Drug Overdose Information

News:

Indiana Health Department Receives $519,117 for Overdose Prevention Work in At-Risk Counties

Indiana Receives Funding to Help Prevent Opioid Overdose Deaths

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

Data:

• Table 1: Drug poisoning deaths and rates by county, 2012-2015
• Map: Drug poisoning death and rates by county, 2012-2015
• Table 2: Drug overdose deaths involving opioid pain relievers, 1999-2015
• Table 3: Drug overdose deaths involving any opioid by year, 2010-2015
• Table 4: Non-fatal emergency department visits due to poisoning overdose, 2009-2015
• Table 5: Non-fatal emergency department visits due to opioid overdoses by county, 2015
• Table 6: Non-fatal hospitalizations due to poisoning overdose, 2009-2015
• Table 7: Non-fatal hospitalizations due to opioid overdoses by county, 2015
• Table 8: Non-fatal emergency department visits due to opioid overdose rates by county, 2011-2015

 

• 2017 Indiana Special Emphasis Report: Drug Overdose Deaths
• 2016 Indiana Special Emphasis Report: Drug Overdose Deaths
• 2015 Indiana Special Emphasis Report: Drug Overdose Deaths
• 2014 Indiana Special Emphasis Report: Drug Overdose Deaths
• 2010-2014 Drug Poisoning Death per 100,000 by County (based on information available as of March 21, 2016)
• Morbidity and Mortality Weekly Report, January 1, 2016
• NCHS Data Brief No. 190 March 2015
• CDC WISQARS
• CDC WONDER

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:

• Naloxone Reporting Guide for ImageTrend

Training:

• Indiana Naloxone Training Program

Resources:

Indiana:

• Indiana Governor's Task Force on Drug Enforcement, Treatment, and Prevention: http://www.in.gov/gtfdetp/index.htm
• Indiana Attorney General Prescription Drug Abuse Prevention Task Force: http://www.in.gov/bitterpill/
• First Do No Harm: The Indiana Healthcare Providers Guide to the Safe, Effective Management of Chronic Non-Terminal Pain: http://www.in.gov/bitterpill/toolkit.html
• Indiana State Department of Health: HIV Outbreak in Southeastern Indiana: http://www.in.gov/isdh/26649.htm
• Commission on Improving the Status of Children in Indiana: https://secure.in.gov/children/index.htm
• Indiana Division of Mental Health and Addiction, Bureau of Mental Health Promotion and Addiction Prevention: http://www.in.gov/fssa/dmha/index.htm
• Indiana’s Prescription Drug Monitoring Program (INSPECT): http://www.in.gov/pla/inspect/
• Indiana's Guidelines for Opioid Prescribing in the Emergency Department

National:

• CDC Injury Prevention and Control: Prescription Drug Overdose: http://www.cdc.gov/drugoverdose/
• Evidence-Based Opioid Prescribing: http://www.supportprop.org/wp-content/uploads/2014/01/PROP_OpioidPrescribing.pdf
• Harm Reduction Coalition Tools & Best Practices: http://harmreduction.org/issues/overdose-prevention/tools-best-practices/
• NIDA for Teens: http://teens.drugabuse.gov/
• Public Health Law Program: State Laws on Prescription Drug Misuse and Abuse: http://www.cdc.gov/phlp/publications/topic/prescription.html
• Prevent Child Injury: Medication Safety Resources:  http://www.preventchildinjury.org/toolkits/medicationsafety
• SAMHSA Opioid Overdose Prevention Toolkit- Updated 2014: http://store.samhsa.gov/product/Opioid-Overdose-Prevention-Toolkit-Updated-2014/SMA14-4742
• Up & Away: http://upandaway.org/
• Use As Directed: Preventing Prescription Drug Overdoses: https://extension.purdue.edu/extmedia/HHS/HHS-790-W.pdf

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:

• 2016 SEOW Treatment and Recovery Report
• The CDC Injury Center released four Prescription Drug Overdose Vital Signs packages:
  1. Prescription Painkiller Overdoses in the U.S.
  2. Use and Abuse of Methadone as a Painkiller
  3. Prescription Painkiller Overdoses - A Growing Epidemic, Especially Among Women
  4. Opioid Painkiller Prescribing - Where You Live Makes a Difference
• Increases in Heroin Overdose Deaths — 28 States, 2010 to 2012 Morbidity and Mortality Weekly Report (MMWR)
• Vital Signs: Demographic and Substance Use Trends Among Heroin Users - United States, 2002-2013
• Vital Signs Heroin Fact Sheet- July 2015
• CDC Vital Signs- Today's Heroin Epidemic Science Clips, Vol. 7, Issue 27, July 7, 2015
  
  
   
  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. Heroin use and heroin use risk behaviors among nonmedical users of prescription opioid pain relievers - United States, 2002-2004 and 2008-2010 Jones CM. Drug Alcohol Depend. 2013 Sep 1;132(1-2):95-100.
  5. 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.
  6. 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.
  7. 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.
  8. Drug-poisoning deaths involving heroin: United States, 2000-2013 Hedegaard H, Chen LH, Warner M. NCHS Data Brief. 2015 Mar(190):1-8.
  9. Intertwined epidemics: national demographic trends in hospitalizations for heroin- and opioid-related overdoses, 1993-2009 Unick GJ, Rosenblum D, Mars S, Ciccarone D. PLoS One. 2013 ;8(2):e54496.
  10. 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:

• The agency data request form
• The division data request form
• A document on letterhead describing the study
• IRB approval (if applicable)

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