Faster Data: The CDC-Funded Enhanced State Opioid …Vivolo-Kantor AM, Seth P, Gladden RM, Mattson CL, Baldwin GT, Kite- Powell A, Coletta MA. Vital Signs: Trends in Emergency Department

#Rx Summit www.NationalRxDrugAbuseSummit.org

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, CDCJulie O'Donnell, PhD, MPH, Epidemiologist, CDC

Federal Track

Moderator: Puja Seth


Disclosures

Puja Seth, PhD; Alana Vivolo-Kantor, PhD, MPH; and Julie O'Donnell, PhD, MPH, have disclosed no relevant, real, or apparent personal or professional financial relationships with proprietary entities that produce healthcare goods and services.


Disclosures

All planners/managers hereby state that they or their spouse/life 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 planners/managers have the following to disclose:- Kelly J. Clark, MD, MBA, FASAM, DFAPA –

Consulting fees: Braeburn, Indivior


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.


Faster Data: The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)

Puja Seth, Ph.D.Alana Vivolo-Kantor, Ph.D.

Julie O’Donnell, Ph.D.

Division of Unintentional Injury PreventionCenters for Disease Control and Prevention


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.


Goals

Describe CDC’s 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.


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 — United States, July 2016–September 2017.(https://www.cdc.gov/mmwr/volumes/67/wr/mm6709e1.htm) MMWR Morb Mortal Wkly Rep.2018;67.

https://www.cdc.gov/mmwr/volumes/67/wr/mm6709e1.htm


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 — United States, July 2016–September 2017.(https://www.cdc.gov/mmwr/volumes/67/wr/mm6709e1.htm) MMWR Morb Mortal Wkly Rep.2018;67.

https://www.cdc.gov/mmwr/volumes/67/wr/mm6709e1.htm


2000 Rapid Increase in Drug Overdose Death Rates by County

SOURCE: NCHS Data Visualization Gallery

#Rx Summit www.NationalRxDrugAbuseSummit.orgSOURCE: NCHS Data Visualization Gallery



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

00,0

00 p

opul

atio

n

Chart1

1999199919991999

10.40.30.7

2001200120012001

1.50.80.40.7

2003200320032003

1.81.30.60.6

2005200520052005

2.31.80.90.7

2007200720072007

31.60.81

2009200920092009

3.51.511

2011201120112011

3.51.20.81.9

2013201320132013

3.81.11.83.4

2015201520152015

4.416.24.9

Synthetic opioidslike fentanyl

3 Waves

Almost 351,630 people have died from an opioid overdose during 1999-2016

Natural and semi-synthetic opioid analgesic

Methadone

Synthetic opioid analgesic, excluding methadone

Heroin

1

0.3

0.3

0.7

1.2

0.5

0.3

0.6

1.7

1

0.5

0.7

1.9

1.5

0.6

0.7

2.7

1.8

0.7

0.8

3.1

1.5

1

1.1

3.7

1.4

0.8

1.4

3.5

1.1

1

2.7

3.9

1

3.1

4.1

Sheet1

Column1Any opioidNatural and semi-synthetic opioid analgesicMethadoneSynthetic opioid analgesic, excluding methadoneHeroin

199910.30.30.7

2.110.40.30.7

20012.41.20.50.30.6

3.21.50.80.40.7

20033.51.710.50.7

3.91.81.30.60.6

20054.31.91.50.60.7

5.12.31.80.90.7

20075.42.71.80.70.8

5.731.60.81

20095.93.11.511.1

6.23.51.511

20116.63.71.40.81.4

6.73.51.20.81.9

20137.43.51.112.7

8.63.81.11.83.4

201510.43.913.14.1

13.34.416.24.9


CDC’s 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.


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

https://www.cdc.gov/drugoverdose/foa/state-opioid-mm.html


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

https://www.cdc.gov/drugoverdose/foa/state-opioid-mm.html


Funded ESOOS states


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 CertificatesME/C reports

Toxicology reports


Next Two Presentations…

The Utilization of Emergency Department Syndromic Surveillance and Emergency Medical Services Data to Monitor Nonfatal Opioid Overdoses – Dr. Alana Vivolo-Kantor

Fatal Opioid Overdose Surveillance:The State Unintentional Drug Overdose Reporting System – Dr. Julie O’Donnell


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 O’Donnell, R. Matthew Gladden



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.



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 (BioSense/ESSENCE)

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


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 (e.g., no

withdrawal/detox) and learn from previous work


Our approach

Non-fatal overdoses

Emergency Department

Near real-time ED collection (i.e.

syndromic, ESSENCE)

Case-level or aggregate data shared

through ESSENCE (BioSense) or directly

with CDC

Discharge/Billing Data


directly with CDC

Emergency Medical Services


directly with CDC

Includes breakdown by

sex, age group, and county of residence.

Race/ethnicity is optional


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 (e.g., ICD-10-CM) – available in billing

data and sometimes in syndromic- Free text fields (e.g., chief complaint provided by Doctor) –

available only in syndromic


Case definitions for suspected overdose

If syndromic...- Uses both discharge codes (i.e., 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 (e.g., herion instead of heroin)

If hospital billing or claims…- Uses only discharge codes (i.e., ICD-9-CM, ICD-10-CM, and

SNOMED)

Discharge codes use are for acute unintentional or undetermined drug poisoning (e.g., T40.1X1A in ICD-10-CM) and may also include some substance use/abuse codes (i.e., F11 in ICD-10-CM)


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 “treatment” (e.g., patient refused or required no treatment or transport)

Different variables used:- Chief Complaint; Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (i.e., Naloxone)- Response to medication administered (i.e., awake following

Naloxone administration)


Challenges in EMS data

Transition to newer versions of NEMSIS- Some states working in up to three versions (v2.2.1, v3.3.4, &

v3.4.0)

Different case definitions in different versions

Missing data feeds

Not all EMS agencies share data

Varying time frame in when data is received-


Data submission process


Sample quality control report

ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)

TOTAL ED VISITS (AGE)

1XX 2017 1 ED Visits mismatch 98287 98309




Sample site report


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

10,0

00 E

D v

isits

Quarter, year

-20.00

-10.00

0.00

10.00

20.00

30.00

40.00

50.00

60.00

70.00

% Δ 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


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

10,0

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



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

10,0

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



Annual percentage changes (11 sites*)


Chart1

Q12016-Q12017Q12016-Q12017Q12016-Q12017

Q22016-Q22017Q22016-Q22017Q22016-Q22017

Q32016-Q32017Q32016-Q32017Q32016-Q32017

All drug

Heroin

Opioid

88.9150252325

30.2341597796

20.8009807928

107.5831326045

47.6222826087

28.3004552352

16.7997701832

21.5786123488

27.1305063812

table with overall

% Δ 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 drug2.8662.254.628.1913.03-8.71

Heroin1.366.747.0112.5114.86-12.09

Opioid7.7-7.858.5312.1214.42-8.68

Q1 2016Q2 2016Q3 2016Q4 2016Q1 2017Q2 2017Q3 2017

All drug39.4840.6165.8968.9474.5884.3076.96

Heroin14.5214.7215.7116.8118.9121.7319.1

Opioid24.4726.3624.2926.3629.5633.8230.88

Q1 2016Q2 2016Q3 2016Q4 2016Q1 2017Q2 2017Q3 2017

All drug39.4840.6165.8968.9474.5884.3076.96

Q1 2016Q2 2016Q3 2016Q4 2016Q1 2017Q2 2017Q3 2017

Opioid24.4726.3624.2926.3629.5633.8230.88

Q1 2016Q2 2016Q3 2016Q4 2016Q1 2017Q2 2017Q3 2017

Heroin14.5214.7215.7116.8118.9121.7319.1


All drug2.8662.254.628.1913.03-8.71


Opioid7.7-7.858.5312.1214.42-8.68


Heroin1.366.747.0112.5114.86-12.09

table with overall

All drug

Suspected all drug overdose rates by 10,000 ED visits

Sheet1

All drug

table by sex

Opioid

Quarter, year

Suspected opioid overdose rates by 10,000 ED visits

table by age

Opioid

table by state

Heroin

Quarter, year

Suspected opioid overdose rates by 10,000 ED visits

Heroin

Q1 2016Q2 2016Q3 2016Q4 2016Q1 2017Q2 2017Q3 2017q1q2q3

All drug39.4840.6165.8968.9474.5884.3076.9688.9150252325107.583132604516.7997701832

Heroin14.5214.7215.7116.8118.9121.7319.130.234159779647.622282608721.5786123488

Opioid24.4726.3624.2926.3629.5633.8230.8820.800980792828.300455235227.1305063812

Q12016-Q12017Q22016-Q22017Q32016-Q32017

All drug88.9150252325107.583132604516.7997701832

Heroin30.234159779647.622282608721.5786123488

Opioid20.800980792828.300455235227.1305063812

All drug

Heroin

Opioid

all drugall opioidsheroin

% Δ fromQ1 2016-Q2 2016% Δ fromQ2 2016-Q3 2016% Δ fromQ3 2016-Q4 2016% Δ fromQ4 2016-Q1 2017% Δ fromQ1 2017-Q2 2017% Δ fromQ2 2017-Q3 2017% Δ fromQ1 2016-Q2 2016% Δ fromQ2 2016-Q3 2016% Δ fromQ3 2016-Q4 2016% Δ fromQ4 2016-Q1 2017% Δ fromQ1 2017-Q2 2017% Δ fromQ2 2017-Q3 2017% Δ fromQ1 2016-Q2 2016% Δ 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-1.4073.558.279.0112.86-9.277.42-7.5811.5712.4113.06-8.291.463.0110.8212.4213.06-12.49

Female8.4151.511.037.3312.57-15.216.59-9.225.3312.0414.94-10.14-1.3212.992.2913.3116.17-12.14

all drug

Q1 2016 rateQ2 2016 rateQ3 2016 rateQ4 2016 rateQ1 2017 rateQ2 2017 rateQ3 2017 rate

Male48.8848.2083.6590.5798.73111.42101.10

Female32.0134.7052.5753.1257.0164.1854.42

opioid


Male36.1138.7935.854044.9650.8346.62

Female15.916.9515.3816.218.1620.8718.75

heroin


Male22.9523.2823.9926.5829.8833.7929.57

Female8.398.289.369.5710.8512.611.07



15 to 24

25 to 34

35 to 54

55 and up

all drug


15 to 24

25 to 34

35 to 54

55 and up

opioid


15 to 24

25 to 34

35 to 54

55 and up

heroin


15 to 24

25 to 34

35 to 54

55 and up



Maine19.41-12.732.252.7815.23-2.0139.51-6.922.57-8.1329.459.8179.36.56-2.99-22.5531.9921.97

Massachusettsn/an/an/an/an/an/a15.61-1.57-8.48-11.483.1118.975.53-3.1-13-16.324.5621.46

New Hampshire5.1115.14-14.38-8.3225.83-9.613.186.4-4.33-17.9129.67-8.768.25-1.84-10.02-20.1633.63-17

Pennsylvanian/an/a8.69-1.0212.11-1.16n/an/a29.7917.5125.89-5.94n/an/a26.0115.3427.35-7.35

Rhode Islandn/an/a7.35-7.9010.02-15.94n/an/a2.84.545.44-11.91n/an/a1.2110.575.66-32.62

West Virginia-15.968.7529.78-15.434.09-16.51-3.679.9543.31-16.644.02-23.77-7.6918.4745.71-15.84-1.99-30.22

Kentucky-1.0212.42-17.0722.1110.92-14.6810.9551.92-26.9440.453.52-20.02-0.4355.41-32.0650.12-4.08-16.24

New Mexico29.322.835.21-0.784.45-7.162.55-12.9826.111.51-5.01-10.93-4.87-30.6132.279.87-17.153.23

Missouri0.68-3.047.540.281.144.212.928.274.77-1.779.547.67-0.4618.390.96-5.129.661.25

Ohion/an/a1.0712.1615.96-18.65n/an/a22.7425.6721.67-31.94n/an/a21.8222.5420.86-33.48

Wisconsin-2.2913.888.6129.288.889.31-9.489.8617.1267.283.223.14-14.579.19.8396.211.966.68

opioid


Maine15.1421.1219.6620.1718.5323.9826.34

Massachusetts70.3681.3380.0673.2764.8666.8779.56

New Hampshire38.0639.2741.7939.9832.8242.5538.82

Pennsylvanian/an/a12.6516.4119.2924.2822.84

Rhode Islandn/an/a14.9815.416.116.9814.96

West Virginia22.5821.7623.9234.2828.5729.7222.66

Kentucky20.9523.2535.3225.836.2437.5230.01

New Mexico19.2719.7617.1921.6822.0120.9118.62

Missouri14.7215.1516.4117.1916.8818.519.91

Ohion/an/a23.628.9736.4144.330.15

Wisconsin6.646.016.67.7312.9413.3613.77

heroin


Maine5.0299.599.317.219.5211.61

Massachusetts40.3542.5841.2635.930.0431.4138.15

New Hampshire25.1427.2126.7124.0319.1925.6421.28



West Virginia14.9613.8116.3623.8420.0619.6613.72

Kentucky17.7217.6427.4118.6327.9626.8222.47

New Mexico9.028.585.957.878.657.177.4

Missouri10.029.9711.811.9211.3112.412.55

Ohion/an/a18.0421.9826.9332.5421.65

Wisconsin2.862.442.672.935.755.866.25

all drug


Maine56.0966.9758.4559.7661.4270.7869.36

Massachusettsn/an/an/an/an/an/an/a

New Hampshire56.7859.6868.7258.8353.9467.8761.35



West Virginia46.2838.8942.2954.8946.4248.3240.34

Kentucky67.5666.8775.1762.3476.1384.4472.05

New Mexico52.9168.4270.3674.0273.4576.7271.23

Missouri32.1332.3531.3733.7333.8334.2135.65

Ohion/an/a86.9687.8998.59114.3293.00

Wisconsin27.2426.6130.3132.9142.5546.3350.64


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, & 21% opioid- Q2 to Q2: 108% all drug, 48% heroin, & 28% opioid- Q3 to Q3: 17% all drug, 22% heroin, & 27% opioid


Emergency department data dissemination efforts

“Opioid Overdoses Treated in Emergency Departments” -https://www.cdc.gov/vitalsigns/opioid-overdoses/index.html

https://www.cdc.gov/vitalsigns/opioid-overdoses/index.html


Fatal Opioid Overdose Surveillance:The State Unintentional Drug Overdose

Reporting System

Presenter: Julie O’Donnell, PhD MPHEpidemiologist

Centers for Disease Control and Prevention

Co-authors: Christine Mattson, Puja Seth, Alana Vivolo-Kantor, R. Matthew Gladden



Julie O’Donnell, PhD, has disclosed no relevant, real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services.



Increase in deaths outpaces increase in use


Fatal opioid

overdose

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions/

comorbidities


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


State Unintentional Drug Overdose Reporting System (SUDORS)

Death certificates

Medical examiner/

coroner reportsToxicology

reports


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


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


Overdose-specific fields


Toxicology information


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


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 text/code fields

Overdose-specific circumstance data collected within 8 months


Preliminary results


Number of opioid overdose deaths increasing, 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)*

*Preliminary results*Missouri, Pennsylvania data not available

Chart1

1st half 2017

2nd half 2016

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Series 1Series 2Series 3

1st half 20175,5922.42

2nd half 20165,3774.42

Category 33.51.83

Category 44.52.85


Number of opioid overdose deaths increasing, 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)*

*Preliminary results*Missouri, Pennsylvania data not available

Total deaths (2016/2017):10,699

Chart1

1st half 2017

2nd half 2016

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Series 1Series 2Series 3

1st half 20175,5922.42

2nd half 20165,3774.42

Category 33.51.83

Category 44.52.85


Number of opioid overdose deaths by state and reporting period

*Preliminary results

Chart1

KYKY

MEME

MAMA

NHNH

NMNM

OHOH

OKOK

RIRI

WVWV

WIWI

2nd-half 2016

1st-half 2017

State

Number of deaths

524

646

156

144

1108

883

193

205

166

155

2063

2389

210

214

145

120

394

442

418

394

Sheet1

KY-2016KY-2017ME-2016ME-2017MA-2016MA-2017MO-2016MO-2017NH-2016NH-2017NM-2016NM-2017OH-2016OH-2017OK-2016OK-2017PA-2016PA-2017RI-2016RI-2017WV-2016WV-2017WI-2016WI-2017

IMF171826070859623684132146131199612918116951002794816420510696

Rx fent5113152106052111152312073

Sheet1

IMF

Rx fent

Sheet2

KYMEMAMONHNMOHOKPARIWVWI

20160.00%28.21%1.63%0.70%12.44%6.63%26.48%0.95%4.90%2.05%20.30%4.07%

201729.86%1.36%0.00%14.85%0.24%46.41%2.35%18.94%8.85%29.02%18.04%

Sheet2

2016

2017

Sheet3

# opioid deaths overall

KYMEMAMONHNMOHOKPARIWVWI

2nd-half 20165241561108427193166206321013881453944187192

1st-half 2017646144883127205155238921414521204423947171

14363

14522

Sheet3

2nd-half 2016

1st-half 2017

State

Number of deaths

Regional

2016 and 2017 data combined (KY currently doesn't 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

KYMEMAMONHNMOHOKPARIWVWIPrescriptionHeroinFentanyl

Prescription0.97%31.33%21.63%21.66%15.19%48.60%19.54%65.25%24.47%38.61%40.14%33.75%Recent release7.89%11.51%9.93%

Heroin48.54%37.00%37.37%42.24%8.86%57.01%35.81%24.35%50.32%23.17%38.60%61.17%Prior OD10.23%12.34%13.31%

Fentanyl74.67%77.16%62.64%87.59%12.15%77.08%18.20%74.15%70.27%66.15%35.98%Current treatment9.80%8.36%7.55%

Recent opioid use relapse7.55%16.20%12.96%

History of heroin abuse19.46%42.59%39.26%

History of Rx opioid abuse14.34%3.61%3.93%

History of Rx opioid AND heroin abuse5.41%6.56%6.03%

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl


Most common prescription opioids involved in opioid overdose deaths

Prescription opioids*3,285 (30%) deaths

Oxycodone1,331 (41%)

Hydrocodone576 (18%)

Methadone542 (17%)

Morphine448 (14%)

Buprenorphine374 (11%)

Oxymorphone334 (10%)


*Substances listed as cause of death; count does not include fentanyl; categories not mutually exclusive


Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal: 4,569 (42%)Recoded: 557 (6%)

HeroinConfirmed: 3,437 (31%)

Probable: 813 (7%)Suspected: 0

Heroin- Confirmed: heroin-positive- Probable: morphine-positive; evidence of injection/heroin use/illicit 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 confirmed/probable/suspected heroin

Unknown: morphine-positive, no scene evidence


Unknown386 (4%)


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


Acknowledgments

State health departments participating in CDC’s Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDC’s 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 O’Donnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson


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, CDCJulie O'Donnell, PhD, MPH, Epidemiologist, CDC

Federal Track

Moderator: Puja Seth

THANK YOU#RxSummit

www.NationalRxDrugAbuseSummit.org

Faster Data: The CDC-Funded Enhanced State Opioid Overdose Surveillance ProgramDisclosuresDisclosuresLearning ObjectivesFaster Data: The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)Disclosure StatementGoalsOpioid Overdoses Treated in Emergency DepartmentsSlide Number 9Slide Number 10Slide Number 11Slide Number 12Slide Number 13Slide Number 14CDC’s Pillars on OpioidsEnhanced State Opioid Overdose Surveillance (ESOOS)Enhanced State Opioid Overdose Surveillance (ESOOS)Funded ESOOS statesSlide Number 19Next Two Presentations…The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdosesDisclosure StatementWhy Emergency Department and Emergency Medical Service Data for Surveillance?Our PhilosophyOur approachEmergency Department DataCase definitions for suspected overdoseEmergency medical services dataChallenges in EMS dataData submission processSample quality control reportSample site reportED results: All drug (11 sites*)ED results: Opioid (11 sites*)ED results: Heroin (11 sites*)Annual percentage changes (11 sites*)SummarySlide Number 38Emergency department data dissemination effortsFatal Opioid Overdose Surveillance:�The State Unintentional Drug Overdose Reporting SystemDisclosure StatementSlide Number 42Increase in deaths outpaces increase in useSlide Number 44Fatal opioid overdose surveillanceSlide Number 46SUDORS data submitted bi-annually SUDORS leverages National Violent Death Reporting System (NVDRS) platform Overdose-specific fieldsOverdose-specific fieldsOverdose-specific fieldsOverdose-specific fieldsOverdose-specific fieldsOverdose-specific fieldsOverdose-specific fieldsOverdose-specific fieldsToxicology informationSUDORS data as good as sources allowDespite limitations, SUDORS data have many strengthsPreliminary resultsNumber of opioid overdose deaths increasing, 2nd-half 2016 to 1st-half 2017Number of opioid overdose deaths increasing, 2nd-half 2016 to 1st-half 2017Number of opioid overdose deaths by state and reporting periodMost common prescription opioids involved in opioid overdose deathsRedefining morphine as heroin using scene and toxicology evidenceSlide Number 66AcknowledgmentsFaster Data: The CDC-Funded Enhanced State Opioid Overdose Surveillance ProgramSlide Number 69

Documents

Faster Data: The CDC-Funded Enhanced State Opioid …Vivolo-Kantor AM, Seth P, Gladden RM, Mattson CL, Baldwin GT, Kite- Powell A, Coletta MA. Vital Signs: Trends in Emergency Department