites)
0
5
10
15
20
25
30
35
40
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Heroin (11 sites)
0
5
10
15
20
25
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-15
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Column1 | Any opioid | Natural and semi-synthetic opioid analgesic | Methadone | Synthetic opioid analgesic excluding methadone | Heroin | ||||||
1999 | 1 | 03 | 03 | 07 | |||||||
21 | 1 | 04 | 03 | 07 | |||||||
2001 | 24 | 12 | 05 | 03 | 06 | ||||||
32 | 15 | 08 | 04 | 07 | |||||||
2003 | 35 | 17 | 1 | 05 | 07 | ||||||
39 | 18 | 13 | 06 | 06 | |||||||
2005 | 43 | 19 | 15 | 06 | 07 | ||||||
51 | 23 | 18 | 09 | 07 | |||||||
2007 | 54 | 27 | 18 | 07 | 08 | ||||||
57 | 3 | 16 | 08 | 1 | |||||||
2009 | 59 | 31 | 15 | 1 | 11 | ||||||
62 | 35 | 15 | 1 | 1 | |||||||
2011 | 66 | 37 | 14 | 08 | 14 | ||||||
67 | 35 | 12 | 08 | 19 | |||||||
2013 | 74 | 35 | 11 | 1 | 27 | ||||||
86 | 38 | 11 | 18 | 34 | |||||||
2015 | 104 | 39 | 1 | 31 | 41 | ||||||
133 | 44 | 1 | 62 | 49 |
1999 | 1999 | 1999 | 1999 | ||||
1 | 04 | 03 | 07 | ||||
2001 | 2001 | 2001 | 2001 | ||||
15 | 08 | 04 | 07 | ||||
2003 | 2003 | 2003 | 2003 | ||||
18 | 13 | 06 | 06 | ||||
2005 | 2005 | 2005 | 2005 | ||||
23 | 18 | 09 | 07 | ||||
2007 | 2007 | 2007 | 2007 | ||||
3 | 16 | 08 | 1 | ||||
2009 | 2009 | 2009 | 2009 | ||||
35 | 15 | 1 | 1 | ||||
2011 | 2011 | 2011 | 2011 | ||||
35 | 12 | 08 | 19 | ||||
2013 | 2013 | 2013 | 2013 | ||||
38 | 11 | 18 | 34 | ||||
2015 | 2015 | 2015 | 2015 | ||||
44 | 1 | 62 | 49 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Goals
Describe CDCrsquos new opioid overdose surveillance program Discuss how rapidly available data can be used to inform
overdose response and prevention efforts Overview of emergency department and emergency medical
services data for use in tracking opioid overdose trends Describe the development of case definitions for opioid and
heroin overdose in emergency department and emergency medical services data
Overview of data available for fatal opioid overdoses and associated risk factors and its use in informing prevention and response recommendations
Rx Summit wwwNationalRxDrugAbuseSummitorg
Opioid Overdoses Treated in Emergency Departments
Vivolo-Kantor AM Seth P Gladden RM Mattson CL Baldwin GT Kite-Powell A Coletta MA Vital Signs Trends in Emergency Department Visits for Suspected Opioid Overdoses mdash United States July 2016ndashSeptember 2017(httpswwwcdcgovmmwrvolumes67wrmm6709e1htm) MMWR Morb Mortal Wkly Rep201867
Rx Summit wwwNationalRxDrugAbuseSummitorg
Vivolo-Kantor AM Seth P Gladden RM Mattson CL Baldwin GT Kite-Powell A Coletta MA Vital Signs Trends in Emergency Department Visits for Suspected Opioid Overdoses mdash United States July 2016ndashSeptember 2017(httpswwwcdcgovmmwrvolumes67wrmm6709e1htm) MMWR Morb Mortal Wkly Rep201867
Rx Summit wwwNationalRxDrugAbuseSummitorg
2000 Rapid Increase in Drug Overdose Death Rates by County
SOURCE NCHS Data Visualization Gallery
Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery
2005 Rapid Increase in Drug Overdose Death Rates by County
Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery
2010 Rapid Increase in Drug Overdose Death Rates by County
Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery
2016 Rapid Increase in Drug Overdose Death Rates by County
Rx Summit wwwNationalRxDrugAbuseSummitorg
RISE IN OPIOID DEATHS
Overlapping Entangled but Distinct Epidemics
Natural and semi-synthetic opioidslike oxycodone or hydrocodone
Methadone
Heroin
SOURCE National Vital Statistics System Mortality File
Dea
ths
per 1
000
00 p
opul
atio
n
Rx Summit wwwNationalRxDrugAbuseSummitorg
CDCrsquos Pillars on Opioids Conducting surveillance and research
Building state local and tribal prevention efforts
Supporting healthcare providers and health systems
Partnering with public safety officials
Encouraging consumers to make safe choices about opioids raising awareness about prescription opioid misuse and overdose
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS) 12 states funded in September 2016 20 additional states and the
District of Columbia funded in September 2017 (through September 2019)
Strategy One Increase timeliness of non-fatal opioid overdose reporting- Use syndromic surveillance to establish an early warning system to
detect sharp increases or decreases in non-fatal opioid overdoses - Three indicators suspected all-drug opioid and heroin
Alaska California Connecticut Delaware DC Florida Georgia Illinois Indiana Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Nevada New Hampshire New Jersey New Mexico North Carolina Ohio Oklahoma Pennsylvania Rhode Island Tennessee Utah Vermont Virginia Washington West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS) Strategy Two Increase timeliness of fatal opioid overdose
reporting- Capture detailed information on toxicology death scene
investigations and other risk factors that may be associated with a fatal overdose
Strategy Three widespread dissemination- Rapidly disseminate surveillance findings to key stakeholders
working to prevent or respond to opioid overdoses
ESOOS program expansion in September 2017- At least 60 for comprehensive toxicology testing for opioid-
involved deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
Funded ESOOS states
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS)
Nonfatal Opioid Overdoses Reported
Quarterly
Emergency Department Visits EMS Transports
Fatal Opioid Overdoses Reported within 8 months
of death
Death CertificatesMEC reports
Toxicology reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
Next Two Presentationshellip
The Utilization of Emergency Department Syndromic Surveillance and Emergency Medical Services Data to Monitor Nonfatal Opioid Overdoses ndash Dr Alana Vivolo-Kantor
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System ndash Dr Julie OrsquoDonnell
Rx Summit wwwNationalRxDrugAbuseSummitorg
The utilization of emergency department syndromic surveillance
and emergency medical services data to monitor nonfatal opioid
overdosesPresenter Alana Vivolo-Kantor PhD
Behavioral ScientistCenters for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Julie OrsquoDonnell R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Alana Vivolo-Kantor PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Why Emergency Department and Emergency Medical Service Data for Surveillance
Need- Identify areas experiencing rapid increases in opioid overdoses to
inform responses- More quickly identify promising practices to reduce opioid overdoses
Proven utility to public health and scalable- Local jurisdictions already using it to track and respond to drug
overdoses- Findings from Epi-Aid investigations and collaborative work with states- Leverage existing state and national resources (BioSenseESSENCE)
Action at local and national level- Track quarterly trends across the nation to inform national policy- Improve more rapid local and state public health response
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our Philosophy
Focus on detecting change- Pushing system by looking at trend data over quarters- Some jurisdictions may be able to get and report preliminary
burden estimates
Jurisdiction-driven definitions will outperform national definitions- Local flexibility enhances quality and utility by accounting for large
variance in text entries and coding
National guidance- National definition will provide a good starting place- Guidance to encourage common conceptual definition (eg no
withdrawaldetox) and learn from previous work
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our approach
Non-fatal overdoses
Emergency Department
Near real-time ED collection (ie
syndromic ESSENCE)
Case-level or aggregate data shared
through ESSENCE (BioSense) or directly
with CDC
DischargeBilling Data
Case-level or aggregate data shared
directly with CDC
Emergency Medical Services
Case-level or aggregate data shared
directly with CDC
Includes breakdown by
sex age group and county of residence
Raceethnicity is optional
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency Department Data
Two sources- Near real-time syndromic data (visit information within 24-48 hours)- Lagged hospital billing or claims data (usually within 3-4 weeks)
Different variables used- Discharge diagnosis codes (eg ICD-10-CM) ndash available in billing
data and sometimes in syndromic- Free text fields (eg chief complaint provided by Doctor) ndash
available only in syndromic
Rx Summit wwwNationalRxDrugAbuseSummitorg
Case definitions for suspected overdose
If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED) and free text fields such as chief complaint or triage notes
- Free text searches use common terms slang and misspellings (eg herion instead of heroin)
If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED)
Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency medical services data
Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on
the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)
Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following
Naloxone administration)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Challenges in EMS data
Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp
v340)
Different case definitions in different versions
Missing data feeds
Not all EMS agencies share data
Varying time frame in when data is received- lt24 hours to 6 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Data submission process
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample quality control report
ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)
TOTAL ED VISITS (AGE)
1XX 2017 1 ED Visits mismatch 98287 98309
2XX 2017 2 ED Visits mismatch 98195 98230
3XX 2017 3 ED Visits mismatch 99167 99205
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample site report
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results All drug (11 sites)
0
10
20
30
40
50
60
70
80
90
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d al
l dru
g ov
erdo
se ra
tes
by
100
00 E
D v
isits
Quarter year
-2000
-1000
000
1000
2000
3000
4000
5000
6000
7000
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Opioid (11 sites)
0
5
10
15
20
25
30
35
40
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Heroin (11 sites)
0
5
10
15
20
25
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-15
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Column1 | Any opioid | Natural and semi-synthetic opioid analgesic | Methadone | Synthetic opioid analgesic excluding methadone | Heroin | ||||||
1999 | 1 | 03 | 03 | 07 | |||||||
21 | 1 | 04 | 03 | 07 | |||||||
2001 | 24 | 12 | 05 | 03 | 06 | ||||||
32 | 15 | 08 | 04 | 07 | |||||||
2003 | 35 | 17 | 1 | 05 | 07 | ||||||
39 | 18 | 13 | 06 | 06 | |||||||
2005 | 43 | 19 | 15 | 06 | 07 | ||||||
51 | 23 | 18 | 09 | 07 | |||||||
2007 | 54 | 27 | 18 | 07 | 08 | ||||||
57 | 3 | 16 | 08 | 1 | |||||||
2009 | 59 | 31 | 15 | 1 | 11 | ||||||
62 | 35 | 15 | 1 | 1 | |||||||
2011 | 66 | 37 | 14 | 08 | 14 | ||||||
67 | 35 | 12 | 08 | 19 | |||||||
2013 | 74 | 35 | 11 | 1 | 27 | ||||||
86 | 38 | 11 | 18 | 34 | |||||||
2015 | 104 | 39 | 1 | 31 | 41 | ||||||
133 | 44 | 1 | 62 | 49 |
1999 | 1999 | 1999 | 1999 | ||||
1 | 04 | 03 | 07 | ||||
2001 | 2001 | 2001 | 2001 | ||||
15 | 08 | 04 | 07 | ||||
2003 | 2003 | 2003 | 2003 | ||||
18 | 13 | 06 | 06 | ||||
2005 | 2005 | 2005 | 2005 | ||||
23 | 18 | 09 | 07 | ||||
2007 | 2007 | 2007 | 2007 | ||||
3 | 16 | 08 | 1 | ||||
2009 | 2009 | 2009 | 2009 | ||||
35 | 15 | 1 | 1 | ||||
2011 | 2011 | 2011 | 2011 | ||||
35 | 12 | 08 | 19 | ||||
2013 | 2013 | 2013 | 2013 | ||||
38 | 11 | 18 | 34 | ||||
2015 | 2015 | 2015 | 2015 | ||||
44 | 1 | 62 | 49 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Opioid Overdoses Treated in Emergency Departments
Vivolo-Kantor AM Seth P Gladden RM Mattson CL Baldwin GT Kite-Powell A Coletta MA Vital Signs Trends in Emergency Department Visits for Suspected Opioid Overdoses mdash United States July 2016ndashSeptember 2017(httpswwwcdcgovmmwrvolumes67wrmm6709e1htm) MMWR Morb Mortal Wkly Rep201867
Rx Summit wwwNationalRxDrugAbuseSummitorg
Vivolo-Kantor AM Seth P Gladden RM Mattson CL Baldwin GT Kite-Powell A Coletta MA Vital Signs Trends in Emergency Department Visits for Suspected Opioid Overdoses mdash United States July 2016ndashSeptember 2017(httpswwwcdcgovmmwrvolumes67wrmm6709e1htm) MMWR Morb Mortal Wkly Rep201867
Rx Summit wwwNationalRxDrugAbuseSummitorg
2000 Rapid Increase in Drug Overdose Death Rates by County
SOURCE NCHS Data Visualization Gallery
Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery
2005 Rapid Increase in Drug Overdose Death Rates by County
Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery
2010 Rapid Increase in Drug Overdose Death Rates by County
Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery
2016 Rapid Increase in Drug Overdose Death Rates by County
Rx Summit wwwNationalRxDrugAbuseSummitorg
RISE IN OPIOID DEATHS
Overlapping Entangled but Distinct Epidemics
Natural and semi-synthetic opioidslike oxycodone or hydrocodone
Methadone
Heroin
SOURCE National Vital Statistics System Mortality File
Dea
ths
per 1
000
00 p
opul
atio
n
Rx Summit wwwNationalRxDrugAbuseSummitorg
CDCrsquos Pillars on Opioids Conducting surveillance and research
Building state local and tribal prevention efforts
Supporting healthcare providers and health systems
Partnering with public safety officials
Encouraging consumers to make safe choices about opioids raising awareness about prescription opioid misuse and overdose
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS) 12 states funded in September 2016 20 additional states and the
District of Columbia funded in September 2017 (through September 2019)
Strategy One Increase timeliness of non-fatal opioid overdose reporting- Use syndromic surveillance to establish an early warning system to
detect sharp increases or decreases in non-fatal opioid overdoses - Three indicators suspected all-drug opioid and heroin
Alaska California Connecticut Delaware DC Florida Georgia Illinois Indiana Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Nevada New Hampshire New Jersey New Mexico North Carolina Ohio Oklahoma Pennsylvania Rhode Island Tennessee Utah Vermont Virginia Washington West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS) Strategy Two Increase timeliness of fatal opioid overdose
reporting- Capture detailed information on toxicology death scene
investigations and other risk factors that may be associated with a fatal overdose
Strategy Three widespread dissemination- Rapidly disseminate surveillance findings to key stakeholders
working to prevent or respond to opioid overdoses
ESOOS program expansion in September 2017- At least 60 for comprehensive toxicology testing for opioid-
involved deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
Funded ESOOS states
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS)
Nonfatal Opioid Overdoses Reported
Quarterly
Emergency Department Visits EMS Transports
Fatal Opioid Overdoses Reported within 8 months
of death
Death CertificatesMEC reports
Toxicology reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
Next Two Presentationshellip
The Utilization of Emergency Department Syndromic Surveillance and Emergency Medical Services Data to Monitor Nonfatal Opioid Overdoses ndash Dr Alana Vivolo-Kantor
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System ndash Dr Julie OrsquoDonnell
Rx Summit wwwNationalRxDrugAbuseSummitorg
The utilization of emergency department syndromic surveillance
and emergency medical services data to monitor nonfatal opioid
overdosesPresenter Alana Vivolo-Kantor PhD
Behavioral ScientistCenters for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Julie OrsquoDonnell R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Alana Vivolo-Kantor PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Why Emergency Department and Emergency Medical Service Data for Surveillance
Need- Identify areas experiencing rapid increases in opioid overdoses to
inform responses- More quickly identify promising practices to reduce opioid overdoses
Proven utility to public health and scalable- Local jurisdictions already using it to track and respond to drug
overdoses- Findings from Epi-Aid investigations and collaborative work with states- Leverage existing state and national resources (BioSenseESSENCE)
Action at local and national level- Track quarterly trends across the nation to inform national policy- Improve more rapid local and state public health response
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our Philosophy
Focus on detecting change- Pushing system by looking at trend data over quarters- Some jurisdictions may be able to get and report preliminary
burden estimates
Jurisdiction-driven definitions will outperform national definitions- Local flexibility enhances quality and utility by accounting for large
variance in text entries and coding
National guidance- National definition will provide a good starting place- Guidance to encourage common conceptual definition (eg no
withdrawaldetox) and learn from previous work
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our approach
Non-fatal overdoses
Emergency Department
Near real-time ED collection (ie
syndromic ESSENCE)
Case-level or aggregate data shared
through ESSENCE (BioSense) or directly
with CDC
DischargeBilling Data
Case-level or aggregate data shared
directly with CDC
Emergency Medical Services
Case-level or aggregate data shared
directly with CDC
Includes breakdown by
sex age group and county of residence
Raceethnicity is optional
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency Department Data
Two sources- Near real-time syndromic data (visit information within 24-48 hours)- Lagged hospital billing or claims data (usually within 3-4 weeks)
Different variables used- Discharge diagnosis codes (eg ICD-10-CM) ndash available in billing
data and sometimes in syndromic- Free text fields (eg chief complaint provided by Doctor) ndash
available only in syndromic
Rx Summit wwwNationalRxDrugAbuseSummitorg
Case definitions for suspected overdose
If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED) and free text fields such as chief complaint or triage notes
- Free text searches use common terms slang and misspellings (eg herion instead of heroin)
If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED)
Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency medical services data
Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on
the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)
Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following
Naloxone administration)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Challenges in EMS data
Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp
v340)
Different case definitions in different versions
Missing data feeds
Not all EMS agencies share data
Varying time frame in when data is received- lt24 hours to 6 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Data submission process
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample quality control report
ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)
TOTAL ED VISITS (AGE)
1XX 2017 1 ED Visits mismatch 98287 98309
2XX 2017 2 ED Visits mismatch 98195 98230
3XX 2017 3 ED Visits mismatch 99167 99205
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample site report
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results All drug (11 sites)
0
10
20
30
40
50
60
70
80
90
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d al
l dru
g ov
erdo
se ra
tes
by
100
00 E
D v
isits
Quarter year
-2000
-1000
000
1000
2000
3000
4000
5000
6000
7000
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Opioid (11 sites)
0
5
10
15
20
25
30
35
40
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Heroin (11 sites)
0
5
10
15
20
25
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-15
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Column1 | Any opioid | Natural and semi-synthetic opioid analgesic | Methadone | Synthetic opioid analgesic excluding methadone | Heroin | ||||||
1999 | 1 | 03 | 03 | 07 | |||||||
21 | 1 | 04 | 03 | 07 | |||||||
2001 | 24 | 12 | 05 | 03 | 06 | ||||||
32 | 15 | 08 | 04 | 07 | |||||||
2003 | 35 | 17 | 1 | 05 | 07 | ||||||
39 | 18 | 13 | 06 | 06 | |||||||
2005 | 43 | 19 | 15 | 06 | 07 | ||||||
51 | 23 | 18 | 09 | 07 | |||||||
2007 | 54 | 27 | 18 | 07 | 08 | ||||||
57 | 3 | 16 | 08 | 1 | |||||||
2009 | 59 | 31 | 15 | 1 | 11 | ||||||
62 | 35 | 15 | 1 | 1 | |||||||
2011 | 66 | 37 | 14 | 08 | 14 | ||||||
67 | 35 | 12 | 08 | 19 | |||||||
2013 | 74 | 35 | 11 | 1 | 27 | ||||||
86 | 38 | 11 | 18 | 34 | |||||||
2015 | 104 | 39 | 1 | 31 | 41 | ||||||
133 | 44 | 1 | 62 | 49 |
1999 | 1999 | 1999 | 1999 | ||||
1 | 04 | 03 | 07 | ||||
2001 | 2001 | 2001 | 2001 | ||||
15 | 08 | 04 | 07 | ||||
2003 | 2003 | 2003 | 2003 | ||||
18 | 13 | 06 | 06 | ||||
2005 | 2005 | 2005 | 2005 | ||||
23 | 18 | 09 | 07 | ||||
2007 | 2007 | 2007 | 2007 | ||||
3 | 16 | 08 | 1 | ||||
2009 | 2009 | 2009 | 2009 | ||||
35 | 15 | 1 | 1 | ||||
2011 | 2011 | 2011 | 2011 | ||||
35 | 12 | 08 | 19 | ||||
2013 | 2013 | 2013 | 2013 | ||||
38 | 11 | 18 | 34 | ||||
2015 | 2015 | 2015 | 2015 | ||||
44 | 1 | 62 | 49 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Vivolo-Kantor AM Seth P Gladden RM Mattson CL Baldwin GT Kite-Powell A Coletta MA Vital Signs Trends in Emergency Department Visits for Suspected Opioid Overdoses mdash United States July 2016ndashSeptember 2017(httpswwwcdcgovmmwrvolumes67wrmm6709e1htm) MMWR Morb Mortal Wkly Rep201867
Rx Summit wwwNationalRxDrugAbuseSummitorg
2000 Rapid Increase in Drug Overdose Death Rates by County
SOURCE NCHS Data Visualization Gallery
Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery
2005 Rapid Increase in Drug Overdose Death Rates by County
Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery
2010 Rapid Increase in Drug Overdose Death Rates by County
Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery
2016 Rapid Increase in Drug Overdose Death Rates by County
Rx Summit wwwNationalRxDrugAbuseSummitorg
RISE IN OPIOID DEATHS
Overlapping Entangled but Distinct Epidemics
Natural and semi-synthetic opioidslike oxycodone or hydrocodone
Methadone
Heroin
SOURCE National Vital Statistics System Mortality File
Dea
ths
per 1
000
00 p
opul
atio
n
Rx Summit wwwNationalRxDrugAbuseSummitorg
CDCrsquos Pillars on Opioids Conducting surveillance and research
Building state local and tribal prevention efforts
Supporting healthcare providers and health systems
Partnering with public safety officials
Encouraging consumers to make safe choices about opioids raising awareness about prescription opioid misuse and overdose
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS) 12 states funded in September 2016 20 additional states and the
District of Columbia funded in September 2017 (through September 2019)
Strategy One Increase timeliness of non-fatal opioid overdose reporting- Use syndromic surveillance to establish an early warning system to
detect sharp increases or decreases in non-fatal opioid overdoses - Three indicators suspected all-drug opioid and heroin
Alaska California Connecticut Delaware DC Florida Georgia Illinois Indiana Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Nevada New Hampshire New Jersey New Mexico North Carolina Ohio Oklahoma Pennsylvania Rhode Island Tennessee Utah Vermont Virginia Washington West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS) Strategy Two Increase timeliness of fatal opioid overdose
reporting- Capture detailed information on toxicology death scene
investigations and other risk factors that may be associated with a fatal overdose
Strategy Three widespread dissemination- Rapidly disseminate surveillance findings to key stakeholders
working to prevent or respond to opioid overdoses
ESOOS program expansion in September 2017- At least 60 for comprehensive toxicology testing for opioid-
involved deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
Funded ESOOS states
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS)
Nonfatal Opioid Overdoses Reported
Quarterly
Emergency Department Visits EMS Transports
Fatal Opioid Overdoses Reported within 8 months
of death
Death CertificatesMEC reports
Toxicology reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
Next Two Presentationshellip
The Utilization of Emergency Department Syndromic Surveillance and Emergency Medical Services Data to Monitor Nonfatal Opioid Overdoses ndash Dr Alana Vivolo-Kantor
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System ndash Dr Julie OrsquoDonnell
Rx Summit wwwNationalRxDrugAbuseSummitorg
The utilization of emergency department syndromic surveillance
and emergency medical services data to monitor nonfatal opioid
overdosesPresenter Alana Vivolo-Kantor PhD
Behavioral ScientistCenters for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Julie OrsquoDonnell R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Alana Vivolo-Kantor PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Why Emergency Department and Emergency Medical Service Data for Surveillance
Need- Identify areas experiencing rapid increases in opioid overdoses to
inform responses- More quickly identify promising practices to reduce opioid overdoses
Proven utility to public health and scalable- Local jurisdictions already using it to track and respond to drug
overdoses- Findings from Epi-Aid investigations and collaborative work with states- Leverage existing state and national resources (BioSenseESSENCE)
Action at local and national level- Track quarterly trends across the nation to inform national policy- Improve more rapid local and state public health response
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our Philosophy
Focus on detecting change- Pushing system by looking at trend data over quarters- Some jurisdictions may be able to get and report preliminary
burden estimates
Jurisdiction-driven definitions will outperform national definitions- Local flexibility enhances quality and utility by accounting for large
variance in text entries and coding
National guidance- National definition will provide a good starting place- Guidance to encourage common conceptual definition (eg no
withdrawaldetox) and learn from previous work
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our approach
Non-fatal overdoses
Emergency Department
Near real-time ED collection (ie
syndromic ESSENCE)
Case-level or aggregate data shared
through ESSENCE (BioSense) or directly
with CDC
DischargeBilling Data
Case-level or aggregate data shared
directly with CDC
Emergency Medical Services
Case-level or aggregate data shared
directly with CDC
Includes breakdown by
sex age group and county of residence
Raceethnicity is optional
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency Department Data
Two sources- Near real-time syndromic data (visit information within 24-48 hours)- Lagged hospital billing or claims data (usually within 3-4 weeks)
Different variables used- Discharge diagnosis codes (eg ICD-10-CM) ndash available in billing
data and sometimes in syndromic- Free text fields (eg chief complaint provided by Doctor) ndash
available only in syndromic
Rx Summit wwwNationalRxDrugAbuseSummitorg
Case definitions for suspected overdose
If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED) and free text fields such as chief complaint or triage notes
- Free text searches use common terms slang and misspellings (eg herion instead of heroin)
If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED)
Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency medical services data
Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on
the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)
Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following
Naloxone administration)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Challenges in EMS data
Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp
v340)
Different case definitions in different versions
Missing data feeds
Not all EMS agencies share data
Varying time frame in when data is received- lt24 hours to 6 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Data submission process
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample quality control report
ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)
TOTAL ED VISITS (AGE)
1XX 2017 1 ED Visits mismatch 98287 98309
2XX 2017 2 ED Visits mismatch 98195 98230
3XX 2017 3 ED Visits mismatch 99167 99205
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample site report
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results All drug (11 sites)
0
10
20
30
40
50
60
70
80
90
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d al
l dru
g ov
erdo
se ra
tes
by
100
00 E
D v
isits
Quarter year
-2000
-1000
000
1000
2000
3000
4000
5000
6000
7000
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Opioid (11 sites)
0
5
10
15
20
25
30
35
40
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Heroin (11 sites)
0
5
10
15
20
25
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-15
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Column1 | Any opioid | Natural and semi-synthetic opioid analgesic | Methadone | Synthetic opioid analgesic excluding methadone | Heroin | ||||||
1999 | 1 | 03 | 03 | 07 | |||||||
21 | 1 | 04 | 03 | 07 | |||||||
2001 | 24 | 12 | 05 | 03 | 06 | ||||||
32 | 15 | 08 | 04 | 07 | |||||||
2003 | 35 | 17 | 1 | 05 | 07 | ||||||
39 | 18 | 13 | 06 | 06 | |||||||
2005 | 43 | 19 | 15 | 06 | 07 | ||||||
51 | 23 | 18 | 09 | 07 | |||||||
2007 | 54 | 27 | 18 | 07 | 08 | ||||||
57 | 3 | 16 | 08 | 1 | |||||||
2009 | 59 | 31 | 15 | 1 | 11 | ||||||
62 | 35 | 15 | 1 | 1 | |||||||
2011 | 66 | 37 | 14 | 08 | 14 | ||||||
67 | 35 | 12 | 08 | 19 | |||||||
2013 | 74 | 35 | 11 | 1 | 27 | ||||||
86 | 38 | 11 | 18 | 34 | |||||||
2015 | 104 | 39 | 1 | 31 | 41 | ||||||
133 | 44 | 1 | 62 | 49 |
1999 | 1999 | 1999 | 1999 | ||||
1 | 04 | 03 | 07 | ||||
2001 | 2001 | 2001 | 2001 | ||||
15 | 08 | 04 | 07 | ||||
2003 | 2003 | 2003 | 2003 | ||||
18 | 13 | 06 | 06 | ||||
2005 | 2005 | 2005 | 2005 | ||||
23 | 18 | 09 | 07 | ||||
2007 | 2007 | 2007 | 2007 | ||||
3 | 16 | 08 | 1 | ||||
2009 | 2009 | 2009 | 2009 | ||||
35 | 15 | 1 | 1 | ||||
2011 | 2011 | 2011 | 2011 | ||||
35 | 12 | 08 | 19 | ||||
2013 | 2013 | 2013 | 2013 | ||||
38 | 11 | 18 | 34 | ||||
2015 | 2015 | 2015 | 2015 | ||||
44 | 1 | 62 | 49 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
2000 Rapid Increase in Drug Overdose Death Rates by County
SOURCE NCHS Data Visualization Gallery
Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery
2005 Rapid Increase in Drug Overdose Death Rates by County
Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery
2010 Rapid Increase in Drug Overdose Death Rates by County
Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery
2016 Rapid Increase in Drug Overdose Death Rates by County
Rx Summit wwwNationalRxDrugAbuseSummitorg
RISE IN OPIOID DEATHS
Overlapping Entangled but Distinct Epidemics
Natural and semi-synthetic opioidslike oxycodone or hydrocodone
Methadone
Heroin
SOURCE National Vital Statistics System Mortality File
Dea
ths
per 1
000
00 p
opul
atio
n
Rx Summit wwwNationalRxDrugAbuseSummitorg
CDCrsquos Pillars on Opioids Conducting surveillance and research
Building state local and tribal prevention efforts
Supporting healthcare providers and health systems
Partnering with public safety officials
Encouraging consumers to make safe choices about opioids raising awareness about prescription opioid misuse and overdose
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS) 12 states funded in September 2016 20 additional states and the
District of Columbia funded in September 2017 (through September 2019)
Strategy One Increase timeliness of non-fatal opioid overdose reporting- Use syndromic surveillance to establish an early warning system to
detect sharp increases or decreases in non-fatal opioid overdoses - Three indicators suspected all-drug opioid and heroin
Alaska California Connecticut Delaware DC Florida Georgia Illinois Indiana Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Nevada New Hampshire New Jersey New Mexico North Carolina Ohio Oklahoma Pennsylvania Rhode Island Tennessee Utah Vermont Virginia Washington West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS) Strategy Two Increase timeliness of fatal opioid overdose
reporting- Capture detailed information on toxicology death scene
investigations and other risk factors that may be associated with a fatal overdose
Strategy Three widespread dissemination- Rapidly disseminate surveillance findings to key stakeholders
working to prevent or respond to opioid overdoses
ESOOS program expansion in September 2017- At least 60 for comprehensive toxicology testing for opioid-
involved deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
Funded ESOOS states
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS)
Nonfatal Opioid Overdoses Reported
Quarterly
Emergency Department Visits EMS Transports
Fatal Opioid Overdoses Reported within 8 months
of death
Death CertificatesMEC reports
Toxicology reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
Next Two Presentationshellip
The Utilization of Emergency Department Syndromic Surveillance and Emergency Medical Services Data to Monitor Nonfatal Opioid Overdoses ndash Dr Alana Vivolo-Kantor
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System ndash Dr Julie OrsquoDonnell
Rx Summit wwwNationalRxDrugAbuseSummitorg
The utilization of emergency department syndromic surveillance
and emergency medical services data to monitor nonfatal opioid
overdosesPresenter Alana Vivolo-Kantor PhD
Behavioral ScientistCenters for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Julie OrsquoDonnell R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Alana Vivolo-Kantor PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Why Emergency Department and Emergency Medical Service Data for Surveillance
Need- Identify areas experiencing rapid increases in opioid overdoses to
inform responses- More quickly identify promising practices to reduce opioid overdoses
Proven utility to public health and scalable- Local jurisdictions already using it to track and respond to drug
overdoses- Findings from Epi-Aid investigations and collaborative work with states- Leverage existing state and national resources (BioSenseESSENCE)
Action at local and national level- Track quarterly trends across the nation to inform national policy- Improve more rapid local and state public health response
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our Philosophy
Focus on detecting change- Pushing system by looking at trend data over quarters- Some jurisdictions may be able to get and report preliminary
burden estimates
Jurisdiction-driven definitions will outperform national definitions- Local flexibility enhances quality and utility by accounting for large
variance in text entries and coding
National guidance- National definition will provide a good starting place- Guidance to encourage common conceptual definition (eg no
withdrawaldetox) and learn from previous work
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our approach
Non-fatal overdoses
Emergency Department
Near real-time ED collection (ie
syndromic ESSENCE)
Case-level or aggregate data shared
through ESSENCE (BioSense) or directly
with CDC
DischargeBilling Data
Case-level or aggregate data shared
directly with CDC
Emergency Medical Services
Case-level or aggregate data shared
directly with CDC
Includes breakdown by
sex age group and county of residence
Raceethnicity is optional
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency Department Data
Two sources- Near real-time syndromic data (visit information within 24-48 hours)- Lagged hospital billing or claims data (usually within 3-4 weeks)
Different variables used- Discharge diagnosis codes (eg ICD-10-CM) ndash available in billing
data and sometimes in syndromic- Free text fields (eg chief complaint provided by Doctor) ndash
available only in syndromic
Rx Summit wwwNationalRxDrugAbuseSummitorg
Case definitions for suspected overdose
If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED) and free text fields such as chief complaint or triage notes
- Free text searches use common terms slang and misspellings (eg herion instead of heroin)
If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED)
Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency medical services data
Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on
the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)
Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following
Naloxone administration)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Challenges in EMS data
Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp
v340)
Different case definitions in different versions
Missing data feeds
Not all EMS agencies share data
Varying time frame in when data is received- lt24 hours to 6 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Data submission process
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample quality control report
ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)
TOTAL ED VISITS (AGE)
1XX 2017 1 ED Visits mismatch 98287 98309
2XX 2017 2 ED Visits mismatch 98195 98230
3XX 2017 3 ED Visits mismatch 99167 99205
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample site report
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results All drug (11 sites)
0
10
20
30
40
50
60
70
80
90
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d al
l dru
g ov
erdo
se ra
tes
by
100
00 E
D v
isits
Quarter year
-2000
-1000
000
1000
2000
3000
4000
5000
6000
7000
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Opioid (11 sites)
0
5
10
15
20
25
30
35
40
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Heroin (11 sites)
0
5
10
15
20
25
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-15
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Column1 | Any opioid | Natural and semi-synthetic opioid analgesic | Methadone | Synthetic opioid analgesic excluding methadone | Heroin | ||||||
1999 | 1 | 03 | 03 | 07 | |||||||
21 | 1 | 04 | 03 | 07 | |||||||
2001 | 24 | 12 | 05 | 03 | 06 | ||||||
32 | 15 | 08 | 04 | 07 | |||||||
2003 | 35 | 17 | 1 | 05 | 07 | ||||||
39 | 18 | 13 | 06 | 06 | |||||||
2005 | 43 | 19 | 15 | 06 | 07 | ||||||
51 | 23 | 18 | 09 | 07 | |||||||
2007 | 54 | 27 | 18 | 07 | 08 | ||||||
57 | 3 | 16 | 08 | 1 | |||||||
2009 | 59 | 31 | 15 | 1 | 11 | ||||||
62 | 35 | 15 | 1 | 1 | |||||||
2011 | 66 | 37 | 14 | 08 | 14 | ||||||
67 | 35 | 12 | 08 | 19 | |||||||
2013 | 74 | 35 | 11 | 1 | 27 | ||||||
86 | 38 | 11 | 18 | 34 | |||||||
2015 | 104 | 39 | 1 | 31 | 41 | ||||||
133 | 44 | 1 | 62 | 49 |
1999 | 1999 | 1999 | 1999 | ||||
1 | 04 | 03 | 07 | ||||
2001 | 2001 | 2001 | 2001 | ||||
15 | 08 | 04 | 07 | ||||
2003 | 2003 | 2003 | 2003 | ||||
18 | 13 | 06 | 06 | ||||
2005 | 2005 | 2005 | 2005 | ||||
23 | 18 | 09 | 07 | ||||
2007 | 2007 | 2007 | 2007 | ||||
3 | 16 | 08 | 1 | ||||
2009 | 2009 | 2009 | 2009 | ||||
35 | 15 | 1 | 1 | ||||
2011 | 2011 | 2011 | 2011 | ||||
35 | 12 | 08 | 19 | ||||
2013 | 2013 | 2013 | 2013 | ||||
38 | 11 | 18 | 34 | ||||
2015 | 2015 | 2015 | 2015 | ||||
44 | 1 | 62 | 49 |
Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery
2005 Rapid Increase in Drug Overdose Death Rates by County
Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery
2010 Rapid Increase in Drug Overdose Death Rates by County
Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery
2016 Rapid Increase in Drug Overdose Death Rates by County
Rx Summit wwwNationalRxDrugAbuseSummitorg
RISE IN OPIOID DEATHS
Overlapping Entangled but Distinct Epidemics
Natural and semi-synthetic opioidslike oxycodone or hydrocodone
Methadone
Heroin
SOURCE National Vital Statistics System Mortality File
Dea
ths
per 1
000
00 p
opul
atio
n
Rx Summit wwwNationalRxDrugAbuseSummitorg
CDCrsquos Pillars on Opioids Conducting surveillance and research
Building state local and tribal prevention efforts
Supporting healthcare providers and health systems
Partnering with public safety officials
Encouraging consumers to make safe choices about opioids raising awareness about prescription opioid misuse and overdose
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS) 12 states funded in September 2016 20 additional states and the
District of Columbia funded in September 2017 (through September 2019)
Strategy One Increase timeliness of non-fatal opioid overdose reporting- Use syndromic surveillance to establish an early warning system to
detect sharp increases or decreases in non-fatal opioid overdoses - Three indicators suspected all-drug opioid and heroin
Alaska California Connecticut Delaware DC Florida Georgia Illinois Indiana Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Nevada New Hampshire New Jersey New Mexico North Carolina Ohio Oklahoma Pennsylvania Rhode Island Tennessee Utah Vermont Virginia Washington West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS) Strategy Two Increase timeliness of fatal opioid overdose
reporting- Capture detailed information on toxicology death scene
investigations and other risk factors that may be associated with a fatal overdose
Strategy Three widespread dissemination- Rapidly disseminate surveillance findings to key stakeholders
working to prevent or respond to opioid overdoses
ESOOS program expansion in September 2017- At least 60 for comprehensive toxicology testing for opioid-
involved deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
Funded ESOOS states
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS)
Nonfatal Opioid Overdoses Reported
Quarterly
Emergency Department Visits EMS Transports
Fatal Opioid Overdoses Reported within 8 months
of death
Death CertificatesMEC reports
Toxicology reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
Next Two Presentationshellip
The Utilization of Emergency Department Syndromic Surveillance and Emergency Medical Services Data to Monitor Nonfatal Opioid Overdoses ndash Dr Alana Vivolo-Kantor
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System ndash Dr Julie OrsquoDonnell
Rx Summit wwwNationalRxDrugAbuseSummitorg
The utilization of emergency department syndromic surveillance
and emergency medical services data to monitor nonfatal opioid
overdosesPresenter Alana Vivolo-Kantor PhD
Behavioral ScientistCenters for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Julie OrsquoDonnell R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Alana Vivolo-Kantor PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Why Emergency Department and Emergency Medical Service Data for Surveillance
Need- Identify areas experiencing rapid increases in opioid overdoses to
inform responses- More quickly identify promising practices to reduce opioid overdoses
Proven utility to public health and scalable- Local jurisdictions already using it to track and respond to drug
overdoses- Findings from Epi-Aid investigations and collaborative work with states- Leverage existing state and national resources (BioSenseESSENCE)
Action at local and national level- Track quarterly trends across the nation to inform national policy- Improve more rapid local and state public health response
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our Philosophy
Focus on detecting change- Pushing system by looking at trend data over quarters- Some jurisdictions may be able to get and report preliminary
burden estimates
Jurisdiction-driven definitions will outperform national definitions- Local flexibility enhances quality and utility by accounting for large
variance in text entries and coding
National guidance- National definition will provide a good starting place- Guidance to encourage common conceptual definition (eg no
withdrawaldetox) and learn from previous work
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our approach
Non-fatal overdoses
Emergency Department
Near real-time ED collection (ie
syndromic ESSENCE)
Case-level or aggregate data shared
through ESSENCE (BioSense) or directly
with CDC
DischargeBilling Data
Case-level or aggregate data shared
directly with CDC
Emergency Medical Services
Case-level or aggregate data shared
directly with CDC
Includes breakdown by
sex age group and county of residence
Raceethnicity is optional
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency Department Data
Two sources- Near real-time syndromic data (visit information within 24-48 hours)- Lagged hospital billing or claims data (usually within 3-4 weeks)
Different variables used- Discharge diagnosis codes (eg ICD-10-CM) ndash available in billing
data and sometimes in syndromic- Free text fields (eg chief complaint provided by Doctor) ndash
available only in syndromic
Rx Summit wwwNationalRxDrugAbuseSummitorg
Case definitions for suspected overdose
If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED) and free text fields such as chief complaint or triage notes
- Free text searches use common terms slang and misspellings (eg herion instead of heroin)
If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED)
Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency medical services data
Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on
the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)
Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following
Naloxone administration)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Challenges in EMS data
Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp
v340)
Different case definitions in different versions
Missing data feeds
Not all EMS agencies share data
Varying time frame in when data is received- lt24 hours to 6 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Data submission process
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample quality control report
ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)
TOTAL ED VISITS (AGE)
1XX 2017 1 ED Visits mismatch 98287 98309
2XX 2017 2 ED Visits mismatch 98195 98230
3XX 2017 3 ED Visits mismatch 99167 99205
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample site report
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results All drug (11 sites)
0
10
20
30
40
50
60
70
80
90
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d al
l dru
g ov
erdo
se ra
tes
by
100
00 E
D v
isits
Quarter year
-2000
-1000
000
1000
2000
3000
4000
5000
6000
7000
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Opioid (11 sites)
0
5
10
15
20
25
30
35
40
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Heroin (11 sites)
0
5
10
15
20
25
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-15
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Column1 | Any opioid | Natural and semi-synthetic opioid analgesic | Methadone | Synthetic opioid analgesic excluding methadone | Heroin | ||||||
1999 | 1 | 03 | 03 | 07 | |||||||
21 | 1 | 04 | 03 | 07 | |||||||
2001 | 24 | 12 | 05 | 03 | 06 | ||||||
32 | 15 | 08 | 04 | 07 | |||||||
2003 | 35 | 17 | 1 | 05 | 07 | ||||||
39 | 18 | 13 | 06 | 06 | |||||||
2005 | 43 | 19 | 15 | 06 | 07 | ||||||
51 | 23 | 18 | 09 | 07 | |||||||
2007 | 54 | 27 | 18 | 07 | 08 | ||||||
57 | 3 | 16 | 08 | 1 | |||||||
2009 | 59 | 31 | 15 | 1 | 11 | ||||||
62 | 35 | 15 | 1 | 1 | |||||||
2011 | 66 | 37 | 14 | 08 | 14 | ||||||
67 | 35 | 12 | 08 | 19 | |||||||
2013 | 74 | 35 | 11 | 1 | 27 | ||||||
86 | 38 | 11 | 18 | 34 | |||||||
2015 | 104 | 39 | 1 | 31 | 41 | ||||||
133 | 44 | 1 | 62 | 49 |
1999 | 1999 | 1999 | 1999 | ||||
1 | 04 | 03 | 07 | ||||
2001 | 2001 | 2001 | 2001 | ||||
15 | 08 | 04 | 07 | ||||
2003 | 2003 | 2003 | 2003 | ||||
18 | 13 | 06 | 06 | ||||
2005 | 2005 | 2005 | 2005 | ||||
23 | 18 | 09 | 07 | ||||
2007 | 2007 | 2007 | 2007 | ||||
3 | 16 | 08 | 1 | ||||
2009 | 2009 | 2009 | 2009 | ||||
35 | 15 | 1 | 1 | ||||
2011 | 2011 | 2011 | 2011 | ||||
35 | 12 | 08 | 19 | ||||
2013 | 2013 | 2013 | 2013 | ||||
38 | 11 | 18 | 34 | ||||
2015 | 2015 | 2015 | 2015 | ||||
44 | 1 | 62 | 49 |
Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery
2010 Rapid Increase in Drug Overdose Death Rates by County
Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery
2016 Rapid Increase in Drug Overdose Death Rates by County
Rx Summit wwwNationalRxDrugAbuseSummitorg
RISE IN OPIOID DEATHS
Overlapping Entangled but Distinct Epidemics
Natural and semi-synthetic opioidslike oxycodone or hydrocodone
Methadone
Heroin
SOURCE National Vital Statistics System Mortality File
Dea
ths
per 1
000
00 p
opul
atio
n
Rx Summit wwwNationalRxDrugAbuseSummitorg
CDCrsquos Pillars on Opioids Conducting surveillance and research
Building state local and tribal prevention efforts
Supporting healthcare providers and health systems
Partnering with public safety officials
Encouraging consumers to make safe choices about opioids raising awareness about prescription opioid misuse and overdose
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS) 12 states funded in September 2016 20 additional states and the
District of Columbia funded in September 2017 (through September 2019)
Strategy One Increase timeliness of non-fatal opioid overdose reporting- Use syndromic surveillance to establish an early warning system to
detect sharp increases or decreases in non-fatal opioid overdoses - Three indicators suspected all-drug opioid and heroin
Alaska California Connecticut Delaware DC Florida Georgia Illinois Indiana Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Nevada New Hampshire New Jersey New Mexico North Carolina Ohio Oklahoma Pennsylvania Rhode Island Tennessee Utah Vermont Virginia Washington West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS) Strategy Two Increase timeliness of fatal opioid overdose
reporting- Capture detailed information on toxicology death scene
investigations and other risk factors that may be associated with a fatal overdose
Strategy Three widespread dissemination- Rapidly disseminate surveillance findings to key stakeholders
working to prevent or respond to opioid overdoses
ESOOS program expansion in September 2017- At least 60 for comprehensive toxicology testing for opioid-
involved deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
Funded ESOOS states
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS)
Nonfatal Opioid Overdoses Reported
Quarterly
Emergency Department Visits EMS Transports
Fatal Opioid Overdoses Reported within 8 months
of death
Death CertificatesMEC reports
Toxicology reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
Next Two Presentationshellip
The Utilization of Emergency Department Syndromic Surveillance and Emergency Medical Services Data to Monitor Nonfatal Opioid Overdoses ndash Dr Alana Vivolo-Kantor
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System ndash Dr Julie OrsquoDonnell
Rx Summit wwwNationalRxDrugAbuseSummitorg
The utilization of emergency department syndromic surveillance
and emergency medical services data to monitor nonfatal opioid
overdosesPresenter Alana Vivolo-Kantor PhD
Behavioral ScientistCenters for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Julie OrsquoDonnell R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Alana Vivolo-Kantor PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Why Emergency Department and Emergency Medical Service Data for Surveillance
Need- Identify areas experiencing rapid increases in opioid overdoses to
inform responses- More quickly identify promising practices to reduce opioid overdoses
Proven utility to public health and scalable- Local jurisdictions already using it to track and respond to drug
overdoses- Findings from Epi-Aid investigations and collaborative work with states- Leverage existing state and national resources (BioSenseESSENCE)
Action at local and national level- Track quarterly trends across the nation to inform national policy- Improve more rapid local and state public health response
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our Philosophy
Focus on detecting change- Pushing system by looking at trend data over quarters- Some jurisdictions may be able to get and report preliminary
burden estimates
Jurisdiction-driven definitions will outperform national definitions- Local flexibility enhances quality and utility by accounting for large
variance in text entries and coding
National guidance- National definition will provide a good starting place- Guidance to encourage common conceptual definition (eg no
withdrawaldetox) and learn from previous work
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our approach
Non-fatal overdoses
Emergency Department
Near real-time ED collection (ie
syndromic ESSENCE)
Case-level or aggregate data shared
through ESSENCE (BioSense) or directly
with CDC
DischargeBilling Data
Case-level or aggregate data shared
directly with CDC
Emergency Medical Services
Case-level or aggregate data shared
directly with CDC
Includes breakdown by
sex age group and county of residence
Raceethnicity is optional
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency Department Data
Two sources- Near real-time syndromic data (visit information within 24-48 hours)- Lagged hospital billing or claims data (usually within 3-4 weeks)
Different variables used- Discharge diagnosis codes (eg ICD-10-CM) ndash available in billing
data and sometimes in syndromic- Free text fields (eg chief complaint provided by Doctor) ndash
available only in syndromic
Rx Summit wwwNationalRxDrugAbuseSummitorg
Case definitions for suspected overdose
If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED) and free text fields such as chief complaint or triage notes
- Free text searches use common terms slang and misspellings (eg herion instead of heroin)
If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED)
Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency medical services data
Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on
the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)
Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following
Naloxone administration)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Challenges in EMS data
Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp
v340)
Different case definitions in different versions
Missing data feeds
Not all EMS agencies share data
Varying time frame in when data is received- lt24 hours to 6 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Data submission process
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample quality control report
ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)
TOTAL ED VISITS (AGE)
1XX 2017 1 ED Visits mismatch 98287 98309
2XX 2017 2 ED Visits mismatch 98195 98230
3XX 2017 3 ED Visits mismatch 99167 99205
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample site report
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results All drug (11 sites)
0
10
20
30
40
50
60
70
80
90
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d al
l dru
g ov
erdo
se ra
tes
by
100
00 E
D v
isits
Quarter year
-2000
-1000
000
1000
2000
3000
4000
5000
6000
7000
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Opioid (11 sites)
0
5
10
15
20
25
30
35
40
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Heroin (11 sites)
0
5
10
15
20
25
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-15
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Column1 | Any opioid | Natural and semi-synthetic opioid analgesic | Methadone | Synthetic opioid analgesic excluding methadone | Heroin | ||||||
1999 | 1 | 03 | 03 | 07 | |||||||
21 | 1 | 04 | 03 | 07 | |||||||
2001 | 24 | 12 | 05 | 03 | 06 | ||||||
32 | 15 | 08 | 04 | 07 | |||||||
2003 | 35 | 17 | 1 | 05 | 07 | ||||||
39 | 18 | 13 | 06 | 06 | |||||||
2005 | 43 | 19 | 15 | 06 | 07 | ||||||
51 | 23 | 18 | 09 | 07 | |||||||
2007 | 54 | 27 | 18 | 07 | 08 | ||||||
57 | 3 | 16 | 08 | 1 | |||||||
2009 | 59 | 31 | 15 | 1 | 11 | ||||||
62 | 35 | 15 | 1 | 1 | |||||||
2011 | 66 | 37 | 14 | 08 | 14 | ||||||
67 | 35 | 12 | 08 | 19 | |||||||
2013 | 74 | 35 | 11 | 1 | 27 | ||||||
86 | 38 | 11 | 18 | 34 | |||||||
2015 | 104 | 39 | 1 | 31 | 41 | ||||||
133 | 44 | 1 | 62 | 49 |
1999 | 1999 | 1999 | 1999 | ||||
1 | 04 | 03 | 07 | ||||
2001 | 2001 | 2001 | 2001 | ||||
15 | 08 | 04 | 07 | ||||
2003 | 2003 | 2003 | 2003 | ||||
18 | 13 | 06 | 06 | ||||
2005 | 2005 | 2005 | 2005 | ||||
23 | 18 | 09 | 07 | ||||
2007 | 2007 | 2007 | 2007 | ||||
3 | 16 | 08 | 1 | ||||
2009 | 2009 | 2009 | 2009 | ||||
35 | 15 | 1 | 1 | ||||
2011 | 2011 | 2011 | 2011 | ||||
35 | 12 | 08 | 19 | ||||
2013 | 2013 | 2013 | 2013 | ||||
38 | 11 | 18 | 34 | ||||
2015 | 2015 | 2015 | 2015 | ||||
44 | 1 | 62 | 49 |
Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery
2016 Rapid Increase in Drug Overdose Death Rates by County
Rx Summit wwwNationalRxDrugAbuseSummitorg
RISE IN OPIOID DEATHS
Overlapping Entangled but Distinct Epidemics
Natural and semi-synthetic opioidslike oxycodone or hydrocodone
Methadone
Heroin
SOURCE National Vital Statistics System Mortality File
Dea
ths
per 1
000
00 p
opul
atio
n
Rx Summit wwwNationalRxDrugAbuseSummitorg
CDCrsquos Pillars on Opioids Conducting surveillance and research
Building state local and tribal prevention efforts
Supporting healthcare providers and health systems
Partnering with public safety officials
Encouraging consumers to make safe choices about opioids raising awareness about prescription opioid misuse and overdose
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS) 12 states funded in September 2016 20 additional states and the
District of Columbia funded in September 2017 (through September 2019)
Strategy One Increase timeliness of non-fatal opioid overdose reporting- Use syndromic surveillance to establish an early warning system to
detect sharp increases or decreases in non-fatal opioid overdoses - Three indicators suspected all-drug opioid and heroin
Alaska California Connecticut Delaware DC Florida Georgia Illinois Indiana Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Nevada New Hampshire New Jersey New Mexico North Carolina Ohio Oklahoma Pennsylvania Rhode Island Tennessee Utah Vermont Virginia Washington West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS) Strategy Two Increase timeliness of fatal opioid overdose
reporting- Capture detailed information on toxicology death scene
investigations and other risk factors that may be associated with a fatal overdose
Strategy Three widespread dissemination- Rapidly disseminate surveillance findings to key stakeholders
working to prevent or respond to opioid overdoses
ESOOS program expansion in September 2017- At least 60 for comprehensive toxicology testing for opioid-
involved deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
Funded ESOOS states
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS)
Nonfatal Opioid Overdoses Reported
Quarterly
Emergency Department Visits EMS Transports
Fatal Opioid Overdoses Reported within 8 months
of death
Death CertificatesMEC reports
Toxicology reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
Next Two Presentationshellip
The Utilization of Emergency Department Syndromic Surveillance and Emergency Medical Services Data to Monitor Nonfatal Opioid Overdoses ndash Dr Alana Vivolo-Kantor
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System ndash Dr Julie OrsquoDonnell
Rx Summit wwwNationalRxDrugAbuseSummitorg
The utilization of emergency department syndromic surveillance
and emergency medical services data to monitor nonfatal opioid
overdosesPresenter Alana Vivolo-Kantor PhD
Behavioral ScientistCenters for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Julie OrsquoDonnell R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Alana Vivolo-Kantor PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Why Emergency Department and Emergency Medical Service Data for Surveillance
Need- Identify areas experiencing rapid increases in opioid overdoses to
inform responses- More quickly identify promising practices to reduce opioid overdoses
Proven utility to public health and scalable- Local jurisdictions already using it to track and respond to drug
overdoses- Findings from Epi-Aid investigations and collaborative work with states- Leverage existing state and national resources (BioSenseESSENCE)
Action at local and national level- Track quarterly trends across the nation to inform national policy- Improve more rapid local and state public health response
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our Philosophy
Focus on detecting change- Pushing system by looking at trend data over quarters- Some jurisdictions may be able to get and report preliminary
burden estimates
Jurisdiction-driven definitions will outperform national definitions- Local flexibility enhances quality and utility by accounting for large
variance in text entries and coding
National guidance- National definition will provide a good starting place- Guidance to encourage common conceptual definition (eg no
withdrawaldetox) and learn from previous work
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our approach
Non-fatal overdoses
Emergency Department
Near real-time ED collection (ie
syndromic ESSENCE)
Case-level or aggregate data shared
through ESSENCE (BioSense) or directly
with CDC
DischargeBilling Data
Case-level or aggregate data shared
directly with CDC
Emergency Medical Services
Case-level or aggregate data shared
directly with CDC
Includes breakdown by
sex age group and county of residence
Raceethnicity is optional
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency Department Data
Two sources- Near real-time syndromic data (visit information within 24-48 hours)- Lagged hospital billing or claims data (usually within 3-4 weeks)
Different variables used- Discharge diagnosis codes (eg ICD-10-CM) ndash available in billing
data and sometimes in syndromic- Free text fields (eg chief complaint provided by Doctor) ndash
available only in syndromic
Rx Summit wwwNationalRxDrugAbuseSummitorg
Case definitions for suspected overdose
If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED) and free text fields such as chief complaint or triage notes
- Free text searches use common terms slang and misspellings (eg herion instead of heroin)
If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED)
Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency medical services data
Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on
the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)
Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following
Naloxone administration)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Challenges in EMS data
Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp
v340)
Different case definitions in different versions
Missing data feeds
Not all EMS agencies share data
Varying time frame in when data is received- lt24 hours to 6 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Data submission process
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample quality control report
ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)
TOTAL ED VISITS (AGE)
1XX 2017 1 ED Visits mismatch 98287 98309
2XX 2017 2 ED Visits mismatch 98195 98230
3XX 2017 3 ED Visits mismatch 99167 99205
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample site report
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results All drug (11 sites)
0
10
20
30
40
50
60
70
80
90
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d al
l dru
g ov
erdo
se ra
tes
by
100
00 E
D v
isits
Quarter year
-2000
-1000
000
1000
2000
3000
4000
5000
6000
7000
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Opioid (11 sites)
0
5
10
15
20
25
30
35
40
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Heroin (11 sites)
0
5
10
15
20
25
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-15
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Column1 | Any opioid | Natural and semi-synthetic opioid analgesic | Methadone | Synthetic opioid analgesic excluding methadone | Heroin | ||||||
1999 | 1 | 03 | 03 | 07 | |||||||
21 | 1 | 04 | 03 | 07 | |||||||
2001 | 24 | 12 | 05 | 03 | 06 | ||||||
32 | 15 | 08 | 04 | 07 | |||||||
2003 | 35 | 17 | 1 | 05 | 07 | ||||||
39 | 18 | 13 | 06 | 06 | |||||||
2005 | 43 | 19 | 15 | 06 | 07 | ||||||
51 | 23 | 18 | 09 | 07 | |||||||
2007 | 54 | 27 | 18 | 07 | 08 | ||||||
57 | 3 | 16 | 08 | 1 | |||||||
2009 | 59 | 31 | 15 | 1 | 11 | ||||||
62 | 35 | 15 | 1 | 1 | |||||||
2011 | 66 | 37 | 14 | 08 | 14 | ||||||
67 | 35 | 12 | 08 | 19 | |||||||
2013 | 74 | 35 | 11 | 1 | 27 | ||||||
86 | 38 | 11 | 18 | 34 | |||||||
2015 | 104 | 39 | 1 | 31 | 41 | ||||||
133 | 44 | 1 | 62 | 49 |
1999 | 1999 | 1999 | 1999 | ||||
1 | 04 | 03 | 07 | ||||
2001 | 2001 | 2001 | 2001 | ||||
15 | 08 | 04 | 07 | ||||
2003 | 2003 | 2003 | 2003 | ||||
18 | 13 | 06 | 06 | ||||
2005 | 2005 | 2005 | 2005 | ||||
23 | 18 | 09 | 07 | ||||
2007 | 2007 | 2007 | 2007 | ||||
3 | 16 | 08 | 1 | ||||
2009 | 2009 | 2009 | 2009 | ||||
35 | 15 | 1 | 1 | ||||
2011 | 2011 | 2011 | 2011 | ||||
35 | 12 | 08 | 19 | ||||
2013 | 2013 | 2013 | 2013 | ||||
38 | 11 | 18 | 34 | ||||
2015 | 2015 | 2015 | 2015 | ||||
44 | 1 | 62 | 49 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
RISE IN OPIOID DEATHS
Overlapping Entangled but Distinct Epidemics
Natural and semi-synthetic opioidslike oxycodone or hydrocodone
Methadone
Heroin
SOURCE National Vital Statistics System Mortality File
Dea
ths
per 1
000
00 p
opul
atio
n
Rx Summit wwwNationalRxDrugAbuseSummitorg
CDCrsquos Pillars on Opioids Conducting surveillance and research
Building state local and tribal prevention efforts
Supporting healthcare providers and health systems
Partnering with public safety officials
Encouraging consumers to make safe choices about opioids raising awareness about prescription opioid misuse and overdose
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS) 12 states funded in September 2016 20 additional states and the
District of Columbia funded in September 2017 (through September 2019)
Strategy One Increase timeliness of non-fatal opioid overdose reporting- Use syndromic surveillance to establish an early warning system to
detect sharp increases or decreases in non-fatal opioid overdoses - Three indicators suspected all-drug opioid and heroin
Alaska California Connecticut Delaware DC Florida Georgia Illinois Indiana Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Nevada New Hampshire New Jersey New Mexico North Carolina Ohio Oklahoma Pennsylvania Rhode Island Tennessee Utah Vermont Virginia Washington West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS) Strategy Two Increase timeliness of fatal opioid overdose
reporting- Capture detailed information on toxicology death scene
investigations and other risk factors that may be associated with a fatal overdose
Strategy Three widespread dissemination- Rapidly disseminate surveillance findings to key stakeholders
working to prevent or respond to opioid overdoses
ESOOS program expansion in September 2017- At least 60 for comprehensive toxicology testing for opioid-
involved deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
Funded ESOOS states
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS)
Nonfatal Opioid Overdoses Reported
Quarterly
Emergency Department Visits EMS Transports
Fatal Opioid Overdoses Reported within 8 months
of death
Death CertificatesMEC reports
Toxicology reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
Next Two Presentationshellip
The Utilization of Emergency Department Syndromic Surveillance and Emergency Medical Services Data to Monitor Nonfatal Opioid Overdoses ndash Dr Alana Vivolo-Kantor
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System ndash Dr Julie OrsquoDonnell
Rx Summit wwwNationalRxDrugAbuseSummitorg
The utilization of emergency department syndromic surveillance
and emergency medical services data to monitor nonfatal opioid
overdosesPresenter Alana Vivolo-Kantor PhD
Behavioral ScientistCenters for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Julie OrsquoDonnell R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Alana Vivolo-Kantor PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Why Emergency Department and Emergency Medical Service Data for Surveillance
Need- Identify areas experiencing rapid increases in opioid overdoses to
inform responses- More quickly identify promising practices to reduce opioid overdoses
Proven utility to public health and scalable- Local jurisdictions already using it to track and respond to drug
overdoses- Findings from Epi-Aid investigations and collaborative work with states- Leverage existing state and national resources (BioSenseESSENCE)
Action at local and national level- Track quarterly trends across the nation to inform national policy- Improve more rapid local and state public health response
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our Philosophy
Focus on detecting change- Pushing system by looking at trend data over quarters- Some jurisdictions may be able to get and report preliminary
burden estimates
Jurisdiction-driven definitions will outperform national definitions- Local flexibility enhances quality and utility by accounting for large
variance in text entries and coding
National guidance- National definition will provide a good starting place- Guidance to encourage common conceptual definition (eg no
withdrawaldetox) and learn from previous work
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our approach
Non-fatal overdoses
Emergency Department
Near real-time ED collection (ie
syndromic ESSENCE)
Case-level or aggregate data shared
through ESSENCE (BioSense) or directly
with CDC
DischargeBilling Data
Case-level or aggregate data shared
directly with CDC
Emergency Medical Services
Case-level or aggregate data shared
directly with CDC
Includes breakdown by
sex age group and county of residence
Raceethnicity is optional
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency Department Data
Two sources- Near real-time syndromic data (visit information within 24-48 hours)- Lagged hospital billing or claims data (usually within 3-4 weeks)
Different variables used- Discharge diagnosis codes (eg ICD-10-CM) ndash available in billing
data and sometimes in syndromic- Free text fields (eg chief complaint provided by Doctor) ndash
available only in syndromic
Rx Summit wwwNationalRxDrugAbuseSummitorg
Case definitions for suspected overdose
If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED) and free text fields such as chief complaint or triage notes
- Free text searches use common terms slang and misspellings (eg herion instead of heroin)
If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED)
Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency medical services data
Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on
the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)
Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following
Naloxone administration)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Challenges in EMS data
Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp
v340)
Different case definitions in different versions
Missing data feeds
Not all EMS agencies share data
Varying time frame in when data is received- lt24 hours to 6 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Data submission process
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample quality control report
ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)
TOTAL ED VISITS (AGE)
1XX 2017 1 ED Visits mismatch 98287 98309
2XX 2017 2 ED Visits mismatch 98195 98230
3XX 2017 3 ED Visits mismatch 99167 99205
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample site report
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results All drug (11 sites)
0
10
20
30
40
50
60
70
80
90
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d al
l dru
g ov
erdo
se ra
tes
by
100
00 E
D v
isits
Quarter year
-2000
-1000
000
1000
2000
3000
4000
5000
6000
7000
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Opioid (11 sites)
0
5
10
15
20
25
30
35
40
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Heroin (11 sites)
0
5
10
15
20
25
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-15
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Column1 | Any opioid | Natural and semi-synthetic opioid analgesic | Methadone | Synthetic opioid analgesic excluding methadone | Heroin | ||||||
1999 | 1 | 03 | 03 | 07 | |||||||
21 | 1 | 04 | 03 | 07 | |||||||
2001 | 24 | 12 | 05 | 03 | 06 | ||||||
32 | 15 | 08 | 04 | 07 | |||||||
2003 | 35 | 17 | 1 | 05 | 07 | ||||||
39 | 18 | 13 | 06 | 06 | |||||||
2005 | 43 | 19 | 15 | 06 | 07 | ||||||
51 | 23 | 18 | 09 | 07 | |||||||
2007 | 54 | 27 | 18 | 07 | 08 | ||||||
57 | 3 | 16 | 08 | 1 | |||||||
2009 | 59 | 31 | 15 | 1 | 11 | ||||||
62 | 35 | 15 | 1 | 1 | |||||||
2011 | 66 | 37 | 14 | 08 | 14 | ||||||
67 | 35 | 12 | 08 | 19 | |||||||
2013 | 74 | 35 | 11 | 1 | 27 | ||||||
86 | 38 | 11 | 18 | 34 | |||||||
2015 | 104 | 39 | 1 | 31 | 41 | ||||||
133 | 44 | 1 | 62 | 49 |
1999 | 1999 | 1999 | 1999 | ||||
1 | 04 | 03 | 07 | ||||
2001 | 2001 | 2001 | 2001 | ||||
15 | 08 | 04 | 07 | ||||
2003 | 2003 | 2003 | 2003 | ||||
18 | 13 | 06 | 06 | ||||
2005 | 2005 | 2005 | 2005 | ||||
23 | 18 | 09 | 07 | ||||
2007 | 2007 | 2007 | 2007 | ||||
3 | 16 | 08 | 1 | ||||
2009 | 2009 | 2009 | 2009 | ||||
35 | 15 | 1 | 1 | ||||
2011 | 2011 | 2011 | 2011 | ||||
35 | 12 | 08 | 19 | ||||
2013 | 2013 | 2013 | 2013 | ||||
38 | 11 | 18 | 34 | ||||
2015 | 2015 | 2015 | 2015 | ||||
44 | 1 | 62 | 49 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
CDCrsquos Pillars on Opioids Conducting surveillance and research
Building state local and tribal prevention efforts
Supporting healthcare providers and health systems
Partnering with public safety officials
Encouraging consumers to make safe choices about opioids raising awareness about prescription opioid misuse and overdose
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS) 12 states funded in September 2016 20 additional states and the
District of Columbia funded in September 2017 (through September 2019)
Strategy One Increase timeliness of non-fatal opioid overdose reporting- Use syndromic surveillance to establish an early warning system to
detect sharp increases or decreases in non-fatal opioid overdoses - Three indicators suspected all-drug opioid and heroin
Alaska California Connecticut Delaware DC Florida Georgia Illinois Indiana Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Nevada New Hampshire New Jersey New Mexico North Carolina Ohio Oklahoma Pennsylvania Rhode Island Tennessee Utah Vermont Virginia Washington West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS) Strategy Two Increase timeliness of fatal opioid overdose
reporting- Capture detailed information on toxicology death scene
investigations and other risk factors that may be associated with a fatal overdose
Strategy Three widespread dissemination- Rapidly disseminate surveillance findings to key stakeholders
working to prevent or respond to opioid overdoses
ESOOS program expansion in September 2017- At least 60 for comprehensive toxicology testing for opioid-
involved deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
Funded ESOOS states
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS)
Nonfatal Opioid Overdoses Reported
Quarterly
Emergency Department Visits EMS Transports
Fatal Opioid Overdoses Reported within 8 months
of death
Death CertificatesMEC reports
Toxicology reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
Next Two Presentationshellip
The Utilization of Emergency Department Syndromic Surveillance and Emergency Medical Services Data to Monitor Nonfatal Opioid Overdoses ndash Dr Alana Vivolo-Kantor
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System ndash Dr Julie OrsquoDonnell
Rx Summit wwwNationalRxDrugAbuseSummitorg
The utilization of emergency department syndromic surveillance
and emergency medical services data to monitor nonfatal opioid
overdosesPresenter Alana Vivolo-Kantor PhD
Behavioral ScientistCenters for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Julie OrsquoDonnell R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Alana Vivolo-Kantor PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Why Emergency Department and Emergency Medical Service Data for Surveillance
Need- Identify areas experiencing rapid increases in opioid overdoses to
inform responses- More quickly identify promising practices to reduce opioid overdoses
Proven utility to public health and scalable- Local jurisdictions already using it to track and respond to drug
overdoses- Findings from Epi-Aid investigations and collaborative work with states- Leverage existing state and national resources (BioSenseESSENCE)
Action at local and national level- Track quarterly trends across the nation to inform national policy- Improve more rapid local and state public health response
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our Philosophy
Focus on detecting change- Pushing system by looking at trend data over quarters- Some jurisdictions may be able to get and report preliminary
burden estimates
Jurisdiction-driven definitions will outperform national definitions- Local flexibility enhances quality and utility by accounting for large
variance in text entries and coding
National guidance- National definition will provide a good starting place- Guidance to encourage common conceptual definition (eg no
withdrawaldetox) and learn from previous work
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our approach
Non-fatal overdoses
Emergency Department
Near real-time ED collection (ie
syndromic ESSENCE)
Case-level or aggregate data shared
through ESSENCE (BioSense) or directly
with CDC
DischargeBilling Data
Case-level or aggregate data shared
directly with CDC
Emergency Medical Services
Case-level or aggregate data shared
directly with CDC
Includes breakdown by
sex age group and county of residence
Raceethnicity is optional
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency Department Data
Two sources- Near real-time syndromic data (visit information within 24-48 hours)- Lagged hospital billing or claims data (usually within 3-4 weeks)
Different variables used- Discharge diagnosis codes (eg ICD-10-CM) ndash available in billing
data and sometimes in syndromic- Free text fields (eg chief complaint provided by Doctor) ndash
available only in syndromic
Rx Summit wwwNationalRxDrugAbuseSummitorg
Case definitions for suspected overdose
If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED) and free text fields such as chief complaint or triage notes
- Free text searches use common terms slang and misspellings (eg herion instead of heroin)
If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED)
Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency medical services data
Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on
the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)
Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following
Naloxone administration)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Challenges in EMS data
Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp
v340)
Different case definitions in different versions
Missing data feeds
Not all EMS agencies share data
Varying time frame in when data is received- lt24 hours to 6 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Data submission process
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample quality control report
ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)
TOTAL ED VISITS (AGE)
1XX 2017 1 ED Visits mismatch 98287 98309
2XX 2017 2 ED Visits mismatch 98195 98230
3XX 2017 3 ED Visits mismatch 99167 99205
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample site report
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results All drug (11 sites)
0
10
20
30
40
50
60
70
80
90
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d al
l dru
g ov
erdo
se ra
tes
by
100
00 E
D v
isits
Quarter year
-2000
-1000
000
1000
2000
3000
4000
5000
6000
7000
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Opioid (11 sites)
0
5
10
15
20
25
30
35
40
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Heroin (11 sites)
0
5
10
15
20
25
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-15
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Column1 | Any opioid | Natural and semi-synthetic opioid analgesic | Methadone | Synthetic opioid analgesic excluding methadone | Heroin | ||||||
1999 | 1 | 03 | 03 | 07 | |||||||
21 | 1 | 04 | 03 | 07 | |||||||
2001 | 24 | 12 | 05 | 03 | 06 | ||||||
32 | 15 | 08 | 04 | 07 | |||||||
2003 | 35 | 17 | 1 | 05 | 07 | ||||||
39 | 18 | 13 | 06 | 06 | |||||||
2005 | 43 | 19 | 15 | 06 | 07 | ||||||
51 | 23 | 18 | 09 | 07 | |||||||
2007 | 54 | 27 | 18 | 07 | 08 | ||||||
57 | 3 | 16 | 08 | 1 | |||||||
2009 | 59 | 31 | 15 | 1 | 11 | ||||||
62 | 35 | 15 | 1 | 1 | |||||||
2011 | 66 | 37 | 14 | 08 | 14 | ||||||
67 | 35 | 12 | 08 | 19 | |||||||
2013 | 74 | 35 | 11 | 1 | 27 | ||||||
86 | 38 | 11 | 18 | 34 | |||||||
2015 | 104 | 39 | 1 | 31 | 41 | ||||||
133 | 44 | 1 | 62 | 49 |
1999 | 1999 | 1999 | 1999 | ||||
1 | 04 | 03 | 07 | ||||
2001 | 2001 | 2001 | 2001 | ||||
15 | 08 | 04 | 07 | ||||
2003 | 2003 | 2003 | 2003 | ||||
18 | 13 | 06 | 06 | ||||
2005 | 2005 | 2005 | 2005 | ||||
23 | 18 | 09 | 07 | ||||
2007 | 2007 | 2007 | 2007 | ||||
3 | 16 | 08 | 1 | ||||
2009 | 2009 | 2009 | 2009 | ||||
35 | 15 | 1 | 1 | ||||
2011 | 2011 | 2011 | 2011 | ||||
35 | 12 | 08 | 19 | ||||
2013 | 2013 | 2013 | 2013 | ||||
38 | 11 | 18 | 34 | ||||
2015 | 2015 | 2015 | 2015 | ||||
44 | 1 | 62 | 49 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
CDCrsquos Pillars on Opioids Conducting surveillance and research
Building state local and tribal prevention efforts
Supporting healthcare providers and health systems
Partnering with public safety officials
Encouraging consumers to make safe choices about opioids raising awareness about prescription opioid misuse and overdose
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS) 12 states funded in September 2016 20 additional states and the
District of Columbia funded in September 2017 (through September 2019)
Strategy One Increase timeliness of non-fatal opioid overdose reporting- Use syndromic surveillance to establish an early warning system to
detect sharp increases or decreases in non-fatal opioid overdoses - Three indicators suspected all-drug opioid and heroin
Alaska California Connecticut Delaware DC Florida Georgia Illinois Indiana Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Nevada New Hampshire New Jersey New Mexico North Carolina Ohio Oklahoma Pennsylvania Rhode Island Tennessee Utah Vermont Virginia Washington West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS) Strategy Two Increase timeliness of fatal opioid overdose
reporting- Capture detailed information on toxicology death scene
investigations and other risk factors that may be associated with a fatal overdose
Strategy Three widespread dissemination- Rapidly disseminate surveillance findings to key stakeholders
working to prevent or respond to opioid overdoses
ESOOS program expansion in September 2017- At least 60 for comprehensive toxicology testing for opioid-
involved deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
Funded ESOOS states
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS)
Nonfatal Opioid Overdoses Reported
Quarterly
Emergency Department Visits EMS Transports
Fatal Opioid Overdoses Reported within 8 months
of death
Death CertificatesMEC reports
Toxicology reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
Next Two Presentationshellip
The Utilization of Emergency Department Syndromic Surveillance and Emergency Medical Services Data to Monitor Nonfatal Opioid Overdoses ndash Dr Alana Vivolo-Kantor
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System ndash Dr Julie OrsquoDonnell
Rx Summit wwwNationalRxDrugAbuseSummitorg
The utilization of emergency department syndromic surveillance
and emergency medical services data to monitor nonfatal opioid
overdosesPresenter Alana Vivolo-Kantor PhD
Behavioral ScientistCenters for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Julie OrsquoDonnell R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Alana Vivolo-Kantor PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Why Emergency Department and Emergency Medical Service Data for Surveillance
Need- Identify areas experiencing rapid increases in opioid overdoses to
inform responses- More quickly identify promising practices to reduce opioid overdoses
Proven utility to public health and scalable- Local jurisdictions already using it to track and respond to drug
overdoses- Findings from Epi-Aid investigations and collaborative work with states- Leverage existing state and national resources (BioSenseESSENCE)
Action at local and national level- Track quarterly trends across the nation to inform national policy- Improve more rapid local and state public health response
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our Philosophy
Focus on detecting change- Pushing system by looking at trend data over quarters- Some jurisdictions may be able to get and report preliminary
burden estimates
Jurisdiction-driven definitions will outperform national definitions- Local flexibility enhances quality and utility by accounting for large
variance in text entries and coding
National guidance- National definition will provide a good starting place- Guidance to encourage common conceptual definition (eg no
withdrawaldetox) and learn from previous work
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our approach
Non-fatal overdoses
Emergency Department
Near real-time ED collection (ie
syndromic ESSENCE)
Case-level or aggregate data shared
through ESSENCE (BioSense) or directly
with CDC
DischargeBilling Data
Case-level or aggregate data shared
directly with CDC
Emergency Medical Services
Case-level or aggregate data shared
directly with CDC
Includes breakdown by
sex age group and county of residence
Raceethnicity is optional
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency Department Data
Two sources- Near real-time syndromic data (visit information within 24-48 hours)- Lagged hospital billing or claims data (usually within 3-4 weeks)
Different variables used- Discharge diagnosis codes (eg ICD-10-CM) ndash available in billing
data and sometimes in syndromic- Free text fields (eg chief complaint provided by Doctor) ndash
available only in syndromic
Rx Summit wwwNationalRxDrugAbuseSummitorg
Case definitions for suspected overdose
If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED) and free text fields such as chief complaint or triage notes
- Free text searches use common terms slang and misspellings (eg herion instead of heroin)
If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED)
Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency medical services data
Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on
the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)
Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following
Naloxone administration)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Challenges in EMS data
Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp
v340)
Different case definitions in different versions
Missing data feeds
Not all EMS agencies share data
Varying time frame in when data is received- lt24 hours to 6 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Data submission process
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample quality control report
ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)
TOTAL ED VISITS (AGE)
1XX 2017 1 ED Visits mismatch 98287 98309
2XX 2017 2 ED Visits mismatch 98195 98230
3XX 2017 3 ED Visits mismatch 99167 99205
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample site report
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results All drug (11 sites)
0
10
20
30
40
50
60
70
80
90
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d al
l dru
g ov
erdo
se ra
tes
by
100
00 E
D v
isits
Quarter year
-2000
-1000
000
1000
2000
3000
4000
5000
6000
7000
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Opioid (11 sites)
0
5
10
15
20
25
30
35
40
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Heroin (11 sites)
0
5
10
15
20
25
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-15
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Column1 | Any opioid | Natural and semi-synthetic opioid analgesic | Methadone | Synthetic opioid analgesic excluding methadone | Heroin | ||||||
1999 | 1 | 03 | 03 | 07 | |||||||
21 | 1 | 04 | 03 | 07 | |||||||
2001 | 24 | 12 | 05 | 03 | 06 | ||||||
32 | 15 | 08 | 04 | 07 | |||||||
2003 | 35 | 17 | 1 | 05 | 07 | ||||||
39 | 18 | 13 | 06 | 06 | |||||||
2005 | 43 | 19 | 15 | 06 | 07 | ||||||
51 | 23 | 18 | 09 | 07 | |||||||
2007 | 54 | 27 | 18 | 07 | 08 | ||||||
57 | 3 | 16 | 08 | 1 | |||||||
2009 | 59 | 31 | 15 | 1 | 11 | ||||||
62 | 35 | 15 | 1 | 1 | |||||||
2011 | 66 | 37 | 14 | 08 | 14 | ||||||
67 | 35 | 12 | 08 | 19 | |||||||
2013 | 74 | 35 | 11 | 1 | 27 | ||||||
86 | 38 | 11 | 18 | 34 | |||||||
2015 | 104 | 39 | 1 | 31 | 41 | ||||||
133 | 44 | 1 | 62 | 49 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
CDCrsquos Pillars on Opioids Conducting surveillance and research
Building state local and tribal prevention efforts
Supporting healthcare providers and health systems
Partnering with public safety officials
Encouraging consumers to make safe choices about opioids raising awareness about prescription opioid misuse and overdose
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS) 12 states funded in September 2016 20 additional states and the
District of Columbia funded in September 2017 (through September 2019)
Strategy One Increase timeliness of non-fatal opioid overdose reporting- Use syndromic surveillance to establish an early warning system to
detect sharp increases or decreases in non-fatal opioid overdoses - Three indicators suspected all-drug opioid and heroin
Alaska California Connecticut Delaware DC Florida Georgia Illinois Indiana Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Nevada New Hampshire New Jersey New Mexico North Carolina Ohio Oklahoma Pennsylvania Rhode Island Tennessee Utah Vermont Virginia Washington West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS) Strategy Two Increase timeliness of fatal opioid overdose
reporting- Capture detailed information on toxicology death scene
investigations and other risk factors that may be associated with a fatal overdose
Strategy Three widespread dissemination- Rapidly disseminate surveillance findings to key stakeholders
working to prevent or respond to opioid overdoses
ESOOS program expansion in September 2017- At least 60 for comprehensive toxicology testing for opioid-
involved deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
Funded ESOOS states
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS)
Nonfatal Opioid Overdoses Reported
Quarterly
Emergency Department Visits EMS Transports
Fatal Opioid Overdoses Reported within 8 months
of death
Death CertificatesMEC reports
Toxicology reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
Next Two Presentationshellip
The Utilization of Emergency Department Syndromic Surveillance and Emergency Medical Services Data to Monitor Nonfatal Opioid Overdoses ndash Dr Alana Vivolo-Kantor
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System ndash Dr Julie OrsquoDonnell
Rx Summit wwwNationalRxDrugAbuseSummitorg
The utilization of emergency department syndromic surveillance
and emergency medical services data to monitor nonfatal opioid
overdosesPresenter Alana Vivolo-Kantor PhD
Behavioral ScientistCenters for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Julie OrsquoDonnell R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Alana Vivolo-Kantor PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Why Emergency Department and Emergency Medical Service Data for Surveillance
Need- Identify areas experiencing rapid increases in opioid overdoses to
inform responses- More quickly identify promising practices to reduce opioid overdoses
Proven utility to public health and scalable- Local jurisdictions already using it to track and respond to drug
overdoses- Findings from Epi-Aid investigations and collaborative work with states- Leverage existing state and national resources (BioSenseESSENCE)
Action at local and national level- Track quarterly trends across the nation to inform national policy- Improve more rapid local and state public health response
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our Philosophy
Focus on detecting change- Pushing system by looking at trend data over quarters- Some jurisdictions may be able to get and report preliminary
burden estimates
Jurisdiction-driven definitions will outperform national definitions- Local flexibility enhances quality and utility by accounting for large
variance in text entries and coding
National guidance- National definition will provide a good starting place- Guidance to encourage common conceptual definition (eg no
withdrawaldetox) and learn from previous work
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our approach
Non-fatal overdoses
Emergency Department
Near real-time ED collection (ie
syndromic ESSENCE)
Case-level or aggregate data shared
through ESSENCE (BioSense) or directly
with CDC
DischargeBilling Data
Case-level or aggregate data shared
directly with CDC
Emergency Medical Services
Case-level or aggregate data shared
directly with CDC
Includes breakdown by
sex age group and county of residence
Raceethnicity is optional
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency Department Data
Two sources- Near real-time syndromic data (visit information within 24-48 hours)- Lagged hospital billing or claims data (usually within 3-4 weeks)
Different variables used- Discharge diagnosis codes (eg ICD-10-CM) ndash available in billing
data and sometimes in syndromic- Free text fields (eg chief complaint provided by Doctor) ndash
available only in syndromic
Rx Summit wwwNationalRxDrugAbuseSummitorg
Case definitions for suspected overdose
If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED) and free text fields such as chief complaint or triage notes
- Free text searches use common terms slang and misspellings (eg herion instead of heroin)
If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED)
Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency medical services data
Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on
the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)
Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following
Naloxone administration)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Challenges in EMS data
Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp
v340)
Different case definitions in different versions
Missing data feeds
Not all EMS agencies share data
Varying time frame in when data is received- lt24 hours to 6 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Data submission process
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample quality control report
ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)
TOTAL ED VISITS (AGE)
1XX 2017 1 ED Visits mismatch 98287 98309
2XX 2017 2 ED Visits mismatch 98195 98230
3XX 2017 3 ED Visits mismatch 99167 99205
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample site report
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results All drug (11 sites)
0
10
20
30
40
50
60
70
80
90
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d al
l dru
g ov
erdo
se ra
tes
by
100
00 E
D v
isits
Quarter year
-2000
-1000
000
1000
2000
3000
4000
5000
6000
7000
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Opioid (11 sites)
0
5
10
15
20
25
30
35
40
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Heroin (11 sites)
0
5
10
15
20
25
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-15
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS) 12 states funded in September 2016 20 additional states and the
District of Columbia funded in September 2017 (through September 2019)
Strategy One Increase timeliness of non-fatal opioid overdose reporting- Use syndromic surveillance to establish an early warning system to
detect sharp increases or decreases in non-fatal opioid overdoses - Three indicators suspected all-drug opioid and heroin
Alaska California Connecticut Delaware DC Florida Georgia Illinois Indiana Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Nevada New Hampshire New Jersey New Mexico North Carolina Ohio Oklahoma Pennsylvania Rhode Island Tennessee Utah Vermont Virginia Washington West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS) Strategy Two Increase timeliness of fatal opioid overdose
reporting- Capture detailed information on toxicology death scene
investigations and other risk factors that may be associated with a fatal overdose
Strategy Three widespread dissemination- Rapidly disseminate surveillance findings to key stakeholders
working to prevent or respond to opioid overdoses
ESOOS program expansion in September 2017- At least 60 for comprehensive toxicology testing for opioid-
involved deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
Funded ESOOS states
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS)
Nonfatal Opioid Overdoses Reported
Quarterly
Emergency Department Visits EMS Transports
Fatal Opioid Overdoses Reported within 8 months
of death
Death CertificatesMEC reports
Toxicology reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
Next Two Presentationshellip
The Utilization of Emergency Department Syndromic Surveillance and Emergency Medical Services Data to Monitor Nonfatal Opioid Overdoses ndash Dr Alana Vivolo-Kantor
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System ndash Dr Julie OrsquoDonnell
Rx Summit wwwNationalRxDrugAbuseSummitorg
The utilization of emergency department syndromic surveillance
and emergency medical services data to monitor nonfatal opioid
overdosesPresenter Alana Vivolo-Kantor PhD
Behavioral ScientistCenters for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Julie OrsquoDonnell R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Alana Vivolo-Kantor PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Why Emergency Department and Emergency Medical Service Data for Surveillance
Need- Identify areas experiencing rapid increases in opioid overdoses to
inform responses- More quickly identify promising practices to reduce opioid overdoses
Proven utility to public health and scalable- Local jurisdictions already using it to track and respond to drug
overdoses- Findings from Epi-Aid investigations and collaborative work with states- Leverage existing state and national resources (BioSenseESSENCE)
Action at local and national level- Track quarterly trends across the nation to inform national policy- Improve more rapid local and state public health response
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our Philosophy
Focus on detecting change- Pushing system by looking at trend data over quarters- Some jurisdictions may be able to get and report preliminary
burden estimates
Jurisdiction-driven definitions will outperform national definitions- Local flexibility enhances quality and utility by accounting for large
variance in text entries and coding
National guidance- National definition will provide a good starting place- Guidance to encourage common conceptual definition (eg no
withdrawaldetox) and learn from previous work
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our approach
Non-fatal overdoses
Emergency Department
Near real-time ED collection (ie
syndromic ESSENCE)
Case-level or aggregate data shared
through ESSENCE (BioSense) or directly
with CDC
DischargeBilling Data
Case-level or aggregate data shared
directly with CDC
Emergency Medical Services
Case-level or aggregate data shared
directly with CDC
Includes breakdown by
sex age group and county of residence
Raceethnicity is optional
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency Department Data
Two sources- Near real-time syndromic data (visit information within 24-48 hours)- Lagged hospital billing or claims data (usually within 3-4 weeks)
Different variables used- Discharge diagnosis codes (eg ICD-10-CM) ndash available in billing
data and sometimes in syndromic- Free text fields (eg chief complaint provided by Doctor) ndash
available only in syndromic
Rx Summit wwwNationalRxDrugAbuseSummitorg
Case definitions for suspected overdose
If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED) and free text fields such as chief complaint or triage notes
- Free text searches use common terms slang and misspellings (eg herion instead of heroin)
If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED)
Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency medical services data
Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on
the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)
Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following
Naloxone administration)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Challenges in EMS data
Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp
v340)
Different case definitions in different versions
Missing data feeds
Not all EMS agencies share data
Varying time frame in when data is received- lt24 hours to 6 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Data submission process
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample quality control report
ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)
TOTAL ED VISITS (AGE)
1XX 2017 1 ED Visits mismatch 98287 98309
2XX 2017 2 ED Visits mismatch 98195 98230
3XX 2017 3 ED Visits mismatch 99167 99205
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample site report
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results All drug (11 sites)
0
10
20
30
40
50
60
70
80
90
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d al
l dru
g ov
erdo
se ra
tes
by
100
00 E
D v
isits
Quarter year
-2000
-1000
000
1000
2000
3000
4000
5000
6000
7000
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Opioid (11 sites)
0
5
10
15
20
25
30
35
40
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Heroin (11 sites)
0
5
10
15
20
25
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-15
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS) Strategy Two Increase timeliness of fatal opioid overdose
reporting- Capture detailed information on toxicology death scene
investigations and other risk factors that may be associated with a fatal overdose
Strategy Three widespread dissemination- Rapidly disseminate surveillance findings to key stakeholders
working to prevent or respond to opioid overdoses
ESOOS program expansion in September 2017- At least 60 for comprehensive toxicology testing for opioid-
involved deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
Funded ESOOS states
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS)
Nonfatal Opioid Overdoses Reported
Quarterly
Emergency Department Visits EMS Transports
Fatal Opioid Overdoses Reported within 8 months
of death
Death CertificatesMEC reports
Toxicology reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
Next Two Presentationshellip
The Utilization of Emergency Department Syndromic Surveillance and Emergency Medical Services Data to Monitor Nonfatal Opioid Overdoses ndash Dr Alana Vivolo-Kantor
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System ndash Dr Julie OrsquoDonnell
Rx Summit wwwNationalRxDrugAbuseSummitorg
The utilization of emergency department syndromic surveillance
and emergency medical services data to monitor nonfatal opioid
overdosesPresenter Alana Vivolo-Kantor PhD
Behavioral ScientistCenters for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Julie OrsquoDonnell R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Alana Vivolo-Kantor PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Why Emergency Department and Emergency Medical Service Data for Surveillance
Need- Identify areas experiencing rapid increases in opioid overdoses to
inform responses- More quickly identify promising practices to reduce opioid overdoses
Proven utility to public health and scalable- Local jurisdictions already using it to track and respond to drug
overdoses- Findings from Epi-Aid investigations and collaborative work with states- Leverage existing state and national resources (BioSenseESSENCE)
Action at local and national level- Track quarterly trends across the nation to inform national policy- Improve more rapid local and state public health response
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our Philosophy
Focus on detecting change- Pushing system by looking at trend data over quarters- Some jurisdictions may be able to get and report preliminary
burden estimates
Jurisdiction-driven definitions will outperform national definitions- Local flexibility enhances quality and utility by accounting for large
variance in text entries and coding
National guidance- National definition will provide a good starting place- Guidance to encourage common conceptual definition (eg no
withdrawaldetox) and learn from previous work
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our approach
Non-fatal overdoses
Emergency Department
Near real-time ED collection (ie
syndromic ESSENCE)
Case-level or aggregate data shared
through ESSENCE (BioSense) or directly
with CDC
DischargeBilling Data
Case-level or aggregate data shared
directly with CDC
Emergency Medical Services
Case-level or aggregate data shared
directly with CDC
Includes breakdown by
sex age group and county of residence
Raceethnicity is optional
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency Department Data
Two sources- Near real-time syndromic data (visit information within 24-48 hours)- Lagged hospital billing or claims data (usually within 3-4 weeks)
Different variables used- Discharge diagnosis codes (eg ICD-10-CM) ndash available in billing
data and sometimes in syndromic- Free text fields (eg chief complaint provided by Doctor) ndash
available only in syndromic
Rx Summit wwwNationalRxDrugAbuseSummitorg
Case definitions for suspected overdose
If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED) and free text fields such as chief complaint or triage notes
- Free text searches use common terms slang and misspellings (eg herion instead of heroin)
If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED)
Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency medical services data
Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on
the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)
Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following
Naloxone administration)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Challenges in EMS data
Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp
v340)
Different case definitions in different versions
Missing data feeds
Not all EMS agencies share data
Varying time frame in when data is received- lt24 hours to 6 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Data submission process
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample quality control report
ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)
TOTAL ED VISITS (AGE)
1XX 2017 1 ED Visits mismatch 98287 98309
2XX 2017 2 ED Visits mismatch 98195 98230
3XX 2017 3 ED Visits mismatch 99167 99205
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample site report
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results All drug (11 sites)
0
10
20
30
40
50
60
70
80
90
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d al
l dru
g ov
erdo
se ra
tes
by
100
00 E
D v
isits
Quarter year
-2000
-1000
000
1000
2000
3000
4000
5000
6000
7000
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Opioid (11 sites)
0
5
10
15
20
25
30
35
40
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Heroin (11 sites)
0
5
10
15
20
25
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-15
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Funded ESOOS states
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS)
Nonfatal Opioid Overdoses Reported
Quarterly
Emergency Department Visits EMS Transports
Fatal Opioid Overdoses Reported within 8 months
of death
Death CertificatesMEC reports
Toxicology reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
Next Two Presentationshellip
The Utilization of Emergency Department Syndromic Surveillance and Emergency Medical Services Data to Monitor Nonfatal Opioid Overdoses ndash Dr Alana Vivolo-Kantor
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System ndash Dr Julie OrsquoDonnell
Rx Summit wwwNationalRxDrugAbuseSummitorg
The utilization of emergency department syndromic surveillance
and emergency medical services data to monitor nonfatal opioid
overdosesPresenter Alana Vivolo-Kantor PhD
Behavioral ScientistCenters for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Julie OrsquoDonnell R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Alana Vivolo-Kantor PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Why Emergency Department and Emergency Medical Service Data for Surveillance
Need- Identify areas experiencing rapid increases in opioid overdoses to
inform responses- More quickly identify promising practices to reduce opioid overdoses
Proven utility to public health and scalable- Local jurisdictions already using it to track and respond to drug
overdoses- Findings from Epi-Aid investigations and collaborative work with states- Leverage existing state and national resources (BioSenseESSENCE)
Action at local and national level- Track quarterly trends across the nation to inform national policy- Improve more rapid local and state public health response
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our Philosophy
Focus on detecting change- Pushing system by looking at trend data over quarters- Some jurisdictions may be able to get and report preliminary
burden estimates
Jurisdiction-driven definitions will outperform national definitions- Local flexibility enhances quality and utility by accounting for large
variance in text entries and coding
National guidance- National definition will provide a good starting place- Guidance to encourage common conceptual definition (eg no
withdrawaldetox) and learn from previous work
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our approach
Non-fatal overdoses
Emergency Department
Near real-time ED collection (ie
syndromic ESSENCE)
Case-level or aggregate data shared
through ESSENCE (BioSense) or directly
with CDC
DischargeBilling Data
Case-level or aggregate data shared
directly with CDC
Emergency Medical Services
Case-level or aggregate data shared
directly with CDC
Includes breakdown by
sex age group and county of residence
Raceethnicity is optional
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency Department Data
Two sources- Near real-time syndromic data (visit information within 24-48 hours)- Lagged hospital billing or claims data (usually within 3-4 weeks)
Different variables used- Discharge diagnosis codes (eg ICD-10-CM) ndash available in billing
data and sometimes in syndromic- Free text fields (eg chief complaint provided by Doctor) ndash
available only in syndromic
Rx Summit wwwNationalRxDrugAbuseSummitorg
Case definitions for suspected overdose
If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED) and free text fields such as chief complaint or triage notes
- Free text searches use common terms slang and misspellings (eg herion instead of heroin)
If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED)
Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency medical services data
Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on
the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)
Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following
Naloxone administration)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Challenges in EMS data
Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp
v340)
Different case definitions in different versions
Missing data feeds
Not all EMS agencies share data
Varying time frame in when data is received- lt24 hours to 6 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Data submission process
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample quality control report
ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)
TOTAL ED VISITS (AGE)
1XX 2017 1 ED Visits mismatch 98287 98309
2XX 2017 2 ED Visits mismatch 98195 98230
3XX 2017 3 ED Visits mismatch 99167 99205
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample site report
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results All drug (11 sites)
0
10
20
30
40
50
60
70
80
90
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d al
l dru
g ov
erdo
se ra
tes
by
100
00 E
D v
isits
Quarter year
-2000
-1000
000
1000
2000
3000
4000
5000
6000
7000
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Opioid (11 sites)
0
5
10
15
20
25
30
35
40
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Heroin (11 sites)
0
5
10
15
20
25
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-15
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Enhanced State Opioid Overdose Surveillance (ESOOS)
Nonfatal Opioid Overdoses Reported
Quarterly
Emergency Department Visits EMS Transports
Fatal Opioid Overdoses Reported within 8 months
of death
Death CertificatesMEC reports
Toxicology reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
Next Two Presentationshellip
The Utilization of Emergency Department Syndromic Surveillance and Emergency Medical Services Data to Monitor Nonfatal Opioid Overdoses ndash Dr Alana Vivolo-Kantor
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System ndash Dr Julie OrsquoDonnell
Rx Summit wwwNationalRxDrugAbuseSummitorg
The utilization of emergency department syndromic surveillance
and emergency medical services data to monitor nonfatal opioid
overdosesPresenter Alana Vivolo-Kantor PhD
Behavioral ScientistCenters for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Julie OrsquoDonnell R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Alana Vivolo-Kantor PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Why Emergency Department and Emergency Medical Service Data for Surveillance
Need- Identify areas experiencing rapid increases in opioid overdoses to
inform responses- More quickly identify promising practices to reduce opioid overdoses
Proven utility to public health and scalable- Local jurisdictions already using it to track and respond to drug
overdoses- Findings from Epi-Aid investigations and collaborative work with states- Leverage existing state and national resources (BioSenseESSENCE)
Action at local and national level- Track quarterly trends across the nation to inform national policy- Improve more rapid local and state public health response
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our Philosophy
Focus on detecting change- Pushing system by looking at trend data over quarters- Some jurisdictions may be able to get and report preliminary
burden estimates
Jurisdiction-driven definitions will outperform national definitions- Local flexibility enhances quality and utility by accounting for large
variance in text entries and coding
National guidance- National definition will provide a good starting place- Guidance to encourage common conceptual definition (eg no
withdrawaldetox) and learn from previous work
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our approach
Non-fatal overdoses
Emergency Department
Near real-time ED collection (ie
syndromic ESSENCE)
Case-level or aggregate data shared
through ESSENCE (BioSense) or directly
with CDC
DischargeBilling Data
Case-level or aggregate data shared
directly with CDC
Emergency Medical Services
Case-level or aggregate data shared
directly with CDC
Includes breakdown by
sex age group and county of residence
Raceethnicity is optional
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency Department Data
Two sources- Near real-time syndromic data (visit information within 24-48 hours)- Lagged hospital billing or claims data (usually within 3-4 weeks)
Different variables used- Discharge diagnosis codes (eg ICD-10-CM) ndash available in billing
data and sometimes in syndromic- Free text fields (eg chief complaint provided by Doctor) ndash
available only in syndromic
Rx Summit wwwNationalRxDrugAbuseSummitorg
Case definitions for suspected overdose
If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED) and free text fields such as chief complaint or triage notes
- Free text searches use common terms slang and misspellings (eg herion instead of heroin)
If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED)
Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency medical services data
Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on
the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)
Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following
Naloxone administration)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Challenges in EMS data
Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp
v340)
Different case definitions in different versions
Missing data feeds
Not all EMS agencies share data
Varying time frame in when data is received- lt24 hours to 6 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Data submission process
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample quality control report
ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)
TOTAL ED VISITS (AGE)
1XX 2017 1 ED Visits mismatch 98287 98309
2XX 2017 2 ED Visits mismatch 98195 98230
3XX 2017 3 ED Visits mismatch 99167 99205
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample site report
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results All drug (11 sites)
0
10
20
30
40
50
60
70
80
90
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d al
l dru
g ov
erdo
se ra
tes
by
100
00 E
D v
isits
Quarter year
-2000
-1000
000
1000
2000
3000
4000
5000
6000
7000
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Opioid (11 sites)
0
5
10
15
20
25
30
35
40
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Heroin (11 sites)
0
5
10
15
20
25
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-15
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Next Two Presentationshellip
The Utilization of Emergency Department Syndromic Surveillance and Emergency Medical Services Data to Monitor Nonfatal Opioid Overdoses ndash Dr Alana Vivolo-Kantor
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System ndash Dr Julie OrsquoDonnell
Rx Summit wwwNationalRxDrugAbuseSummitorg
The utilization of emergency department syndromic surveillance
and emergency medical services data to monitor nonfatal opioid
overdosesPresenter Alana Vivolo-Kantor PhD
Behavioral ScientistCenters for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Julie OrsquoDonnell R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Alana Vivolo-Kantor PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Why Emergency Department and Emergency Medical Service Data for Surveillance
Need- Identify areas experiencing rapid increases in opioid overdoses to
inform responses- More quickly identify promising practices to reduce opioid overdoses
Proven utility to public health and scalable- Local jurisdictions already using it to track and respond to drug
overdoses- Findings from Epi-Aid investigations and collaborative work with states- Leverage existing state and national resources (BioSenseESSENCE)
Action at local and national level- Track quarterly trends across the nation to inform national policy- Improve more rapid local and state public health response
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our Philosophy
Focus on detecting change- Pushing system by looking at trend data over quarters- Some jurisdictions may be able to get and report preliminary
burden estimates
Jurisdiction-driven definitions will outperform national definitions- Local flexibility enhances quality and utility by accounting for large
variance in text entries and coding
National guidance- National definition will provide a good starting place- Guidance to encourage common conceptual definition (eg no
withdrawaldetox) and learn from previous work
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our approach
Non-fatal overdoses
Emergency Department
Near real-time ED collection (ie
syndromic ESSENCE)
Case-level or aggregate data shared
through ESSENCE (BioSense) or directly
with CDC
DischargeBilling Data
Case-level or aggregate data shared
directly with CDC
Emergency Medical Services
Case-level or aggregate data shared
directly with CDC
Includes breakdown by
sex age group and county of residence
Raceethnicity is optional
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency Department Data
Two sources- Near real-time syndromic data (visit information within 24-48 hours)- Lagged hospital billing or claims data (usually within 3-4 weeks)
Different variables used- Discharge diagnosis codes (eg ICD-10-CM) ndash available in billing
data and sometimes in syndromic- Free text fields (eg chief complaint provided by Doctor) ndash
available only in syndromic
Rx Summit wwwNationalRxDrugAbuseSummitorg
Case definitions for suspected overdose
If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED) and free text fields such as chief complaint or triage notes
- Free text searches use common terms slang and misspellings (eg herion instead of heroin)
If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED)
Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency medical services data
Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on
the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)
Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following
Naloxone administration)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Challenges in EMS data
Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp
v340)
Different case definitions in different versions
Missing data feeds
Not all EMS agencies share data
Varying time frame in when data is received- lt24 hours to 6 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Data submission process
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample quality control report
ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)
TOTAL ED VISITS (AGE)
1XX 2017 1 ED Visits mismatch 98287 98309
2XX 2017 2 ED Visits mismatch 98195 98230
3XX 2017 3 ED Visits mismatch 99167 99205
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample site report
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results All drug (11 sites)
0
10
20
30
40
50
60
70
80
90
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d al
l dru
g ov
erdo
se ra
tes
by
100
00 E
D v
isits
Quarter year
-2000
-1000
000
1000
2000
3000
4000
5000
6000
7000
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Opioid (11 sites)
0
5
10
15
20
25
30
35
40
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Heroin (11 sites)
0
5
10
15
20
25
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-15
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
The utilization of emergency department syndromic surveillance
and emergency medical services data to monitor nonfatal opioid
overdosesPresenter Alana Vivolo-Kantor PhD
Behavioral ScientistCenters for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Julie OrsquoDonnell R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Alana Vivolo-Kantor PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Why Emergency Department and Emergency Medical Service Data for Surveillance
Need- Identify areas experiencing rapid increases in opioid overdoses to
inform responses- More quickly identify promising practices to reduce opioid overdoses
Proven utility to public health and scalable- Local jurisdictions already using it to track and respond to drug
overdoses- Findings from Epi-Aid investigations and collaborative work with states- Leverage existing state and national resources (BioSenseESSENCE)
Action at local and national level- Track quarterly trends across the nation to inform national policy- Improve more rapid local and state public health response
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our Philosophy
Focus on detecting change- Pushing system by looking at trend data over quarters- Some jurisdictions may be able to get and report preliminary
burden estimates
Jurisdiction-driven definitions will outperform national definitions- Local flexibility enhances quality and utility by accounting for large
variance in text entries and coding
National guidance- National definition will provide a good starting place- Guidance to encourage common conceptual definition (eg no
withdrawaldetox) and learn from previous work
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our approach
Non-fatal overdoses
Emergency Department
Near real-time ED collection (ie
syndromic ESSENCE)
Case-level or aggregate data shared
through ESSENCE (BioSense) or directly
with CDC
DischargeBilling Data
Case-level or aggregate data shared
directly with CDC
Emergency Medical Services
Case-level or aggregate data shared
directly with CDC
Includes breakdown by
sex age group and county of residence
Raceethnicity is optional
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency Department Data
Two sources- Near real-time syndromic data (visit information within 24-48 hours)- Lagged hospital billing or claims data (usually within 3-4 weeks)
Different variables used- Discharge diagnosis codes (eg ICD-10-CM) ndash available in billing
data and sometimes in syndromic- Free text fields (eg chief complaint provided by Doctor) ndash
available only in syndromic
Rx Summit wwwNationalRxDrugAbuseSummitorg
Case definitions for suspected overdose
If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED) and free text fields such as chief complaint or triage notes
- Free text searches use common terms slang and misspellings (eg herion instead of heroin)
If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED)
Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency medical services data
Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on
the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)
Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following
Naloxone administration)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Challenges in EMS data
Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp
v340)
Different case definitions in different versions
Missing data feeds
Not all EMS agencies share data
Varying time frame in when data is received- lt24 hours to 6 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Data submission process
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample quality control report
ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)
TOTAL ED VISITS (AGE)
1XX 2017 1 ED Visits mismatch 98287 98309
2XX 2017 2 ED Visits mismatch 98195 98230
3XX 2017 3 ED Visits mismatch 99167 99205
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample site report
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results All drug (11 sites)
0
10
20
30
40
50
60
70
80
90
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d al
l dru
g ov
erdo
se ra
tes
by
100
00 E
D v
isits
Quarter year
-2000
-1000
000
1000
2000
3000
4000
5000
6000
7000
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Opioid (11 sites)
0
5
10
15
20
25
30
35
40
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Heroin (11 sites)
0
5
10
15
20
25
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-15
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Alana Vivolo-Kantor PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Why Emergency Department and Emergency Medical Service Data for Surveillance
Need- Identify areas experiencing rapid increases in opioid overdoses to
inform responses- More quickly identify promising practices to reduce opioid overdoses
Proven utility to public health and scalable- Local jurisdictions already using it to track and respond to drug
overdoses- Findings from Epi-Aid investigations and collaborative work with states- Leverage existing state and national resources (BioSenseESSENCE)
Action at local and national level- Track quarterly trends across the nation to inform national policy- Improve more rapid local and state public health response
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our Philosophy
Focus on detecting change- Pushing system by looking at trend data over quarters- Some jurisdictions may be able to get and report preliminary
burden estimates
Jurisdiction-driven definitions will outperform national definitions- Local flexibility enhances quality and utility by accounting for large
variance in text entries and coding
National guidance- National definition will provide a good starting place- Guidance to encourage common conceptual definition (eg no
withdrawaldetox) and learn from previous work
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our approach
Non-fatal overdoses
Emergency Department
Near real-time ED collection (ie
syndromic ESSENCE)
Case-level or aggregate data shared
through ESSENCE (BioSense) or directly
with CDC
DischargeBilling Data
Case-level or aggregate data shared
directly with CDC
Emergency Medical Services
Case-level or aggregate data shared
directly with CDC
Includes breakdown by
sex age group and county of residence
Raceethnicity is optional
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency Department Data
Two sources- Near real-time syndromic data (visit information within 24-48 hours)- Lagged hospital billing or claims data (usually within 3-4 weeks)
Different variables used- Discharge diagnosis codes (eg ICD-10-CM) ndash available in billing
data and sometimes in syndromic- Free text fields (eg chief complaint provided by Doctor) ndash
available only in syndromic
Rx Summit wwwNationalRxDrugAbuseSummitorg
Case definitions for suspected overdose
If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED) and free text fields such as chief complaint or triage notes
- Free text searches use common terms slang and misspellings (eg herion instead of heroin)
If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED)
Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency medical services data
Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on
the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)
Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following
Naloxone administration)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Challenges in EMS data
Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp
v340)
Different case definitions in different versions
Missing data feeds
Not all EMS agencies share data
Varying time frame in when data is received- lt24 hours to 6 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Data submission process
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample quality control report
ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)
TOTAL ED VISITS (AGE)
1XX 2017 1 ED Visits mismatch 98287 98309
2XX 2017 2 ED Visits mismatch 98195 98230
3XX 2017 3 ED Visits mismatch 99167 99205
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample site report
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results All drug (11 sites)
0
10
20
30
40
50
60
70
80
90
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d al
l dru
g ov
erdo
se ra
tes
by
100
00 E
D v
isits
Quarter year
-2000
-1000
000
1000
2000
3000
4000
5000
6000
7000
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Opioid (11 sites)
0
5
10
15
20
25
30
35
40
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Heroin (11 sites)
0
5
10
15
20
25
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-15
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Why Emergency Department and Emergency Medical Service Data for Surveillance
Need- Identify areas experiencing rapid increases in opioid overdoses to
inform responses- More quickly identify promising practices to reduce opioid overdoses
Proven utility to public health and scalable- Local jurisdictions already using it to track and respond to drug
overdoses- Findings from Epi-Aid investigations and collaborative work with states- Leverage existing state and national resources (BioSenseESSENCE)
Action at local and national level- Track quarterly trends across the nation to inform national policy- Improve more rapid local and state public health response
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our Philosophy
Focus on detecting change- Pushing system by looking at trend data over quarters- Some jurisdictions may be able to get and report preliminary
burden estimates
Jurisdiction-driven definitions will outperform national definitions- Local flexibility enhances quality and utility by accounting for large
variance in text entries and coding
National guidance- National definition will provide a good starting place- Guidance to encourage common conceptual definition (eg no
withdrawaldetox) and learn from previous work
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our approach
Non-fatal overdoses
Emergency Department
Near real-time ED collection (ie
syndromic ESSENCE)
Case-level or aggregate data shared
through ESSENCE (BioSense) or directly
with CDC
DischargeBilling Data
Case-level or aggregate data shared
directly with CDC
Emergency Medical Services
Case-level or aggregate data shared
directly with CDC
Includes breakdown by
sex age group and county of residence
Raceethnicity is optional
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency Department Data
Two sources- Near real-time syndromic data (visit information within 24-48 hours)- Lagged hospital billing or claims data (usually within 3-4 weeks)
Different variables used- Discharge diagnosis codes (eg ICD-10-CM) ndash available in billing
data and sometimes in syndromic- Free text fields (eg chief complaint provided by Doctor) ndash
available only in syndromic
Rx Summit wwwNationalRxDrugAbuseSummitorg
Case definitions for suspected overdose
If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED) and free text fields such as chief complaint or triage notes
- Free text searches use common terms slang and misspellings (eg herion instead of heroin)
If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED)
Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency medical services data
Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on
the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)
Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following
Naloxone administration)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Challenges in EMS data
Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp
v340)
Different case definitions in different versions
Missing data feeds
Not all EMS agencies share data
Varying time frame in when data is received- lt24 hours to 6 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Data submission process
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample quality control report
ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)
TOTAL ED VISITS (AGE)
1XX 2017 1 ED Visits mismatch 98287 98309
2XX 2017 2 ED Visits mismatch 98195 98230
3XX 2017 3 ED Visits mismatch 99167 99205
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample site report
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results All drug (11 sites)
0
10
20
30
40
50
60
70
80
90
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d al
l dru
g ov
erdo
se ra
tes
by
100
00 E
D v
isits
Quarter year
-2000
-1000
000
1000
2000
3000
4000
5000
6000
7000
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Opioid (11 sites)
0
5
10
15
20
25
30
35
40
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Heroin (11 sites)
0
5
10
15
20
25
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-15
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our Philosophy
Focus on detecting change- Pushing system by looking at trend data over quarters- Some jurisdictions may be able to get and report preliminary
burden estimates
Jurisdiction-driven definitions will outperform national definitions- Local flexibility enhances quality and utility by accounting for large
variance in text entries and coding
National guidance- National definition will provide a good starting place- Guidance to encourage common conceptual definition (eg no
withdrawaldetox) and learn from previous work
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our approach
Non-fatal overdoses
Emergency Department
Near real-time ED collection (ie
syndromic ESSENCE)
Case-level or aggregate data shared
through ESSENCE (BioSense) or directly
with CDC
DischargeBilling Data
Case-level or aggregate data shared
directly with CDC
Emergency Medical Services
Case-level or aggregate data shared
directly with CDC
Includes breakdown by
sex age group and county of residence
Raceethnicity is optional
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency Department Data
Two sources- Near real-time syndromic data (visit information within 24-48 hours)- Lagged hospital billing or claims data (usually within 3-4 weeks)
Different variables used- Discharge diagnosis codes (eg ICD-10-CM) ndash available in billing
data and sometimes in syndromic- Free text fields (eg chief complaint provided by Doctor) ndash
available only in syndromic
Rx Summit wwwNationalRxDrugAbuseSummitorg
Case definitions for suspected overdose
If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED) and free text fields such as chief complaint or triage notes
- Free text searches use common terms slang and misspellings (eg herion instead of heroin)
If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED)
Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency medical services data
Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on
the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)
Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following
Naloxone administration)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Challenges in EMS data
Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp
v340)
Different case definitions in different versions
Missing data feeds
Not all EMS agencies share data
Varying time frame in when data is received- lt24 hours to 6 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Data submission process
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample quality control report
ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)
TOTAL ED VISITS (AGE)
1XX 2017 1 ED Visits mismatch 98287 98309
2XX 2017 2 ED Visits mismatch 98195 98230
3XX 2017 3 ED Visits mismatch 99167 99205
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample site report
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results All drug (11 sites)
0
10
20
30
40
50
60
70
80
90
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d al
l dru
g ov
erdo
se ra
tes
by
100
00 E
D v
isits
Quarter year
-2000
-1000
000
1000
2000
3000
4000
5000
6000
7000
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Opioid (11 sites)
0
5
10
15
20
25
30
35
40
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Heroin (11 sites)
0
5
10
15
20
25
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-15
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Our approach
Non-fatal overdoses
Emergency Department
Near real-time ED collection (ie
syndromic ESSENCE)
Case-level or aggregate data shared
through ESSENCE (BioSense) or directly
with CDC
DischargeBilling Data
Case-level or aggregate data shared
directly with CDC
Emergency Medical Services
Case-level or aggregate data shared
directly with CDC
Includes breakdown by
sex age group and county of residence
Raceethnicity is optional
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency Department Data
Two sources- Near real-time syndromic data (visit information within 24-48 hours)- Lagged hospital billing or claims data (usually within 3-4 weeks)
Different variables used- Discharge diagnosis codes (eg ICD-10-CM) ndash available in billing
data and sometimes in syndromic- Free text fields (eg chief complaint provided by Doctor) ndash
available only in syndromic
Rx Summit wwwNationalRxDrugAbuseSummitorg
Case definitions for suspected overdose
If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED) and free text fields such as chief complaint or triage notes
- Free text searches use common terms slang and misspellings (eg herion instead of heroin)
If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED)
Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency medical services data
Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on
the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)
Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following
Naloxone administration)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Challenges in EMS data
Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp
v340)
Different case definitions in different versions
Missing data feeds
Not all EMS agencies share data
Varying time frame in when data is received- lt24 hours to 6 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Data submission process
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample quality control report
ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)
TOTAL ED VISITS (AGE)
1XX 2017 1 ED Visits mismatch 98287 98309
2XX 2017 2 ED Visits mismatch 98195 98230
3XX 2017 3 ED Visits mismatch 99167 99205
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample site report
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results All drug (11 sites)
0
10
20
30
40
50
60
70
80
90
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d al
l dru
g ov
erdo
se ra
tes
by
100
00 E
D v
isits
Quarter year
-2000
-1000
000
1000
2000
3000
4000
5000
6000
7000
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Opioid (11 sites)
0
5
10
15
20
25
30
35
40
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Heroin (11 sites)
0
5
10
15
20
25
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-15
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency Department Data
Two sources- Near real-time syndromic data (visit information within 24-48 hours)- Lagged hospital billing or claims data (usually within 3-4 weeks)
Different variables used- Discharge diagnosis codes (eg ICD-10-CM) ndash available in billing
data and sometimes in syndromic- Free text fields (eg chief complaint provided by Doctor) ndash
available only in syndromic
Rx Summit wwwNationalRxDrugAbuseSummitorg
Case definitions for suspected overdose
If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED) and free text fields such as chief complaint or triage notes
- Free text searches use common terms slang and misspellings (eg herion instead of heroin)
If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED)
Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency medical services data
Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on
the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)
Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following
Naloxone administration)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Challenges in EMS data
Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp
v340)
Different case definitions in different versions
Missing data feeds
Not all EMS agencies share data
Varying time frame in when data is received- lt24 hours to 6 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Data submission process
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample quality control report
ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)
TOTAL ED VISITS (AGE)
1XX 2017 1 ED Visits mismatch 98287 98309
2XX 2017 2 ED Visits mismatch 98195 98230
3XX 2017 3 ED Visits mismatch 99167 99205
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample site report
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results All drug (11 sites)
0
10
20
30
40
50
60
70
80
90
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d al
l dru
g ov
erdo
se ra
tes
by
100
00 E
D v
isits
Quarter year
-2000
-1000
000
1000
2000
3000
4000
5000
6000
7000
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Opioid (11 sites)
0
5
10
15
20
25
30
35
40
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Heroin (11 sites)
0
5
10
15
20
25
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-15
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Case definitions for suspected overdose
If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED) and free text fields such as chief complaint or triage notes
- Free text searches use common terms slang and misspellings (eg herion instead of heroin)
If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and
SNOMED)
Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency medical services data
Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on
the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)
Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following
Naloxone administration)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Challenges in EMS data
Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp
v340)
Different case definitions in different versions
Missing data feeds
Not all EMS agencies share data
Varying time frame in when data is received- lt24 hours to 6 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Data submission process
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample quality control report
ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)
TOTAL ED VISITS (AGE)
1XX 2017 1 ED Visits mismatch 98287 98309
2XX 2017 2 ED Visits mismatch 98195 98230
3XX 2017 3 ED Visits mismatch 99167 99205
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample site report
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results All drug (11 sites)
0
10
20
30
40
50
60
70
80
90
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d al
l dru
g ov
erdo
se ra
tes
by
100
00 E
D v
isits
Quarter year
-2000
-1000
000
1000
2000
3000
4000
5000
6000
7000
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Opioid (11 sites)
0
5
10
15
20
25
30
35
40
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Heroin (11 sites)
0
5
10
15
20
25
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-15
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency medical services data
Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on
the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)
Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following
Naloxone administration)
Rx Summit wwwNationalRxDrugAbuseSummitorg
Challenges in EMS data
Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp
v340)
Different case definitions in different versions
Missing data feeds
Not all EMS agencies share data
Varying time frame in when data is received- lt24 hours to 6 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Data submission process
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample quality control report
ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)
TOTAL ED VISITS (AGE)
1XX 2017 1 ED Visits mismatch 98287 98309
2XX 2017 2 ED Visits mismatch 98195 98230
3XX 2017 3 ED Visits mismatch 99167 99205
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample site report
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results All drug (11 sites)
0
10
20
30
40
50
60
70
80
90
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d al
l dru
g ov
erdo
se ra
tes
by
100
00 E
D v
isits
Quarter year
-2000
-1000
000
1000
2000
3000
4000
5000
6000
7000
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Opioid (11 sites)
0
5
10
15
20
25
30
35
40
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Heroin (11 sites)
0
5
10
15
20
25
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-15
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Challenges in EMS data
Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp
v340)
Different case definitions in different versions
Missing data feeds
Not all EMS agencies share data
Varying time frame in when data is received- lt24 hours to 6 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Data submission process
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample quality control report
ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)
TOTAL ED VISITS (AGE)
1XX 2017 1 ED Visits mismatch 98287 98309
2XX 2017 2 ED Visits mismatch 98195 98230
3XX 2017 3 ED Visits mismatch 99167 99205
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample site report
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results All drug (11 sites)
0
10
20
30
40
50
60
70
80
90
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d al
l dru
g ov
erdo
se ra
tes
by
100
00 E
D v
isits
Quarter year
-2000
-1000
000
1000
2000
3000
4000
5000
6000
7000
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Opioid (11 sites)
0
5
10
15
20
25
30
35
40
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Heroin (11 sites)
0
5
10
15
20
25
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-15
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Data submission process
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample quality control report
ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)
TOTAL ED VISITS (AGE)
1XX 2017 1 ED Visits mismatch 98287 98309
2XX 2017 2 ED Visits mismatch 98195 98230
3XX 2017 3 ED Visits mismatch 99167 99205
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample site report
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results All drug (11 sites)
0
10
20
30
40
50
60
70
80
90
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d al
l dru
g ov
erdo
se ra
tes
by
100
00 E
D v
isits
Quarter year
-2000
-1000
000
1000
2000
3000
4000
5000
6000
7000
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Opioid (11 sites)
0
5
10
15
20
25
30
35
40
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Heroin (11 sites)
0
5
10
15
20
25
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-15
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample quality control report
ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)
TOTAL ED VISITS (AGE)
1XX 2017 1 ED Visits mismatch 98287 98309
2XX 2017 2 ED Visits mismatch 98195 98230
3XX 2017 3 ED Visits mismatch 99167 99205
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample site report
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results All drug (11 sites)
0
10
20
30
40
50
60
70
80
90
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d al
l dru
g ov
erdo
se ra
tes
by
100
00 E
D v
isits
Quarter year
-2000
-1000
000
1000
2000
3000
4000
5000
6000
7000
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Opioid (11 sites)
0
5
10
15
20
25
30
35
40
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Heroin (11 sites)
0
5
10
15
20
25
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-15
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Sample site report
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results All drug (11 sites)
0
10
20
30
40
50
60
70
80
90
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d al
l dru
g ov
erdo
se ra
tes
by
100
00 E
D v
isits
Quarter year
-2000
-1000
000
1000
2000
3000
4000
5000
6000
7000
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Opioid (11 sites)
0
5
10
15
20
25
30
35
40
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Heroin (11 sites)
0
5
10
15
20
25
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-15
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results All drug (11 sites)
0
10
20
30
40
50
60
70
80
90
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d al
l dru
g ov
erdo
se ra
tes
by
100
00 E
D v
isits
Quarter year
-2000
-1000
000
1000
2000
3000
4000
5000
6000
7000
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Opioid (11 sites)
0
5
10
15
20
25
30
35
40
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Heroin (11 sites)
0
5
10
15
20
25
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-15
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Opioid (11 sites)
0
5
10
15
20
25
30
35
40
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Heroin (11 sites)
0
5
10
15
20
25
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-15
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
ED results Heroin (11 sites)
0
5
10
15
20
25
Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017
Susp
ecte
d op
ioid
ove
rdos
e ra
tes
by
100
00 E
D v
isits
Quarter year
-15
-10
-5
0
5
10
15
20
Δ fromQ1-Q2 2016
Δ fromQ2-Q3 2016
Δ fromQ3-Q4 2016
Δ fromQ4 2016-Q1
2017
Δ fromQ1-Q2 2017
Δ fromQ2-Q3 2017
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Annual percentage changes (11 sites)
Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Q12016-Q12017 | Q12016-Q12017 | Q12016-Q12017 | |||
Q22016-Q22017 | Q22016-Q22017 | Q22016-Q22017 | |||
Q32016-Q32017 | Q32016-Q32017 | Q32016-Q32017 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 | |||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | ||||||||
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | |||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | ||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
All drug | 286 | 6225 | 462 | 819 | 1303 | -871 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Opioid | 77 | -785 | 853 | 1212 | 1442 | -868 | |||||||||
Δ fromQ1-Q2 2016 | Δ fromQ2-Q3 2016 | Δ fromQ3-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1-Q2 2017 | Δ fromQ2-Q3 2017 | ||||||||||
Heroin | 136 | 674 | 701 | 1251 | 1486 | -1209 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Q1 2016 | Q2 2016 | Q3 2016 | Q4 2016 | Q1 2017 | Q2 2017 | Q3 2017 | q1 | q2 | q3 | ||||||||||||
All drug | 3948 | 4061 | 6589 | 6894 | 7458 | 8430 | 7696 | 889150252325 | 1075831326045 | 167997701832 | |||||||||||
Heroin | 1452 | 1472 | 1571 | 1681 | 1891 | 2173 | 191 | 302341597796 | 476222826087 | 215786123488 | |||||||||||
Opioid | 2447 | 2636 | 2429 | 2636 | 2956 | 3382 | 3088 | 208009807928 | 283004552352 | 271305063812 | |||||||||||
Q12016-Q12017 | Q22016-Q22017 | Q32016-Q32017 | |||||||||||||||||||
All drug | 889150252325 | 1075831326045 | 167997701832 | ||||||||||||||||||
Heroin | 302341597796 | 476222826087 | 215786123488 | ||||||||||||||||||
Opioid | 208009807928 | 283004552352 | 271305063812 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Male | -140 | 7355 | 827 | 901 | 1286 | -927 | 742 | -758 | 1157 | 1241 | 1306 | -829 | 146 | 301 | 1082 | 1242 | 1306 | -1249 | |||||||||||||||||||
Female | 841 | 5151 | 103 | 733 | 1257 | -1521 | 659 | -922 | 533 | 1204 | 1494 | -1014 | -132 | 1299 | 229 | 1331 | 1617 | -1214 | |||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 4888 | 4820 | 8365 | 9057 | 9873 | 11142 | 10110 | ||||||||||||||||||||||||||||||
Female | 3201 | 3470 | 5257 | 5312 | 5701 | 6418 | 5442 | ||||||||||||||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 3611 | 3879 | 3585 | 40 | 4496 | 5083 | 4662 | ||||||||||||||||||||||||||||||
Female | 159 | 1695 | 1538 | 162 | 1816 | 2087 | 1875 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Male | 2295 | 2328 | 2399 | 2658 | 2988 | 3379 | 2957 | ||||||||||||||||||||||||||||||
Female | 839 | 828 | 936 | 957 | 1085 | 126 | 1107 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
all drug | all opioids | heroin | ||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | |||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
all drug | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
opioid | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up | ||||||||||||||||||||||||||||||||||||
heroin | ||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | ||||||||||||||||||||||||||||||
15 to 24 | ||||||||||||||||||||||||||||||||||||
25 to 34 | ||||||||||||||||||||||||||||||||||||
35 to 54 | ||||||||||||||||||||||||||||||||||||
55 and up |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
all drug | all opioids | heroin | |||||||||||||||||||||||||||||||||||
Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | Δ fromQ1 2016-Q2 2016 | Δ fromQ2 2016-Q3 2016 | Δ fromQ3 2016-Q4 2016 | Δ fromQ4 2016-Q1 2017 | Δ fromQ1 2017-Q2 2017 | Δ fromQ2 2017-Q3 2017 | ||||||||||||||||||||
Maine | 1941 | -1273 | 225 | 278 | 1523 | -201 | 3951 | -692 | 257 | -813 | 2945 | 981 | 793 | 656 | -299 | -2255 | 3199 | 2197 | |||||||||||||||||||
Massachusetts | na | na | na | na | na | na | 1561 | -157 | -848 | -1148 | 311 | 1897 | 553 | -31 | -13 | -1632 | 456 | 2146 | |||||||||||||||||||
New Hampshire | 511 | 1514 | -1438 | -832 | 2583 | -961 | 318 | 64 | -433 | -1791 | 2967 | -876 | 825 | -184 | -1002 | -2016 | 3363 | -17 | |||||||||||||||||||
Pennsylvania | na | na | 869 | -102 | 1211 | -116 | na | na | 2979 | 1751 | 2589 | -594 | na | na | 2601 | 1534 | 2735 | -735 | |||||||||||||||||||
Rhode Island | na | na | 735 | -790 | 1002 | -1594 | na | na | 28 | 454 | 544 | -1191 | na | na | 121 | 1057 | 566 | -3262 | |||||||||||||||||||
West Virginia | -1596 | 875 | 2978 | -1543 | 409 | -1651 | -367 | 995 | 4331 | -1664 | 402 | -2377 | -769 | 1847 | 4571 | -1584 | -199 | -3022 | |||||||||||||||||||
Kentucky | -102 | 1242 | -1707 | 2211 | 1092 | -1468 | 1095 | 5192 | -2694 | 4045 | 352 | -2002 | -043 | 5541 | -3206 | 5012 | -408 | -1624 | |||||||||||||||||||
New Mexico | 2932 | 283 | 521 | -078 | 445 | -716 | 255 | -1298 | 2611 | 151 | -501 | -1093 | -487 | -3061 | 3227 | 987 | -1715 | 323 | |||||||||||||||||||
Missouri | 068 | -304 | 754 | 028 | 114 | 421 | 292 | 827 | 477 | -177 | 954 | 767 | -046 | 1839 | 096 | -512 | 966 | 125 | |||||||||||||||||||
Ohio | na | na | 107 | 1216 | 1596 | -1865 | na | na | 2274 | 2567 | 2167 | -3194 | na | na | 2182 | 2254 | 2086 | -3348 | |||||||||||||||||||
Wisconsin | -229 | 1388 | 861 | 2928 | 888 | 931 | -948 | 986 | 1712 | 6728 | 322 | 314 | -1457 | 91 | 983 | 9621 | 196 | 668 | |||||||||||||||||||
opioid | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 1514 | 2112 | 1966 | 2017 | 1853 | 2398 | 2634 | ||||||||||||||||||||||||||||||
Massachusetts | 7036 | 8133 | 8006 | 7327 | 6486 | 6687 | 7956 | ||||||||||||||||||||||||||||||
New Hampshire | 3806 | 3927 | 4179 | 3998 | 3282 | 4255 | 3882 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1265 | 1641 | 1929 | 2428 | 2284 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 1498 | 154 | 161 | 1698 | 1496 | ||||||||||||||||||||||||||||||
West Virginia | 2258 | 2176 | 2392 | 3428 | 2857 | 2972 | 2266 | ||||||||||||||||||||||||||||||
Kentucky | 2095 | 2325 | 3532 | 258 | 3624 | 3752 | 3001 | ||||||||||||||||||||||||||||||
New Mexico | 1927 | 1976 | 1719 | 2168 | 2201 | 2091 | 1862 | ||||||||||||||||||||||||||||||
Missouri | 1472 | 1515 | 1641 | 1719 | 1688 | 185 | 1991 | ||||||||||||||||||||||||||||||
Ohio | na | na | 236 | 2897 | 3641 | 443 | 3015 | ||||||||||||||||||||||||||||||
Wisconsin | 664 | 601 | 66 | 773 | 1294 | 1336 | 1377 | ||||||||||||||||||||||||||||||
heroin | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 502 | 9 | 959 | 931 | 721 | 952 | 1161 | ||||||||||||||||||||||||||||||
Massachusetts | 4035 | 4258 | 4126 | 359 | 3004 | 3141 | 3815 | ||||||||||||||||||||||||||||||
New Hampshire | 2514 | 2721 | 2671 | 2403 | 1919 | 2564 | 2128 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 1013 | 1277 | 1473 | 1876 | 1738 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 803 | 812 | 898 | 949 | 639 | ||||||||||||||||||||||||||||||
West Virginia | 1496 | 1381 | 1636 | 2384 | 2006 | 1966 | 1372 | ||||||||||||||||||||||||||||||
Kentucky | 1772 | 1764 | 2741 | 1863 | 2796 | 2682 | 2247 | ||||||||||||||||||||||||||||||
New Mexico | 902 | 858 | 595 | 787 | 865 | 717 | 74 | ||||||||||||||||||||||||||||||
Missouri | 1002 | 997 | 118 | 1192 | 1131 | 124 | 1255 | ||||||||||||||||||||||||||||||
Ohio | na | na | 1804 | 2198 | 2693 | 3254 | 2165 | ||||||||||||||||||||||||||||||
Wisconsin | 286 | 244 | 267 | 293 | 575 | 586 | 625 | ||||||||||||||||||||||||||||||
all drug | |||||||||||||||||||||||||||||||||||||
Q1 2016 rate | Q2 2016 rate | Q3 2016 rate | Q4 2016 rate | Q1 2017 rate | Q2 2017 rate | Q3 2017 rate | |||||||||||||||||||||||||||||||
Maine | 5609 | 6697 | 5845 | 5976 | 6142 | 7078 | 6936 | ||||||||||||||||||||||||||||||
Massachusetts | na | na | na | na | na | na | na | ||||||||||||||||||||||||||||||
New Hampshire | 5678 | 5968 | 6872 | 5883 | 5394 | 6787 | 6135 | ||||||||||||||||||||||||||||||
Pennsylvania | na | na | 8374 | 9102 | 9010 | 10100 | 9983 | ||||||||||||||||||||||||||||||
Rhode Island | na | na | 3567 | 3829 | 3527 | 3880 | 3262 | ||||||||||||||||||||||||||||||
West Virginia | 4628 | 3889 | 4229 | 5489 | 4642 | 4832 | 4034 | ||||||||||||||||||||||||||||||
Kentucky | 6756 | 6687 | 7517 | 6234 | 7613 | 8444 | 7205 | ||||||||||||||||||||||||||||||
New Mexico | 5291 | 6842 | 7036 | 7402 | 7345 | 7672 | 7123 | ||||||||||||||||||||||||||||||
Missouri | 3213 | 3235 | 3137 | 3373 | 3383 | 3421 | 3565 | ||||||||||||||||||||||||||||||
Ohio | na | na | 8696 | 8789 | 9859 | 11432 | 9300 | ||||||||||||||||||||||||||||||
Wisconsin | 2724 | 2661 | 3031 | 3291 | 4255 | 4633 | 5064 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Summary
Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017
Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin
Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Emergency department data dissemination efforts
ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose
Reporting System
Presenter Julie OrsquoDonnell PhD MPHEpidemiologist
Centers for Disease Control and Prevention
Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Disclosure Statement
Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services
Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Increase in deaths outpaces increase in use
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid
overdose
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Fatal opioid overdose surveillance
Track specific substances contributing to overdose deaths
Detect newly-emerging substances involved in overdose
Determine risk factors circumstances associated with fatal overdose
Assess common drug combinations Provide more timely data on overdose deaths
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
State Unintentional Drug Overdose Reporting System (SUDORS)
Death certificates
Medical examiner
coroner reportsToxicology
reports
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data submitted bi-annually
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
1 Data entry started
2 Data entry finished
1 Data entry started
2 Data entry finished
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS leverages National Violent Death Reporting System (NVDRS) platform
- Basic descriptors- Compare across demographics
- Recent release from institution- Overdose location - Survival time
- Mental health diagnoses- Substance abuse treatment history
- Substances present- Substances contributing to death
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Overdose-specific fields
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Toxicology information
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS data as good as sources allow
Death Certificates
- Drug specificity- Time lag in
cause of death codes
Medical Examiner Coroner Reports
- Scene evidence availability
- Death scene investigation
Toxicology Reports
- Testing availability
- Emerging substances
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Despite limitations SUDORS data have many strengths
Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months
Flexibility to include substances contributing to death outside of death certificate textcode fields
Overdose-specific circumstance data collected within 8 months
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
Cohort 1 states (N=10)
Preliminary resultsMissouri Pennsylvania data not available
Total deaths (20162017)10699
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
1st half 2017 | |
2nd half 2016 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Series 1 | Series 2 | Series 3 | |||||
1st half 2017 | 5592 | 24 | 2 | ||||
2nd half 2016 | 5377 | 44 | 2 | ||||
Category 3 | 35 | 18 | 3 | ||||
Category 4 | 45 | 28 | 5 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Number of opioid overdose deaths by state and reporting period
Preliminary results
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
KY | KY | ||
ME | ME | ||
MA | MA | ||
NH | NH | ||
NM | NM | ||
OH | OH | ||
OK | OK | ||
RI | RI | ||
WV | WV | ||
WI | WI |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
KY-2016 | KY-2017 | ME-2016 | ME-2017 | MA-2016 | MA-2017 | MO-2016 | MO-2017 | NH-2016 | NH-2017 | NM-2016 | NM-2017 | OH-2016 | OH-2017 | OK-2016 | OK-2017 | PA-2016 | PA-2017 | RI-2016 | RI-2017 | WV-2016 | WV-2017 | WI-2016 | WI-2017 | |||||||||||||||||||||||||
IMF | 171 | 82 | 60 | 708 | 596 | 236 | 84 | 132 | 146 | 13 | 11 | 996 | 1291 | 8 | 11 | 695 | 1002 | 79 | 48 | 164 | 205 | 106 | 96 | |||||||||||||||||||||||||
Rx fent | 5 | 1 | 1 | 3 | 1 | 5 | 2 | 1 | 0 | 6 | 0 | 5 | 2 | 11 | 11 | 5 | 2 | 3 | 1 | 2 | 0 | 7 | 3 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||
2016 | 000 | 2821 | 163 | 070 | 1244 | 663 | 2648 | 095 | 490 | 205 | 2030 | 407 | |||||||||||||||
2017 | 2986 | 136 | 000 | 1485 | 024 | 4641 | 235 | 1894 | 885 | 2902 | 1804 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
opioid deaths overall | |||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | ||||||||||||||||||
2nd-half 2016 | 524 | 156 | 1108 | 427 | 193 | 166 | 2063 | 210 | 1388 | 145 | 394 | 418 | 7192 | ||||||||||||||||
1st-half 2017 | 646 | 144 | 883 | 127 | 205 | 155 | 2389 | 214 | 1452 | 120 | 442 | 394 | 7171 | ||||||||||||||||
14363 | |||||||||||||||||||||||||||||
14522 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
2016 and 2017 data combined (KY currently doesnt have any 2017 data in there) | |||||||||||||||||||||||||||||||||||
of all opioid deaths with these categories as cause of death (not mutually exclusive) | of each drug category with circumstances | ||||||||||||||||||||||||||||||||||
KY | ME | MA | MO | NH | NM | OH | OK | PA | RI | WV | WI | Prescription | Heroin | Fentanyl | |||||||||||||||||||||
Prescription | 097 | 3133 | 2163 | 2166 | 1519 | 4860 | 1954 | 6525 | 2447 | 3861 | 4014 | 3375 | Recent release | 789 | 1151 | 993 | |||||||||||||||||||
Heroin | 4854 | 3700 | 3737 | 4224 | 886 | 5701 | 3581 | 2435 | 5032 | 2317 | 3860 | 6117 | Prior OD | 1023 | 1234 | 1331 | |||||||||||||||||||
Fentanyl | 7467 | 7716 | 6264 | 8759 | 1215 | 7708 | 1820 | 7415 | 7027 | 6615 | 3598 | Current treatment | 980 | 836 | 755 | ||||||||||||||||||||
Recent opioid use relapse | 755 | 1620 | 1296 | ||||||||||||||||||||||||||||||||
History of heroin abuse | 1946 | 4259 | 3926 | ||||||||||||||||||||||||||||||||
History of Rx opioid abuse | 1434 | 361 | 393 | ||||||||||||||||||||||||||||||||
History of Rx opioid AND heroin abuse | 541 | 656 | 603 |
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Most common prescription opioids involved in opioid overdose deaths
Prescription opioids3285 (30) deaths
Oxycodone1331 (41)
Hydrocodone576 (18)
Methadone542 (17)
Morphine448 (14)
Buprenorphine374 (11)
Oxymorphone334 (10)
Preliminary results
Substances listed as cause of death count does not include fentanyl categories not mutually exclusive
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Redefining morphine as heroin using scene and toxicology evidence
MorphineOriginal 4569 (42)Recoded 557 (6)
HeroinConfirmed 3437 (31)
Probable 813 (7)Suspected 0
Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no
evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death
Morphine recoded morphine-positive not confirmedprobablesuspected heroin
Unknown morphine-positive no scene evidence
Preliminary results
Unknown386 (4)
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
SUDORS Data
Drug potency
Polysubstance use
Route of administration
Overdose response
Health conditions
comorbidities
Capturing fentanyl analogs
All substances
present
Scene evidence indicating route(s)
Bystanders present naloxone
administration
Pain treatment
comorbidities
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Acknowledgments
State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program
State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE
CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin
- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
Rx Summit wwwNationalRxDrugAbuseSummitorg
Faster Data The CDC-Funded Enhanced State Opioid Overdose
Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team
Centers for Disease Control and Prevention (CDC)
Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC
Julie ODonnell PhD MPH Epidemiologist CDC
Federal Track
Moderator Puja Seth
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg
THANK YOURxSummit
wwwNationalRxDrugAbuseSummitorg