Vital Signs: Trends in Emergency Department Visits for Suspected Opioid Overdoses - United States, July 2016-September 2017

Abstract

Introduction: From 2015 to 2016, opioid overdose deaths increased 27.7%, indicating a worsening of the opioid overdose epidemic and highlighting the importance of rapid data collection, analysis, and dissemination.

Methods: Emergency department (ED) syndromic and hospital billing data on opioid-involved overdoses during July 2016-September 2017 were examined. Temporal trends in opioid overdoses from 52 jurisdictions in 45 states were analyzed at the regional level and by demographic characteristics. To assess trends based on urban development, data from 16 states were analyzed by state and urbanization level.

Results: From July 2016 through September 2017, a total of 142,557 ED visits (15.7 per 10,000 visits) from 52 jurisdictions in 45 states were suspected opioid-involved overdoses. This rate increased on average by 5.6% per quarter. Rates increased across demographic groups and all five U.S. regions, with largest increases in the Southwest, Midwest, and West (approximately 7%-11% per quarter). In 16 states, 119,198 ED visits (26.7 per 10,000 visits) were suspected opioid-involved overdoses. Ten states (Delaware, Illinois, Indiana, Maine, Missouri, Nevada, North Carolina, Ohio, Pennsylvania, and Wisconsin) experienced significant quarterly rate increases from third quarter 2016 to third quarter 2017, and in one state (Kentucky), rates decreased significantly. The highest rate increases occurred in large central metropolitan areas.

Conclusions and implications for public health practice: With continued increases in opioid overdoses, availability of timely data are important to inform actions taken by EDs and public health practitioners. Increases in opioid overdoses varied by region and urbanization level, indicating a need for localized responses. Educating ED physicians and staff members about appropriate services for immediate care and treatment and implementing a post-overdose protocol that includes naloxone provision and linking persons into treatment could assist EDs with preventing overdose.

Figure 1

Quarterly rate of suspected opioid overdose, by U.S. region — 52 jurisdictions in 45 states, National Syndromic Surveillance Program, July 2016–September 2017 Abbreviation: ED = emergency department. * Per 10,000 ED visits. ^† Northeast Region: HHS Region 1 (Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont), Region 2 (New Jersey and New York), and Region 3 (District of Columbia, Maryland, Pennsylvania, Virginia, and West Virginia); Southeast Region: HHS Region 4 (Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee); Southwest Region: HHS Region 6 (Arkansas, Louisiana, New Mexico, and Texas); Midwest Region: HHS Region 5 (Indiana, Illinois, Michigan, Minnesota, Ohio, and Wisconsin) and Region 7 (Iowa, Kansas, Missouri, and Nebraska); West Region: HHS Region 8 (Colorado, Montana, North Dakota, and Utah), Region 9 (Arizona, California, and Nevada) and Region 10 (Alaska, Idaho, Oregon, and Washington). ^§ Data current as of December 13, 2017.

Figure 2

Quarterly rate of suspected opioid overdose, by level of county urbanization^, — 16 states, Enhanced State Opioid Overdose Surveillance program, July 2016–September 2017 Abbreviation: ED = emergency department. * Per 10,000 ED visits. ^† The six classification levels for counties were 1) large central metro: part of a metropolitan statistical area with ≥1 million population and covers a principal city; 2) large fringe metro: part of a metropolitan statistical area with ≥1 million population but does not cover a principal city; 3) medium metro: part of a metropolitan statistical area with ≥250,000 but <1 million population; 4) small metro: part of a metropolitan statistical area with <250,000 population; 5) micropolitan (nonmetro): part of a micropolitan statistical area (has an urban cluster of ≥10,000 but <50,000 population); and 6) noncore (nonmetro): not part of a metropolitan or micropolitan statistical area. ^§ The average linear quarterly percentage change (QPC) was significant for large central metro (average QPC = 11.7, 95% confidence interval [CI] = 10.7 to 12.7, p<.001). QPCs for large fringe metro (average QPC = 5.1, 95% CI = −0.3 to 10.7); medium metro (average QPC = 11.4, 95% CI = −1.3 to 25.8); small metro (average QPC = 9.3, 95% CI = −0.1 to 19.5); micropolitan (average QPC = 6.4, 95% CI = −3.1 to 16.9); and noncore (average QPC = 6.4, 95% CI = −2.8 to 16.5) were not significant. ^¶ Delaware, Illinois, Indiana, Kentucky, Maine, Massachusetts, Missouri, New Hampshire, New Mexico, Nevada, North Carolina, Ohio, Pennsylvania, Rhode Island, West Virginia, and Wisconsin. ** Data current as of January 8, 2018.