Estimating the ratio of fatal to non-fatal overdoses involving all drugs, all opioids, synthetic opioids, heroin or stimulants, USA, 2010-2020

Abstract

Introduction: US drug overdose deaths are at historic levels. For every fatal drug overdose, there are many more non-fatal; however, minimal nationally representative data exist on trends in the ratio of fatal to non-fatal drug overdoses and how this differs by drug type.

Methods: Data from the Centers for Disease Control and Prevention's National Vital Statistics System were used to assess the number of fatal overdoses; data from the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample database were used to estimate the number of non-fatal overdoses treated in emergency departments. Counts of fatal and non-fatal overdoses by drug type (all drug, all opioid, synthetic opioid, heroin, stimulant, and opioid and stimulant polysubstance) were calculated from 2010 to 2020 (for non-fatal synthetic opioid-involved overdoses, from 2016 to 2020 only). Trends in overdose counts and the ratio of fatal to non-fatal overdoses were assessed.

Results: On average, counts of fatal overdoses increased quarterly among all drug types, and non-fatal overdoses increased among most drug types. Over the 11-year period, the greatest average quarterly percent change (AQPC) in fatal overdose counts was among synthetic opioid-involved overdoses (AQPC: 7.1%; 95% CI: 6.0 to 8.2) and for non-fatal overdoses was among heroin-involved overdoses (AQPC: 4.3%; 95% CI: 3.9 to 4.8). During 2010‒2020, there was approximately 1 fatal overdose per 15 non-fatal. The ratio of fatal to non-fatal drug overdoses increased among every drug type except heroin; ratio increases were driven by greater relative increases in fatal overdoses compared with non-fatal.

Conclusions: Assessment of the ratio of fatal to non-fatal drug overdoses can be used to understand the lethality of different drugs and inform response and prevention efforts.

Keywords: Drugs; Epidemiology; Surveillance.

Figure 1

(A) Counts of fatal all drug overdoses and non-fatal all drug overdose emergency department visits and (B) ratio of fatal to non-fatal all drug overdoses, by quarter, 2010‒2020, USA. The vertical dashed line denotes where coding of non-fatal overdoses changed from ICD-9-CM to ICD-10-CM beginning 1 October 2015. ICD-9-CM, International Classification of Diseases, 9th Revision, Clinical Modification; ICD-10-CM, International Classification of Diseases, 10th Revision, Clinical Modification.

Figure 2

(A) Counts of fatal opioid-involved overdoses and non-fatal opioid-involved overdose emergency department visits and (B) ratio of fatal to non-fatal opioid-involved overdoses, by quarter, 2010‒2020, USA. The vertical dashed line denotes where coding of non-fatal overdoses changed from ICD-9-CM to ICD-10-CM beginning 1 October 2015. ICD-9-CM, International Classification of Diseases, 9th Revision, Clinical Modification; ICD-10-CM, International Classification of Diseases, 10th Revision, Clinical Modification.

Figure 3

(A) Counts of fatal synthetic opioid-involved overdoses and non-fatal synthetic opioid-involved overdose emergency department visits and (B) ratio of fatal to non-fatal synthetic opioid-involved overdoses, by quarter, 2010‒2020, USA. The vertical dashed line denotes where coding of non-fatal overdoses changed from ICD-9-CM to ICD-10-CM beginning 1 October 2015. Prior to this coding change in October 2015, there were no diagnosis codes specific for synthetic opioids available for non-fatal data. ICD-9-CM, International Classification of Diseases, 9th Revision, Clinical Modification; ICD-10-CM, International Classification of Diseases, 10th Revision, Clinical Modification.

Figure 4

(A) Counts of fatal heroin-involved overdoses and non-fatal heroin-involved overdose emergency department visits and (B) ratio of fatal to non-fatal heroin-involved overdoses, by quarter, 2010‒2020, USA. The vertical dashed line denotes where coding of non-fatal overdoses changed from ICD-9-CM to ICD-10-CM beginning 1 October 2015. ICD-9-CM, International Classification of Diseases, 9th Revision, Clinical Modification; ICD-10-CM, International Classification of Diseases, 10th Revision, Clinical Modification.

Figure 5

(A) Counts of fatal stimulant-involved overdoses and non-fatal stimulant-involved overdose emergency department visits and (B) ratio of fatal to non-fatal stimulant-involved overdoses, by quarter, 2010‒2020, USA. The vertical dashed line denotes where coding of non-fatal overdoses changed from ICD-9-CM to ICD-10-CM beginning 1 October 2015. ICD-9-CM, International Classification of Diseases, 9th Revision, Clinical Modification; ICD-10-CM, International Classification of Diseases, 10th Revision, Clinical Modification.

Figure 6

(A) Counts of fatal opioid- and stimulant-involved polysubstance overdoses and non-fatal opioid and stimulant polysubstance overdose emergency department visits and (B) ratio of fatal to non-fatal opioid- and stimulant-involved polysubstance overdoses, by quarter, 2010‒2020, USA. The vertical dashed line denotes where coding of non-fatal overdoses changed from ICD-9-CM to ICD-10-CM beginning 1 October 2015. ICD-9-CM, International Classification of Diseases, 9th Revision, Clinical Modification; ICD-10-CM, International Classification of Diseases, 10th Revision, Clinical Modification.