Emergency Visits for Suspected Opioid Overdoses Rose 29.7% in a Year, 2016–2017

This page summarizes a CDC Vital Signs report published in March 2018, covering July 2016 to September 2017.

The U.S. opioid overdose epidemic was getting worse. In 2016, 63,632 people died of drug overdoses, 21.4% more than in 2015, and nearly two thirds of those deaths (66.4%) involved prescription opioids, illicit opioids or both, up 27.7%. Heroin and synthetic opioids such as fentanyl were driving the rise. But timely national data on overdoses treated in emergency departments (EDs) did not exist: hospital billing data, which showed about 92,000 ED visits for unintentional nonfatal opioid overdoses in 2014, arrive long after the fact.

Syndromic data, collected in near real time from ED visits and viewable within 24 to 48 hours, can serve as an early warning. And because people who overdose are more likely to overdose again, EDs are a crucial place to connect them to treatment.

The data

CDC analyzed ED visits by people aged 11 and older from two sources:

• The National Syndromic Surveillance Program (NSSP), covering about 60% of U.S. ED visits, from 52 jurisdictions in 45 states, analyzed by region.
• The Enhanced State Opioid Overdose Surveillance (ESOOS) program, with syndromic and billing data from 16 states that could be analyzed by state and county: Delaware, Illinois, Indiana, Kentucky, Maine, Massachusetts, Missouri, New Hampshire, New Mexico, Nevada, North Carolina, Ohio, Pennsylvania, Rhode Island, West Virginia and Wisconsin.

Visits were counted as suspected opioid overdoses based on diagnosis codes or chief-complaint text mentioning opioids and an overdose.

A national rise

Of about 91 million ED visits in NSSP from July 2016 through September 2017, 142,557 (15.7 per 10,000 visits) were suspected opioid overdoses. The rate rose an average of 5.6% each quarter, and 29.7% from the third quarter of 2016 to the third quarter of 2017.

Every region saw an increase over that year:

So did every demographic group: males (30.2%), females (24.0%), and people aged 25–34 (30.7%), 35–54 (36.3%) and 55 and older (31.9%).

Quarterly rate of suspected opioid overdose ED visits by U.S. region, 52 jurisdictions in 45 states, July 2016–September 2017. CDC, MMWR.

State by state

In the 16 ESOOS states, 119,198 of about 45 million ED visits (26.7 per 10,000) were suspected opioid overdoses, and visits rose 34.5% over the year. Ten states had significant increases and one a significant decrease, with wide variation even within regions:

• Midwest: every state rose significantly: Wisconsin (108.6%), Illinois (65.5%), Indiana (35.1%), Ohio (27.7%) and Missouri (21.4%).
• Northeast: significant increases in Delaware (105.0%), Pennsylvania (80.6%) and Maine (34.0%), but small, nonsignificant decreases (under 10%) in Massachusetts, New Hampshire and Rhode Island.
• Southeast: a significant increase in North Carolina (31.1%), a significant decrease in Kentucky (15.0%) and a small nonsignificant decrease in West Virginia (5.3%).
• West: a significant increase in Nevada (17.9%).

Cities hit hardest

Overdose visits rose significantly at every level of urbanization, most in large central metropolitan areas (cities of 1 million or more):

Quarterly rate of suspected opioid overdose ED visits by county urbanization, 16 states, July 2016–September 2017. CDC, MMWR.

What it means

National survey data suggested heroin use and opioid misuse might be leveling off, yet overdose ED visits climbed sharply, perhaps because of the unpredictable availability and potency of illicit drugs such as fentanyl sold as or mixed into heroin. The Midwest's increases matched death trends; the rises in the Southwest and West and falls in Kentucky and West Virginia were unexpected and might foreshadow changes in deaths. Decreases in some Northeast states matched early 2017 death reports there and may reflect efforts such as expanded access to medication-assisted treatment.

The authors conclude that:

• real-time ED data can warn communities of overdose spikes, allowing faster, coordinated responses such as sending more naloxone to affected areas and issuing health alerts, and data should be shared across neighboring jurisdictions, since drug supplies cross borders
• responses must be local, because trends vary by region, state and urbanization
• EDs are a key point of intervention: staff can check prescription drug monitoring data, educate patients, and follow post-overdose protocols that provide naloxone and link patients to treatment, case management or peer navigators, and harm reduction services such as syringe services programs

Limitations: case definitions may over- or undercount overdoses, so the report compares trends rather than absolute rates; hospital participation in NSSP changed over time; and the results may not apply to areas outside the two systems.

Sources

• Vivolo-Kantor AM, Seth P, Gladden RM, et al. "Vital Signs: Trends in Emergency Department Visits for Suspected Opioid Overdoses — United States, July 2016–September 2017." MMWR 67(9). https://www.cdc.gov/mmwr/volumes/67/wr/mm6709e1.htm
• CDC Vital Signs: https://www.cdc.gov/vitalsigns/