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The Opioid Crisis at a Glance

January 2018


Methods

Panel 1

Data on opioid-related emergency room visits and inpatient stays were derived from the national quarterly counts extracted from HCUP Fast Stats, Opioid-Related Hospital Use, Show Data Export Options. This file reflects data from the Nationwide Emergency Department Sample (NEDS) and National Inpatient Sample (NIS) of the Hospital Cost and Utilization Project (HCUP) of the Agency for Healthcare Research and Quality (AHRQ). The data were last updated in December 2017 to include the most current available data (for 2015).

Emergency department (ED) visits are defined as ED encounters that do not result in a hospital admission to the same hospital (i.e., treat-and-release ED visits). ED patients who continue on to an admission to the same hospital are counted with the inpatient stays.

In all cases, the visit or stay is considered to be opioid related if any of the listed diagnosis codes on the record contain any of the following ICD-9-CM codes: 304.00-304.02 (opioid type dependence – unspecified, continuous, episodic); 304.70-304.72 (combinations of opioid type drug with any other drug dependence – unspecified, continuous, episodic); 305.50-305.52 (opioid abuse – unspecified, continuous, episodic); 965.00-965.02, 965.09, 970.1 [poisoning by opium (alkaloids) unspecified, heroin, methadone, other opiates and related narcotics, opiate antagonists]; E850.0-E850.2 (accidental poisoning by heroin, methadone, other opiates and related narcotics); or E935.0-E935.2, E940.1 (heroin, methadone, other opiates and related narcotics, opiate antagonists causing adverse effects in therapeutic use).

There were 273,500 ED visits in 2006 and 667,500 ED visits in 2015 (a 144 percent increase to 76.2 visits per hour in 2015). There were 489,400 inpatient stays in 2006 and 802,900 inpatient stays in 2015 (a 64 percent increase to 91.7 admissions per hour in 2015).

Panels 2-5

Data on opioid overdose deaths were derived from the multiple cause-of-death files of the Wide-ranging Online Data for Epidemiologic Research (WONDER) data system maintained by the Centers for Disease Control and Prevention (CDC). The information was last updated in December 2017 to reflect data through 2016.

Deaths were identified as due to an opioid overdose if the ICD-10 code for the underlying cause of death was X40-X44 (accidental poisoning), X60-X64 (intentional self-poisoning) or Y10-14 (poisoning of undetermined intent) and if any of the multiple cause of death codes indicated that the type of substance involved in the poisoning was T40.1 (heroin), T40.2 (natural and semi-synthetic opioids), T40.3 (methadone) or T40.4 (synthetic opioids other than methadone). Because a single death may involve multiple substances, summing across the number of deaths involving each substance will overestimate the number of opioid-related overdoses. Following the classification scheme adopted by the CDC, methadone and natural and semi-synthetic opioids (e.g., oxycodone and hydrocodone) were grouped into a single category encompassing commonly prescribed opioids. Synthetic opioids other than methadone include substances such as tramadol and fentanyl (both pharmaceutically manufactured and illicitly manufactured).

Panel 2

In 2016, there were 40,704 overdose deaths involving one or more of the opioids described above, or 4.6 such deaths every hour.

Panel 3

Of these deaths in 2016, 15,433 involved heroin, 19,390 involved synthetic opioids other than methadone, and 17,065 involved commonly prescribed opioids (some deaths were classified into more than one category). Comparable figures for the years 2001, 2006 and 2011 were, respectively:

  • for heroin – 1,777; 2,082; and 4,383
  • for synthetic opioids – 956; 2,701; and 2,662
  • for commonly prescribed opioids – 4,762; 11,567; and 15,115

Panel 4

In 2016, 5,036 (32.6 percent) of all overdose deaths involving heroin and 6,084 (31.4 percent) of all overdose deaths involving synthetic opioids occurred among individuals aged from 25 to 34, whereas 4,307 (25.2 percent) of all overdose deaths involving commonly prescribed opioids occurred for individuals aged 45 to 54.

Panel 5

In 2016, 27,512 (67.6 percent) of the 40,704 opioid-related deaths occurred among men.

Panel 6

Data on state laws were derived from the Prescription Drug Abuse Policy System. Question 9.1 in the section on Naloxone Overdose Prevention Laws was used to determine which states used standing orders to permit pharmacists to dispense or distribute naloxone without a patient-specific prescription from another medical professional. Question 4 in the Prescription Drug Monitoring Program (PDMP) Reporting and Authorized Use section was used to determine which states required prescribers to check the PDMP database before prescribing controlled substances.

Opioid abuse is now claiming more than four lives every hour in the U.S. This represents a dramatic increase in deaths related to opioids in just a few years—much of the increase attributable to heroin and synthetic opioids like fentanyl.