2018 Surveillance Report slides clearance FINAL 8.31.18 ... · These slides contain selected data...

Surveillance ReportHighlights from the 2018 Annual Surveillance

Report of Drug-Related Risks and Outcomes —

United States

Background

� These slides contain selected data from the second annual surveillance

report summarizing the latest information at the national level for

prescribing patterns, drug use, and nonfatal and fatal overdose related

to the current drug overdose epidemic.

� Intended to serve as a resource for persons charged with addressing this

ongoing national crisis.

� Suggested citation when using resources from this presentation:

Centers for Disease Control and Prevention. 2018 Annual

Surveillance Report of Drug-Related Risks and Outcomes —

United States. Surveillance Special Report. Centers for Disease

Control and Prevention, U.S. Department of Health and Human

Services. Published August 31, 2018. Accessed [date] from

www.cdc.gov/drugoverdose/pdf/pubs/2018-cdc-drug-

surveillance-report.pdf

Data Sources

Outcome Data Source Year(s)

Opioid prescribing practices IQVIA™ 2006–2017

Drug use, misuse, substance use disorder,

and treatment

National Survey on Drug Use and Health

(NSDUH)a 2016

Nonfatal overdose hospitalizations and

emergency department visits

Healthcare Cost and Utilization Project

(HCUP)b 2015

Drug overdose mortalityNational Vital Statistics System (NVSS),

Mortality Componentc 1999–2016

aA product of the Substance Abuse and Mental Health Services Administration (SAMHSA).bA product of the Agency for Healthcare Research and Quality (AHRQ).cMaintained by the National Center for Health Statistics, CDC.

Opioid Prescribing Practices

Opioid prescriptions (Rx) Number Rateb

All opioids 191,146,822 58.5

LA/ER opioidsc 17,442,895 5.3

Days of supply per Rx

< 30 days 110,759,830 33.9

≥ 30 days 80,386,991 24.6

Average opioid Rx per patient 3.4

Average days of supply per Rx 18.3

Source: IQVIA™ Transactional Data Warehouse.

Abbreviation: Rx, prescription.aOpioid prescriptions, including codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, oxycodone, oxymorphone, propoxyphene, tapentadol, tramadol, and Butrans® and

Belbuca® (buprenorphine), were identified using the National Drug Code. bRate per 100 persons.cLA/ER represents opioids that are long acting (LA) or extended release (ER).

Total number and rate of opioid prescriptionsa (Rx) dispensed per 100 persons annually —

United States, 2017


Total number and rate of morphine milligram equivalents (MME) dispensed per 100 persons

annually — United States, 2017

Morphine milligram equivalents (MME) Number Ratea

Total MME 166,941,732,435

MME per capita 511.1

Average MME per Rx 873.4

Average daily MME per Rx 45.3

Daily dosage per Rx

< 50 MME 142,842,185 43.7

≥ 50 but < 90 MME 32,079,439 9.8

≥ 90 MME (high dose) 16,225,198 5.0

Source: IQVIA™ Transactional Data Warehouse.

Abbreviation: MME, morphine milligram equivalents; Rx, prescription.aRate per 100 persons.


Percent of persons who had at least one prescription filled for an opioida by sex —

United States, 2017

Source: IQVIA™ Total Patient Tracker, 2017 Enhanced.aOpioid prescriptions, including codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, oxycodone, oxymorphone, propoxyphene, tapentadol, tramadol, and Butrans®

and Belbuca® (buprenorphine), were identified using the National Drug Code.

14.8

19.9

0.0

5.0

10.0

15.0

20.0

25.0

Male Female

Percent



Percent of persons who had at least one prescription filled for an opioida by age group —

United States, 2017

Source: IQVIA™ Total Patient Tracker, 2017 Enhanced.aOpioid prescriptions, including codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, oxycodone, oxymorphone, propoxyphene, tapentadol, tramadol and

Butrans® and Belbuca® (buprenorphine), were identified using the National Drug Code.

1.7

10.4

13.0

17.3

20.5

23.1

26.3 26.8

17.4

0.0

5.0

10.0

15.0

20.0

25.0

30.0

0–14 15–19 20–24 25–34 35–44 45–54 55–64 ≥ 65 All ages

Percent

Age Group (years)


Annual opioida prescribing rates overall and for high dosage prescriptionsb (≥ 90 MME/day)c —

United States, 2006–2017

Source: IQVIA™ Transactional Data Warehouse.aOpioid prescriptions, including codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, oxycodone, oxymorphone, propoxyphene, tapentadol, tramadol and Butrans® and Belbuca®

(buprenorphine), were identified using the National Drug Code.bHigh dosage prescriptions were defined as opioid prescriptions resulting in a daily dosage of ≥ 90 morphine milligram equivalents.cTemporal trends from 2006 to 2017 were evaluated by applying joinpoint regression methodology. This modeling approach simultaneously identified statistically significant trends as well as shifts in

trends that occurred within a time series. A maximum of two joinpoints was allowed. Different dash types correspond to year groupings as determined by joinpoint regression.

0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

80.0

90.0

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Prescribing rate

per 100 persons

Year

High Dosage

Overall

Temporal trendsc

Overall

2006–2010

2010–2014

2014–2017

High Dosage

2006–2009

2009–2017


Annual opioida prescribing rates by days of supply per prescriptionb — United States, 2006–2017

Source: IQVIA™ Transactional Data Warehouse.aOpioid prescriptions, including codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, oxycodone, oxymorphone, propoxyphene, tapentadol, tramadol and Butrans®

and Belbuca® (buprenorphine), were identified using the National Drug Code.bTemporal trends from 2006 to 2017 were evaluated by applying joinpoint regression methodology. This modeling approach simultaneously identified statistically significant trends as well

as shifts in trends that occurred within a time series. A maximum of two joinpoints was allowed. Different dash types correspond to year groupings as determined by joinpoint regression.

0.0

10.0

20.0

30.0

40.0

50.0

60.0

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Prescribing rate

per 100 persons

Year

< 30 days

≥ 30 days

Temporal trendsb

< 30 days

2006–2010

2010–2014

2014–2107

≥ 30 days

2006–2010

2010–2015

2015–2017


Average daily morphine milligram equivalents (MME) per opioida prescriptionb —


0.0

10.0

20.0

30.0

40.0

50.0

60.0

70.0

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Average MME

per day

Year




Temporal trendsb

2006–2010

2010–2013

2013–2017


Average days of supply per opioida prescriptionb — United States, 2006–2017

10.0

11.0

12.0

13.0

14.0

15.0

16.0

17.0

18.0

19.0

2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017

Average days

of supply

Year




Temporal trendsb

2006–2009

2009–2013

2013–2017

Drug Use, Misuse, Substance Use Disorder, and Treatment


Self-reported prevalence of illicit drug use and prescription drug misusea in the past year, persons

12+ years old — United States, 2016

Source: 2016 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration. Rockville, MD.aMisuse of prescription drugs is defined as use in any way not directed by a doctor, including use without a prescription of one’s own medication; use in greater amounts, more often, or longer

than told to take a drug; or use in any other way not directed by a doctor. Prescription drugs do not include over-the-counter drugs.bMarijuana was classified as an illicit substance in NSDUH because it remains an illegal substance (Schedule I drug) under federal law.cOpioids include heroin use, prescription pain reliever misuse, or both; therefore, the numbers for heroin use and prescription pain reliever misuse do not add to those for opioid misuse

because of poly-drug use. This category includes misuse of prescription fentanyl but excludes use of illicit fentanyl.

b

c

4.3

2.2 2.1

0.6

13.9

0.4

4.4

1.9

0.5

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

1

Percent

Prescription pain relievers

Prescription tranquilizers

Prescription stimulants

Prescription sedatives

Marijuana

Heroin

Opioids

Cocaine

Methamphetamine

Substance Category


Self-reported prevalence of prescription drug misusea in the past year by sex, persons


Source: 2016 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration. Rockville, MD.aMisuse of prescription drugs is defined as use in any way not directed by a doctor, including use without a prescription of one’s own medication; use in greater amounts, more often,

or longer than told to take a drug; or use in any other way not directed by a doctor. Prescription drugs do not include over-the-counter drugs.

4.8

2.2 2.3

0.5

3.8

2.31.9

0.6

0.0

1.0

2.0

3.0

4.0

5.0

6.0

Prescription pain relievers Prescription tranquilizers Prescription stimulants Prescription sedatives

Percent

Male Female


Self-reported prevalence of prescription drug misusea in the past year by race/ethnicity,b persons



than told to take a drug; or use in any other way not directed by a doctor. Prescription drugs do not include over-the-counter drugs.bAll race/ethnicity categories other than “Hispanic” are non-Hispanic. Data on two or more races are not included.cLow precision for Native Hawaiian/other Pacific Islander race, no estimate reported.

4.5

2.6 2.5

0.7

3.9

1.5

0.8

0.3

4.2

1.81.6

0.5

3.9

1.5

0.8

0.3

4.2

0.8

1.81.8

0.7

1.2

0.2

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

4.5

5.0


Percent

White Black Hispanic American Indian/Alaska Native Native Hawaiian/other Pacific Islander Asian

c


Self-reported prevalence of prescription drug misusea in the past year by age group, persons



than told to take a drug; or use in any other way not directed by a doctor. Prescription drugs do not include over-the-counter drugs.

3.5

1.7

1.7

0.4

7.1

5.3

7.5

0.7

6.9

3.3

3.9

0.9

5.3

2.2

1.7

0.4

4.3

1.8

1.1

0.8

3.7

1.7

0.8

0.3

4.4

2.3

0.8

0.6

3.8

1.6

0.5

0.5

2.2

0.8

0.2 0

.5

1.2

0.7

0.2 0

.4

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0


Percent

12–17 18–25 26–34 35–39 40–44 45–49 50–54 55–59 60–64 65+


Self-reported prevalence of prescription pain reliever misusea in the past year by region, persons



than told to take a drug; or use in any other way not directed by a doctor. Prescription drugs do not include over-the-counter drugs.

4.1 per 100,000 population




Self-reported prevalence of illicit drug use in the past year by sex, persons 12+ years old —

United States, 2016

Source: 2016 National Survey on Drug Use and Health (NSDUH). Substance Abuse and Mental Health Services Administration. Rockville, MD.aMarijuana was classified as an illicit substance in NSDUH because it remains an illegal substance (Schedule I drug) under federal law.

16.7

0.5

2.5

0.6

11.3

0.31.3

0.4

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

Marijuana Heroin Cocaine Methamphetamine

Percent

Male Female

a


14

.2

0.4

2.0

0.6

16

.6

0.3

1.9

0.2

11

.9

0.2 1

.7

0.4

19

.4

0.3

2.0

1.0

12

.8

0.1 1

.5

0.6

6.9

0.7

0.1

0.0

5.0

10.0

15.0

20.0

25.0


Percent

White Black Hispanic American Indian/Alaska Native Native Hawaiian/Other Pacific Islander Asian

Self-reported prevalence of illicit drug use in the past year by race/ethnicity,a persons 12+ years old —

United States, 2016

Source: 2016 National Survey on Drug Use and Health (NSDUH). Substance Abuse and Mental Health Services Administration. Rockville, MD.aAll race/ethnicity categories other than “Hispanic” are non-Hispanic. Data on two or more races are not included.bMarijuana was classified as an illicit substance in NSDUH because it remains an illegal substance (Schedule I drug) under federal law.cLow precision for Asian race, no estimate reported.

cb


Self-reported prevalence of illicit drug use in the past year by age group, persons 12+ years old —

United States, 2016

12

.0

0.1 0.5

0.1

33

.0

0.7

5.6

0.8

22

.3

0.9

3.8

0.9

14

.7

0.5 1

.5

0.8

10

.3

0.4 1.2

0.8

11

.1

0.2 1

.4

0.4

9.1

0.2 0.9

0.7

10

.5

0.5 1

.4

0.7

7.1

0.1 0.7

0.1

3.3

0.2

0.0

0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0


Percent

12–17 18–25 26–34 35–39 40–44 45–49 50–54 55–59 60–64 65+

b

Source: 2016 National Survey on Drug Use and Health (NSDUH). Substance Abuse and Mental Health Services Administration. Rockville, MD.aMarijuana was classified as an illicit substance in NSDUH because it remains an illegal substance (Schedule I drug) under federal law.bLow precision for age 65+, no estimate reported.cPercents are rounded to the nearest tenth. Because of the rounding, some percents equal to 0.0 are displayed. These prevalence estimates are rounded down from < 0.05 percent and

do not represent an absence of persons displaying a particular characteristic.

a c


Self-reported prevalence of marijuana use in the past year by region, persons 12+ years old —

United States, 2016

Source: 2016 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration. Rockville, MD.






Self-reported prevalence of heroin use in the past year by region, persons 12+ years old —

United States, 2016





Self-reported prevalence of cocaine use in the past year by region, persons 12+ years old —

United States, 2016







Self-reported prevalence of methamphetamine use in the past year by region, persons








Self-reported prevalence of substance use disordera in the past year, persons 12+ years old —

United States, 2016

0.7

0.2 0.20.1

1.5

0.2

0.8

0.3 0.3

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

1

Percent

Prescription pain relievers

Prescription tranquilizers

Prescription stimulants

Prescription sedatives

Marijuana

Heroin

Opioids

Cocaine

Methamphetamines

Source: 2016 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration. Rockville, MD.aSubstance use disorder is defined as meeting criteria for illicit or prescription drug dependence or abuse. Dependence or abuse is based on definitions found in the 4th edition

of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).bOpioids include heroin use, prescription pain reliever misuse, or both; therefore, the numbers for heroin use and prescription pain reliever misuse do not add to those for

opioid misuse because of poly-drug use. This category includes misuse of prescription fentanyl but excludes use of illicit fentanyl.

b

Substance Category


Self-reported prevalence of illicit and prescription drug treatmenta in the past year, persons


Source: 2016 National Survey on Drug Use and Health. Substance Abuse and Mental Health Services Administration. Rockville, MD.aIllicit or prescription drug treatment refers to treatment received in order to reduce or stop illicit drug use or prescription drug use, or for medical problems associated with illicit drug use or

prescription drug use. It includes treatment received at any location, such as a hospital (inpatient), rehabilitation facility (inpatient or outpatient), mental health center, emergency room, private

doctor's office, self-help group, or prison/jail. Illicit drug use includes the use of marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, or methamphetamine. A specialty facility

includes a hospital (inpatient only), rehabilitation facility (inpatient or outpatient), or mental health center.

0.8

0.5

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

0.8

0.9

Any location Specialty facility

Percent

Nonfatal Overdose Hospitalizations and Emergency Department (ED) Visits

Nonfatal Overdose Hospitalizations and (ED) Visits

Age-adjusted rates of drug poisoning-related hospitalizationsa by selected substances —

United States, 2015

Source: Weighted national estimates from Healthcare Cost and Utilization Project Nationwide Inpatient Sample, 2015, Agency for Healthcare Research and Quality. Data are from 2015, when

HCUP transitioned from using ICD-9-CM to ICD-10-CM/PCM diagnosis codes and should not be compared with other years. Results may have been affected by the transition; please see the

Surveillance Report technical notes for a discussion of transition.aIn-hospital deaths and patients who transferred from another hospital were excluded. Visits with missing age and gender were excluded. Numbers subject to rounding error.bFor the first three quarters of 2015, includes ICD-9-CM principal diagnosis code of 965.00, 965.01, 965.02, 965.09 or external cause of injury E850.0, E850.1, E850.2; for the fourth quarter of

2015, includes ICD-10-CM/PCS contributing causes T40.0, T40.1, T40.2, T40.3, T40.6, T40.69.cFor the first three quarters of 2015, includes ICD-9-CM principal diagnosis code of 965.00, 965.09 or external cause of injury E850.2; for the fourth quarter of 2015, includes ICD-10-CM/PCS

contributing causes T40.0, T40.2, T40.4, T40.6, T40.69.

96.2

23.2

5.31.7

16.7

5.8 4.7

0.0

20.0

40.0

60.0

80.0

100.0

120.0

All drug All opioid Heroin Methadone Other opioids Cocaine Methamphetamine

Rate per

100,000 persons

b c


Age-adjusted rates of drug poisoning-related hospitalizationsa by selected substances and sex —

United States, 2015

86.5

22.8

7.21.7

14.57.7 5.9

105.7

23.4

3.3 1.6

18.8

3.9 3.6

0.0

20.0

40.0

60.0

80.0

100.0

120.0


Rate per

100,000 persons

Male Female

Source: Weighted national estimates from Healthcare Cost and Utilization Project Nationwide Inpatient Sample, 2015, Agency for Healthcare Research and Quality. Data are from 2015,

when HCUP transitioned from using ICD-9-CM to ICD-10-CM/PCM diagnosis codes and should not be compared with other years. Results may have been affected by the transition; please

see the Surveillance Report technical notes for a discussion of transition.aIn-hospital deaths and patients who transferred from another hospital were excluded. Visits with missing age and gender were excluded. Numbers subject to rounding error.bFor the first three quarters of 2015, includes ICD-9-CM principal diagnosis code of 965.00, 965.01, 965.02, 965.09 or external cause of injury E850.0, E850.1, E850.2; for the fourth

quarter of 2015, includes ICD-10-CM/PCS contributing causes T40.0, T40.1, T40.2, T40.3, T40.6, T40.69. cFor the first three quarters of 2015, includes ICD-9-CM principal diagnosis code of 965.00, 965.09 or external cause of injury E850.2; for the fourth quarter of 2015, includes ICD-10-

CM/PCS contributing causes T40.0, T40.2, T40.4, T40.6, T40.69.

b c


Age-adjusted rates of drug poisoning-related hospitalizationsa by selected substances and age

group — United States, 2015

15

.4

0.8

0.1 0.7

10

3.5

9.1

2.3

0.4 6

.6

11

6.3

24

.2

12

.3

1.3

11

.5

11

4.6

29

.5

13

.2

2.2

15

11

9.4

28

7.8

2.3

18

.6

13

6.9

36

.3

5.9

2.8

28

.2

12

7.5

42

.4

4.0

3.3

35

.7

10

3.7

28

.7

0.6 1.4

26

.8

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

All drug All opioid Heroin Methadone Other opioids

Rate per

100,000

persons

0–14 15–19 20–24 25–34 35–44 45–54 55–64 65+

Source: Weighted national estimates from Healthcare Cost and Utilization Project Nationwide Inpatient Sample, 2015, Agency for Healthcare Research and Quality. Data are from 2015, when HCUP

transitioned from using ICD-9-CM to ICD-10-CM/PCM diagnosis codes and should not be compared with other years. Results may have been affected by the transition; please see the Surveillance

Report technical notes for a discussion of transition.aIn-hospital deaths and patients who transferred from another hospital were excluded. Visits with missing age and gender were excluded. Numbers subject to rounding error.bFor the first three quarters of 2015, includes ICD-9-CM principal diagnosis code of 965.00, 965.01, 965.02, 965.09 or external cause of injury E850.0, E850.1, E850.2; for the fourth quarter of 2015,

includes ICD-10-CM/PCS contributing causes T40.0, T40.1, T40.2, T40.3, T40.6, T40.69. cBecause the relative standard error was > 30% or the standard error = 0 for age group 0–14, the value of the estimate was considered unreliable and was not reported.dFor the first three quarters of 2015, includes ICD-9-CM principal diagnosis code of 965.00, 965.09 or external cause of injury E850.2; for the fourth quarter of 2015, includes ICD-10-CM/PCS


b c d


Age-adjusted rates of drug poisoning-related hospitalizationsa by selected substances and

age group — United States, 2015

0.20.6

1.6

3.6

5.1

8.07.7

9.89.2

7.7

13.2

6.3

9.1

3.6

1.7

0.6

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

Cocaine Methamphetamine

Rate per

100,000

persons

0–14 15–19 20–24 25–34 35–44 45–54 55–64 65+



Surveillance Report technical notes for a discussion of transition.aIn-hospital deaths and patients who transferred from another hospital were excluded. Visits with missing age and gender were excluded. Numbers subject to rounding error.


Age-adjusted rates of all opioida poisoning-related hospitalizationsb by region —

United States, 2015



Surveillance Report technical notes for a discussion of transition.aFor the first three quarters of 2015, includes ICD-9-CM principal diagnosis code of 965.00, 965.01, 965.02, 965.09 or external cause of injury E850.0, E850.1, E850.2; for the fourth quarter of

2015, includes ICD-10-CM/PCS contributing causes T40.0, T40.1, T40.2, T40.3, T40.6, T40.69. bIn-hospital deaths and patients who transferred from another hospital were excluded. Visits with missing age and gender were excluded. Numbers subject to rounding error.






Age-adjusted rates of heroin poisoning-related hospitalizationsa by region —

United States, 2015


when HCUP transitioned from using ICD-9-CM to ICD-10-CM/PCM diagnosis codes and should not be compared with other years. Results may have been affected by the transition;

please see the Surveillance Report technical notes for a discussion of transition.aIn-hospital deaths and patients who transferred from another hospital were excluded. Visits with missing age and gender were excluded. Numbers subject to rounding error.






Age-adjusted rates of methadone poisoning-related hospitalizationsa by region —

United States, 2015



Report technical notes for a discussion of transition.aIn-hospital deaths and patients who transferred from another hospital were excluded. Visits with missing age and gender were excluded. Numbers subject to rounding error.






Age-adjusted rates of cocaine poisoning-related hospitalizationsa by region —

United States, 2015



Surveillance Report technical notes for a discussion of transition.aIn-hospital deaths and patients who transferred from another hospital were excluded. Visits with missing age and gender were excluded. Numbers subject to rounding error.






Age-adjusted rates of methamphetamine poisoning-related hospitalizationsa by region —

United States, 2015

Source: Weighted national estimates from Healthcare Cost and Utilization Project Nationwide Inpatient Sample, 2015, Agency for Healthcare Research and Quality. Data are from

2015, when HCUP transitioned from using ICD-9-CM to ICD-10-CM/PCM diagnosis codes and should not be compared with other years. Results may have been affected by the

transition; please see the Surveillance Report technical notes for a discussion of transition.aIn-hospital deaths and patients who transferred from another hospital were excluded. Visits with missing age and gender were excluded. Numbers subject to rounding error.






Age-adjusted rates of drug poisoning-related emergency department visitsa by selected

substances — United States, 2015

174.6

44.0

25.9

1.1

17.3

3.0 5.2

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

160.0

180.0


Rate per

100,000 persons



Report technical notes for a discussion of transition.aPersons who were hospitalized, died, or transferred to another facility were excluded. Visits with missing age and gender were excluded. Numbers subject to rounding error.bFor the first three quarters of 2015, includes ICD-9-CM principal diagnosis code of 965.00, 965.01, 965.02, 965.09 or external cause of injury E850.0, E850.1, E850.2; for the fourth quarter of 2015,

includes ICD-10-CM/PCS contributing causes T40.0, T40.1, T40.2, T40.3, T40.6, T40.69. cFor the first three quarters of 2015, includes ICD-9-CM principal diagnosis code of 965.00, 965.09 or external cause of injury E850.2; for the fourth quarter of 2015, includes ICD-10-CM/PCS


b c


Age-adjusted rates of drug poisoning-related emergency department visitsa by selected substances

and sex — United States, 2015

167.2

54.0

35.7

1.3

17.5

3.9 6.2

182.1

34.0

16.1

1.0

17.1

2.2 4.2

0.0

20.0

40.0

60.0

80.0

100.0

120.0

140.0

160.0

180.0

200.0


Rate per

100,000

persons

Male Female


when HCUP transitioned from using ICD-9-CM to ICD-10-CM/PCM diagnosis codes and should not be compared with other years. Results may have been affected by the transition; please

see the Surveillance Report technical notes for a discussion of transition.aPersons who were hospitalized, died, or transferred to another facility were excluded. Visits with missing age and gender were excluded. Numbers subject to rounding error.bFor the first three quarters of 2015, includes ICD-9-CM principal diagnosis code of 965.00, 965.01, 965.02, 965.09 or external cause of injury E850.0, E850.1, E850.2; for the fourth

quarter of 2015, includes ICD-10-CM/PCS contributing causes T40.0, T40.1, T40.2, T40.3, T40.6, T40.69. cFor the first three quarters of 2015, includes ICD-9-CM principal diagnosis code of 965.00, 965.09 or external cause of injury E850.2; for the fourth quarter of 2015, includes ICD-10-

CM/PCS contributing causes T40.0, T40.2, T40.4, T40.6, T40.69.

b c



and age group — United States, 2015

13

4.5

4.0

0.1 3.9

30

7.7

26

.5

11

.2

0.3 1

5.2

28

1.1

99

.7

73

.2

1.1

26

.0

26

0.6

11

1.4

81

.8

2.3

28

.6

18

0.7

59

.5

35

.9

1.9

22

.2

14

5.8

41

.6

18

.5

1.5

22

.0

10

7.1

28

.5

8.2

1.7

18

.8

88

.9

14

.1

1.0

0.5 1

2.6

0.0

25.0

50.0

75.0

100.0

125.0

150.0

175.0

200.0

225.0

250.0

275.0

300.0

325.0

All drug All opioid Heroin Methadone Other opioids

Rate per

100,000

persons

0–14 15–19 20–24 25–34 35–44 45–54 55–64 65+

c



Surveillance Report technical notes for a discussion of transition.aPersons who were hospitalized, died, or transferred to another facility were excluded. Visits with missing age and gender were excluded. Numbers subject to rounding error.bFor the first three quarters of 2015, includes ICD-9-CM principal diagnosis code of 965.00, 965.01, 965.02, 965.09 or external cause of injury E850.0, E850.1, E850.2; for the fourth quarter of

2015, includes ICD-10-CM/PCS contributing causes T40.0, T40.1, T40.2, T40.3, T40.6, T40.69. cFor the first three quarters of 2015, includes ICD-9-CM principal diagnosis code of 965.00, 965.09 or external cause of injury E850.2; for the fourth quarter of 2015, includes ICD-10-CM/PCS


b



and age group — United States, 2015

0.7

3.9

2.0

8.3

5.1

11.8

6.4

10.3

4.7

6.4

3.82.9

2.01.2

0.4 0.4

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

Cocaine Methamphetamine

Rate per

100,000

persons

0–14 15–19 20–24 25–34 35–44 45–54 55–64 65+



please see the Surveillance Report technical notes for a discussion of transition.aPersons who were hospitalized, died, or transferred to another facility were excluded. Visits with missing age and gender were excluded. Numbers subject to rounding error.


Age-adjusted rates of all opioida poisoning-related emergency department visitsb by region —

United States, 2015



please see the Surveillance Report technical notes for a discussion of transition.aFor the first three quarters of 2015, includes ICD-9-CM principal diagnosis code of 965.00, 965.01, 965.02, 965.09 or external cause of injury E850.0, E850.1, E850.2; for the fourth

quarter of 2015, includes ICD-10-CM/PCS contributing causes T40.0, T40.1, T40.2, T40.3, T40.6, T40.69. bPersons who were hospitalized, died, or transferred to another facility were excluded. Visits with missing age and gender were excluded. Numbers subject to rounding error.






Age-adjusted rates of heroin poisoning-related emergency department visitsa by region —

United States, 2015



transition; please see the Surveillance Report technical notes for a discussion of transition.aPersons who were hospitalized, died, or transferred to another facility were excluded. Visits with missing age and gender were excluded. Numbers subject to rounding error.






Age-adjusted rates of methadone poisoning-related emergency department visitsa by region —

United States, 2015









Age-adjusted rates of cocaine poisoning-related emergency department visitsa by region —

United States, 2015









Age-adjusted rates of methamphetamine poisoning-related emergency department visitsa by region

— United States, 2015








Drug Overdose Mortality


Age-adjusted rates of drug overdose deathsa and drug overdose deaths involving any opioidb

for all intents and for unintentional intent by year — United States, 1999–2016

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

20.0

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016

Rate per

100,000

persons

Year

Drug overdose deaths (of all

intents)

Unintentional drug overdose

deaths

Drug overdose deaths involving any

opioid (of all intents)

Unintentional drug overdose

deaths involving any opioid

Source: National Vital Statistics System, Mortality File, CDC WONDER.aDeaths are classified using the International Classification of Diseases, Tenth Revision (ICD–10). All drug overdose deaths are identified using underlying cause-of-death codes X40–X44

(unintentional), X60–X64 (suicide), X85 (homicide), and Y10–Y14 (undetermined). Unintentional drug overdose deaths are identified using underlying cause-of-death codes X40–X44. Note that

overall drug overdose deaths and opioid overdose deaths include deaths of any intent. In 2016, 5.7% of drug overdose deaths had undetermined intent; this is a decrease from 14.7% of drug

overdose deaths that had an undetermined intent in 1999. Some of these deaths may be unintentional drug overdose deaths.bDrug overdose deaths, as defined, that involve opium (T40.0), heroin (T40.1), natural and semi-synthetic opioids (T40.2), methadone (T40.3), other synthetic opioids excluding methadone (T40.4),

and other and unspecified narcotics (T40.6).


Age-adjusted ratesa of drug overdose deaths by drug or drug class and year —


0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

Rate per

100,000

persons

Year

Synthetic opioids other

than methadone

Prescription opioids

Heroin

Cocaine

Psychostimulants with

abuse potential

b

c

Source: National Vital Statistics System, Mortality File, CDC WONDER.aRate per 100,000 population age-adjusted to the 2000 U.S. standard population using the vintage year population of the data year. Because deaths might involve more than one drug, some

deaths are included in more than one category. Specification on death certificates of drugs involved with deaths varies over time. In 2016, 15% of drug overdose deaths did not include

information on the specific type of drug(s) involved Some of these deaths may have involved opioids or stimulants.bDrug overdose deaths that involve synthetic opioids other than methadone (T40.4).cDrug overdose deaths that involve natural and semi-synthetic opioids (T40.2) or methadone (T40.3). dDrug overdose deaths that involve psychostimulants with abuse potential (T43.6).

d


Ratesa of drug overdose deaths by drug or drug class and age group — United States, 2016

Source: National Vital Statistics System, Mortality File, CDC WONDER.aRate per 100,000 population using the vintage year population of the data year. Because deaths might involve more than one drug, some deaths are included in more than one category.

Specification on death certificates of drugs involved with deaths varies over time. In 2016, 15% of drug overdose deaths did not include information on the specific type of drug(s) involved. Some

of these deaths may have involved opioids or stimulants.bDrug overdose deaths that involve synthetic opioids other than methadone (T40.4).cDrug overdose deaths that involve natural and semi-synthetic opioids (T40.2) or methadone (T40.3).dDrug overdose deaths that involve psychostimulants with abuse potential (T43.6).

4.5

2.6

4.0

1.7

1.3

13

.6

7.7

11

.3

5.7

3.9

11

.9

9.2

9.0

6.0

4.5

9.0

10

.1

7.0

6.1

4.55

.4

8.4

4.3

4.2

3.0

0.8

1.9

0.6

0.6

0.4

0.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

Synthetic opioids other than

methadone

Prescription opioids Heroin Cocaine Psychostimulants with

abuse potential

Rate per

100,000

persons

15–24 25–34 35–44 45–54 55–64 ≥65

b

c

d


Age-adjusted ratesa of drug overdose deaths by sex — United States, 2016

8.9

6.2

7.5

4.7

3.43.54.3

2.41.8

1.4

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0

10.0


methadone

Prescription opioids Heroin Cocaine Psychostimulants with

abuse potential

Rate per

100,000

persons

Male Female



information on the specific type of drug(s) involved. Some of these deaths may have involved opioids or stimulants.bDrug overdose deaths that involve synthetic opioids other than methadone (T40.4).cDrug overdose deaths that involve natural and semi-synthetic opioids (T40.2) or methadone (T40.3).dDrug overdose deaths that involve psychostimulants with abuse potential (T43.6).

b

c

d


Age-adjusted ratesa of drug overdose deaths by race/ethnicity — United States, 2016

8.2

7.0

6.3

3.43.0

5.6

3.3

4.5

6.1

1.2

0.6 0.7 0.5 0.40.8

4.1

6.5

5.0

2.1

6.9

2.7

2.1

2.8

2.01.5

0.0

1.0

2.0

3.0

4.0

5.0

6.0

7.0

8.0

9.0


methadone

Prescription opioids Heroin Cocaine Psychostimulants with abuse

potential

Rate per

100,000

persons

White, non-Hispanic Black, non-Hispanic Asian/Pacific Islander, non-Hispanic American Indian/Alaska Native, non-Hispanic Hispanic



information on the specific type of drug(s) involved. Some of these deaths may have involved opioids or stimulants.bDrug overdose deaths that involve synthetic opioids other than methadone (T40.4).cDrug overdose deaths that involve natural and semi-synthetic opioids (T40.2) or methadone (T40.3).dDrug overdose deaths that involve psychostimulants with abuse potential (T43.6).

b

c

d

Limitations

� Since four distinct data sources were used, terminology and definitions were not

standardized across all outcomes, and the most recent year of data varied by source.

• Comparability of data across sections is limited.

� In the mortality section, involved drugs were not specified in approximately 20% of drug

overdose deaths, potentially leading to an underestimate of rates by drug or drug class.

However, drug specificity has improved over time; in 2016, 15% of deaths lacked drug

specificity.

� Polysubstance use (i.e., the consumption of more than one drug over a defined period,

simultaneously or at different times) was not examined.

� For a detailed description of the data sources, definitions, and limitations, please refer

to the technical notes in the surveillance report.*

� www.cdc.gov/drugoverdose/pdf/pubs/2018-cdc-drug-surveillance-report.pdf

*Centers for Disease Control and Prevention. 2018 Annual Surveillance Report of Drug-Related Risks and Outcomes — United States. Surveillance Special Report.

Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. Published August 31, 2018.

Conclusions

1. Opioid prescribing and high-dose prescribing continued to decrease

through 2017.

2. A low percentage of those needing treatment for substance abuse are able

to access it. In addition to expanding treatment options and access,

additional measures are needed to prevent illicit drug use and prescription

drug misuse in a dynamic drug landscape.

3. Drug overdose deaths in 2016 reached a new record high.

4. Heroin, synthetic opioids other than methadone (mostly illicitly

manufactured fentanyl), cocaine, and psychostimulants with abuse

potential were driving increases in overdose deaths in 2016.

CDC’s Opioid Overdose Prevention Efforts

CDC’s Mission

Prevent opioid-related harms and overdose deaths by:

� Conducting surveillance and research to improve data quality and track trends;

� Building state, local, and tribal capacity by scaling up effective public health

interventions;

� Supporting providers, health systems, and payers with tools,

recommendations, and guidance to improve patient safety;

� Partnering with public safety to respond quicker and more effectively; and

� Empowering consumers to make safe choices.

Conducting surveillance and research

� Enhanced State Opioid Overdose Surveillance (ESOOS)

• Funds 32 states and Washington, D.C., to increase timeliness and

comprehensiveness of nonfatal and fatal opioid overdose reporting and

dissemination of results to key stakeholders

• Serves as an early warning system to detect sharp increases (i.e., potential

outbreaks) or decreases (i.e., rapidly identify successful intervention efforts)

• Uses the State Unintentional Drug Overdose Report System (SUDORS) to

integrate data on opioid overdose deaths from death certificates and unique

medical examiner and coroner investigations, including toxicology reports.

• For more information: www.cdc.gov/drugoverdose/foa/state-opioid-mm.html

� Prevention for States (PfS)

• Funds 29 states to enhance and maximize prescription drug monitoring

programs, implement interventions, and evaluate the impact of state policies

• For more information:

www.cdc.gov/drugoverdose/states/state_prevention.html

� Data-Driven Prevention Initiative (DDPI)

• Funds 13 states and Washington, D.C., to improve data collection and

analysis around opioid misuse, abuse, and overdose, and develop

comprehensive prevention programs

• For more information: www.cdc.gov/drugoverdose/foa/ddpi.html

Building state, local, and tribal capacity

� CDC’s Guideline for Prescribing Opioids for Chronic Pain —

released March 2016

• Serves as a resource to providers treating chronic pain for adult patients in

primary care settings outside of end-of-life, palliative, and active cancer care.

• For more information: www.cdc.gov/drugoverdose/prescribing/resources.html

Supporting providers, health systems, and payers

� Heroin Response Strategy

• A collaboration between CDC and the Office of the National Drug Control

Policy and 10 High Intensity Drug Trafficking Areas (HIDTAs)

• Coordinates data sharing across public health and public safety, develops and

supports implementation of evidence-based strategies, and strengthens the

engagement of local communities to create targeted responses

Partnering with public safety

� Rx Awareness campaign

• Raises awareness about the risks of opioid misuse and abuse in order to

empower people to make safer choices

• For more information: www.cdc.gov/rxawareness/index.html

Empowering consumers

For more information, contact CDC

1-800-CDC-INFO (232-4636)

TTY: 1-888-232-6348 www.cdc.gov

The findings and conclusions in this report are those of the authors and do not necessarily represent the

official position of the Centers for Disease Control and Prevention.

For a detailed description of data sources, definitions, and statistical analyses, as well as an in-depth

presentation of results, please refer to:

Centers for Disease Control and Prevention. 2018 Surveillance Report of Drug-Related Risks and

Outcomes — United States. Surveillance Special Report. Centers for Disease Control and Prevention.

U.S. Department of Health and Human Services. www.cdc.gov/drugoverdose/pdf/pubs/2018-cdc-

drug-surveillance-report.pdf Published August 31, 2018.

For more information, see: www.cdc.gov/drugoverdose

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