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Indiana State Department of Health

Trauma System/Injury Prevention Program Home > Injury Prevention > Drug Overdose Information Drug Overdose Information

News:

INDIANA RECEIVES FUNDING TO HELP PREVENT OPIOID OVERDOSE DEATHS

INDIANAPOLIS—The Indiana State Department of Health has received a grant from the Centers for Disease Control and Prevention (CDC) to help prevent overdose deaths related to prescription opioids as part of the CDC’s Prescription Drug Overdose: Prevention for States program.

“As we have seen here in Indiana, opioid overuse is a problem that many people struggle with,” said State Health Commissioner Jerome Adams, M.D., M.P.H. “This funding will help us gather data to inform strategies on how to prevent opioid overdoses.” Dr. Adams is also a member of the Governor’s Task Force on Drug Enforcement, Treatment and Prevention, which was created by Governor Mike Pence to combat drug abuse and addiction in Indiana.

The CDC’s National Center for Injury Prevention and Control has expanded its Prevention for States program to an additional 13 states this year to help turn the tide on the prescription drug overdose epidemic. Funding will support enhancements to INSPECT, the Indiana prescription drug monitoring program at the Indiana Professional Licensing Agency; improvements to opioid prescribing practices, prevention efforts at the state and community levels to address new and emerging problems related to prescription drug overdoses and a partnership with the IU Fairbanks School of Public Health to evaluate opioid prescribing practices in Indiana. The Indiana State Department of Health will use this funding to expand the Indiana Violent Death Reporting System. The expansion will provide additional data regarding opioid overdose at the county level and will help inform prevention efforts and expand use of data for public health surveillance.

The Prevention for States program is a part of CDC’s ongoing efforts to scale up prevention activities as part of a national response to the opioid overdose epidemic. Prevention for States provides resources and support to advance comprehensive state-level interventions for preventing prescription drug overuse, misuse, abuse and overdose. For more information about Prescription Drug Overdose: Prevention for States, visit http://www.cdc.gov/drugoverdose/states/state_prevention.html.   

Indiana State Department of Health Launches Website Showing Locations Where Life-Saving Naloxone Can Be Obtained

State health officials unveiled a new online registry that will connect those on the front lines of the battle against addiction with entities that can dispense a life-saving antidote for opioid overdoses.The Overdose Prevention Therapy-Indiana, or optIN, registry allows nonprofits, pharmacies, local health departments, addiction treatment facilities, correctional facilities and other entities to register as providers of naloxone, a non-narcotic medication that reverses life-threatening respiratory failure that is usually the cause of overdose deaths. Entities must obtain a prescription, or standing order, from a prescriber allowing them to distribute naloxone, provide training in the use of naloxone, instruct those who administer it to call 911 and provide a list of options for substance abuse treatment. Registered entities will also report the number of doses distributed to the state annually. The registry can be accessed at https://optin.in.gov/.

The registry was created to support entities that register to dispense naloxone to families or friends of someone at risk of opioid overdose.  Aaron's Law, which Governor Mike Pence signed in April in honor of Aaron Sims of Indianapolis, allows healthcare providers to provide a standing order for naloxone to registered entities so they can dispense it to Hoosiers without a prescription. Aaron died of a heroin overdose in 2013 at age 20. According to the Centers for Disease Control and Prevention (CDC), drug overdoses are the leading cause of injury-related death for Americans ages 25 to 64. Indiana ranked 16th nationally for drug overdose deaths in 2013.

Naloxone is a Food and Drug Administration-approved medication and has been used for more than 40 years by emergency medical services personnel to reverse opioid overdose and revive people who might have died without treatment. It is not addictive, and although it is only effective at reversing overdoses of opioid drugs like heroin or prescription painkillers, it is not harmful if administered to someone who has not taken opioids. In March 2014, Indiana lawmakers granted immunity for first responders to use naloxone. Governor Pence has directed state agencies to raise the awareness of Aaron’s Law, which puts this life-saving tool in the hands of friends, family members and others closest to people at risk of an overdose.

Data:

FAQ:

Naloxone and Aaron’s Law: Frequently Asked Questions 

What ICD-9-CM codes are used to identify inpatient & outpatient cases with drug overdose?
Inpatient and outpatient data are coded using ICD-9-CM. Poisoning by drugs, medicinal and biological substances is coded with ICD-9-CM diagnostic codes 960-979. Poisoning by analgesics, antipyretics, and antirheumatics is 965, with opiates and related narcotics as 965.0. For the subset of opiates and related narcotics, heroin code is 965.01 and methadone code is 965.02. Poisoning by sedatives and hypnotics is 967.

It is important to look at the data notes on prepared reports to ensure accurate comparisons across different sources. It is important to consult an ICD-9-CM coding book or website to identify codes for desired codes.

What ICD-10 codes are used to identify drug overdose deaths?
Drug overdose deaths are typically first identified through underlying cause of death coded on death certificate as drug overdose fatality or “acute drug overdose” (ICD-10 codes: X40-X44.9, X60-X64, X85, Y10-Y14.9). Then, drug-specific overdose deaths were identified through 10 contributory cause of death fields based on the appropriate ICD-10 codes. For instance, for specific-drug related deaths, heroin ICD-10 code is T40.1; opioid pain reliever codes are T40.2, T40.3, and T40.4; benzodiazepine code is T42.8; and cocaine code is T40.5.

It is important to look at the data notes on prepared reports to ensure accurate comparisons across different sources. It is important to consult an ICD-10 coding book or website to identify codes for desired codes. These recommendations are based on the guidelines from: Gabella BA, Proescholdbell SK, Hume B, et. al. State Special Emphasis Report: Instructions Drug Overdose Data. Atlanta (GA): Centers for Disease Control and Prevention, National Center for Injury Prevention and Control; 2014.

Common Definitions:

Overdose: When a drug is swallowed, inhaled, injected, or absorbed through the skin in excessive amounts and injures the body. Overdoses are either intentional or unintentional. If the person taking or giving a substance did not mean to hurt themselves or others, then it is unintentional.

Misuse: The use of prescription drugs in a manner other than as directed.

Abuse: Continued use of illicit or prescription drugs despite problems from drug use with relationships, work, school, health, or safety. People with substance abuse often experience loss of control and take drugs in larger amounts or for longer than they intended.

Diversion: The use of prescription drugs for recreational consumption, such as diverting them from their original medical purpose.

Naloxone (also known as Narcan): A prescription drug that can reverse an opioid or heroin overdose if administered in time.

Poisoning: Injury or death due to the ingestion, inhalation, absorption through the skin, or injection of a drug, toxin, or other chemical such as gases and corrosives. Examples of poisonings include harmful effects resulting from exposure to alcohol, disinfectants, cleansers, paints, insecticides, and caustics.

Prescription Drug Monitoring Programs (PDMPs): State-run electronic databases used to track the prescribing and dispensing of controlled prescription drugs to patients.

Opioid: Derived from the opium poppy (or synthetic versions of it) and used for pain relief. Examples include hydrocodone (Vicodin®), oxycodone (OxyCotin®, Fentora®), methadone, and codeine.

Benzodiazepine: Central nervous system depressants used as sedatives, to induce sleep, prevent seizures, and relieve anxiety.

Common Acronyms:

CDC: Centers for Disease Control and Prevention
DMHA: Division of Mental Health and Addiction
ED: Emergency Department
EMS: Emergency Medical Services
ICD-9- CM: International Classification of Disease- Ninth Revision – Clinical Modification
ICD-10: International Classification of Diseases – Tenth Revision
NAS: Neonatal Abstinence Syndrome
PDO: Prescription Drug Overdose
SAMHSA: Substance Abuse and Mental Health Services Administration

Reporting the Administration of an Overdose Intervention Drug in ImageTrend:

Training:

Resources:

Indiana:

National:

Helplines:

  • Get help for substance abuse problems at 1-800-662-HELP.
  • Call Poison Help 1-800-222-1222 if you have questions about medicines.

Additional Articles and Resources:

    1. *The changing face of heroin use in the United States: a retrospective analysis of the past 50 years Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. JAMA Psychiatry. 2014 Jul 1;71(7):821-6.
    2. *Improving public health through access to and utilization of medication assisted treatment Kresina TF, Lubran R. Int J Environ Res Public Health. 2011 Oct;8(10):4102-17.
    3. National and state treatment need and capacity for opioid agonist medication-assisted treatment Jones CM, Campopiano M, Baldwin G, McCance-Katz E. Am J Public Health. 2015 Jun 11:e1-e9.
    4. Increases in heroin overdose deaths - 28 states, 2010 to 2012 Rudd RA, Paulozzi LJ, Bauer MJ, Burleson RW, Carlson RE, Dao D, Davis JW, et al . MMWR Morb Mortal Wkly Rep. 2014 Oct 3;63(39):849-54.
    5. Opioid overdose prevention programs providing naloxone to laypersons - United States, 2014 Wheeler E, Jones TS, Gilbert MK, Davidson PJ. MMWR Morb Mortal Wkly Rep. 2015 Jun 19;64(23):631-5.
    6. Increases in hepatitis C virus infection related to injection drug use among persons aged </=30 years - Kentucky, Tennessee, Virginia, and West Virginia, 2006-2012 Zibbell JE, Iqbal K, Patel RC, Suryaprasad A, Sanders KJ, Moore-Moravian L, Serrecchia J, Blankenship S, Ward JW, Holtzman D. MMWR Morb Mortal Wkly Rep. 2015 May 8;64(17):453-8.
    7. Drug-poisoning deaths involving heroin: United States, 2000-2013 Hedegaard H, Chen LH, Warner M. NCHS Data Brief. 2015 Mar(190):1-8.
    8. Associations of nonmedical pain reliever use and initiation of heroin use in the United States Muhuri PK, Gfroerer JC, Davies MC. Rockville, MD: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. 2013.

Data Requests:

If you are interested in identifiable data, you must fill out both the ISDH Division of Trauma and Injury Prevention division data request form and the agency data request form.

If you are interested in de-identified, statewide data, fill out the division data request form and return it to the ISDH Division of Trauma and Injury Prevention. Please allow at least 3 business days for the request to be processed.

If you are interested in patient level data or variables that could lead to individual identification, it will need administrative approval. Please submit to the Division of Trauma and Injury Prevention:

All completed forms can be emailed to indianatrauma@isdh.in.gov

Indiana