Nonfatal Drug Overdoses Treated in Emergency Departments, 2016–2017

Drug overdoses killed 70,237 people in the United States in 2017, a 9.6% rise in the rate from 2016. Nonfatal overdoses treated in emergency departments (EDs) matter too: tracking them shows where overdoses are rising and where prevention is needed. CDC used the Nationwide Emergency Department Sample of the Healthcare Cost and Utilization Project — a nationally representative sample of visits to nonfederal hospital EDs in 36 states and the District of Columbia — to compare 2016 with 2017.

How it was done

Overdoses were identified from discharge diagnosis codes for six groups: all drugs, all opioids, nonheroin opioids, heroin, benzodiazepines and cocaine. Only first visits for an overdose were counted, whatever the intent — unintentional, self-harm, assault or undetermined. A visit involving several drugs could count in more than one group. Rates per 100,000 people were age-adjusted (except by age group) and compared by sex, age, region, urban or rural county, and intent.

The totals

In 2017, EDs treated 967,615 nonfatal drug overdoses (300.2 per 100,000 people), including 305,623 involving opioids. Compared with 2016, the rates changed as follows:

Who and where

All drugs. Rates were highest among females (308.2), people aged 15–34 (427.1–476.4), the Midwest (378.6) and micropolitan (nonmetro) counties (363.3). They rose 5.0% among males and 3.7% among females.

Opioids. Rates were highest among males (112.6), people aged 25–34 (209.3), the Midwest (129.2) and medium metro counties (111.4). They fell among young people — 4.7% at ages 0–14, 10.5% at 15–19 and 9.6% at 20–24. By region, all-drug and opioid rates rose in the Midwest (6.1% and 7.9%), South (3.2% and 5.2%) and West (8.1% and 3.9%); in the Northeast the all-drug rate held steady while the opioid rate fell 5.8%.

Heroin and other opioids. Both were highest among males, people aged 25–34, the Midwest and medium metro counties. Heroin rates rose among males (4.1%) and females (3.0%), while nonheroin opioid rates rose only among males (7.0%). Heroin overdose rates fell by half at ages 0–14, 21.8% at 15–19 and 14.1% at 20–24. Heroin rates rose 8.6% in the Midwest, 8.2% in the South and 11.3% in the West, and fell 8.8% in the Northeast.

Benzodiazepines and cocaine. Benzodiazepine overdose rates were highest among females (42.3), people aged 20–44, the Midwest and medium metro counties, and fell in most age groups and every region. Cocaine rates were highest among males (15.2), people aged 25–34 and 45–54, the South (15.1) and large central metro counties (16.5), and rose in every age group and region.

Big cities. In large central metro counties, rates rose for every category: all drugs 11.7%, opioids 15.2%, nonheroin opioids 11.9%, heroin 21.4%, benzodiazepines 4.7% and cocaine 71.9%.

Intent. Three-quarters of overdoses were unintentional, from 48% for benzodiazepines to 91% for heroin, and unintentional overdoses rose for every group except benzodiazepines. Self-harm overdoses rose 4.8% for all drugs but fell for opioids (6.7%), nonheroin opioids (7.4%) and benzodiazepines (3.4%).

What it means

The sharp rise in cocaine overdoses may point to more polysubstance use: an earlier study found that in 2016 about 27% of nonfatal cocaine overdoses in EDs also involved an opioid, and such combined overdoses had risen 17% from 2015 while cocaine-only overdoses fell 14%. Intentional overdoses appeared to be leveling off, consistent with death data. Declines among young people may reflect less drug use and fewer people starting. Rising overdoses in the West, Midwest and South matched increases in drug supply and deaths there. The Northeast's drop in opioid overdoses did not match its rising drug supply; the authors suggested that more lethal opioids such as illicitly made fentanyl may kill people before they can reach an ED.

The authors called for stronger surveillance, prevention, treatment and public safety efforts. CDC's Overdose Data to Action program, begun in September 2019, supports states, territories and localities with better, faster data and data-driven prevention. EDs can start medication-assisted treatment and link patients to care for substance use and mental disorders, give naloxone to patients who use opioids or other illicit drugs, check prescription drug monitoring data, and follow CDC's guideline for prescribing opioids for chronic pain.

Limitations: drug combinations were not analyzed and ED drug testing is limited; the data could not tell prescribed from illicit drugs; coding varies between hospitals; visits, not people, were counted; overdoses never seen in an ED were missed; intent is hard to judge in the ED; and discharge data are less timely and local than syndromic or emergency medical services data.

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Sources

• Vivolo-Kantor AM, Hoots BE, Scholl L, et al. "Nonfatal Drug Overdoses Treated in Emergency Departments — United States, 2016–2017." MMWR 2020;69(13).