Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

Rx Summit wwwNationalRxDrugAbuseSummitorg

Disclosures

Puja Seth PhD Alana Vivolo-Kantor PhD MPH and Julie ODonnell PhD MPH have disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce healthcare goods and services

Rx Summit wwwNationalRxDrugAbuseSummitorg

Disclosures

All plannersmanagers hereby state that they or their spouselife partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months

The following plannersmanagers have the following to disclose- Kelly J Clark MD MBA FASAM DFAPA ndash

Consulting fees Braeburn Indivior

Rx Summit wwwNationalRxDrugAbuseSummitorg

Learning Objectives

Describe the process to develop CDC and state case definitions

Identify patterns of recent nonfatal heroin and opioid drug overdoses across 12 states

Identify drugs involved in deaths and circumstances precipitating the deaths based on data

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)

Puja Seth PhDAlana Vivolo-Kantor PhD

Julie OrsquoDonnell PhD

Division of Unintentional Injury PreventionCenters for Disease Control and Prevention

Rx Summit wwwNationalRxDrugAbuseSummitorg

Disclosure Statement

Puja Seth PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services

Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control

Rx Summit wwwNationalRxDrugAbuseSummitorg

Goals

Describe CDCrsquos new opioid overdose surveillance program Discuss how rapidly available data can be used to inform

overdose response and prevention efforts Overview of emergency department and emergency medical

services data for use in tracking opioid overdose trends Describe the development of case definitions for opioid and

heroin overdose in emergency department and emergency medical services data

Overview of data available for fatal opioid overdoses and associated risk factors and its use in informing prevention and response recommendations

Rx Summit wwwNationalRxDrugAbuseSummitorg

Opioid Overdoses Treated in Emergency Departments

Vivolo-Kantor AM Seth P Gladden RM Mattson CL Baldwin GT Kite-Powell A Coletta MA Vital Signs Trends in Emergency Department Visits for Suspected Opioid Overdoses mdash United States July 2016ndashSeptember 2017(httpswwwcdcgovmmwrvolumes67wrmm6709e1htm) MMWR Morb Mortal Wkly Rep201867

Rx Summit wwwNationalRxDrugAbuseSummitorg

Disclosures

Puja Seth PhD Alana Vivolo-Kantor PhD MPH and Julie ODonnell PhD MPH have disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce healthcare goods and services

Rx Summit wwwNationalRxDrugAbuseSummitorg

Disclosures

All plannersmanagers hereby state that they or their spouselife partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months

The following plannersmanagers have the following to disclose- Kelly J Clark MD MBA FASAM DFAPA ndash

Consulting fees Braeburn Indivior

Rx Summit wwwNationalRxDrugAbuseSummitorg

Learning Objectives

Describe the process to develop CDC and state case definitions

Identify patterns of recent nonfatal heroin and opioid drug overdoses across 12 states

Identify drugs involved in deaths and circumstances precipitating the deaths based on data

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)

Puja Seth PhDAlana Vivolo-Kantor PhD

Julie OrsquoDonnell PhD

Division of Unintentional Injury PreventionCenters for Disease Control and Prevention

Rx Summit wwwNationalRxDrugAbuseSummitorg

Disclosure Statement

Puja Seth PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services

Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control

Rx Summit wwwNationalRxDrugAbuseSummitorg

Goals

Describe CDCrsquos new opioid overdose surveillance program Discuss how rapidly available data can be used to inform

overdose response and prevention efforts Overview of emergency department and emergency medical

services data for use in tracking opioid overdose trends Describe the development of case definitions for opioid and

heroin overdose in emergency department and emergency medical services data

Overview of data available for fatal opioid overdoses and associated risk factors and its use in informing prevention and response recommendations

Rx Summit wwwNationalRxDrugAbuseSummitorg

Opioid Overdoses Treated in Emergency Departments

Vivolo-Kantor AM Seth P Gladden RM Mattson CL Baldwin GT Kite-Powell A Coletta MA Vital Signs Trends in Emergency Department Visits for Suspected Opioid Overdoses mdash United States July 2016ndashSeptember 2017(httpswwwcdcgovmmwrvolumes67wrmm6709e1htm) MMWR Morb Mortal Wkly Rep201867

Rx Summit wwwNationalRxDrugAbuseSummitorg

Disclosures

All plannersmanagers hereby state that they or their spouselife partner do not have any financial relationships or relationships to products or devices with any commercial interest related to the content of this activity of any amount during the past 12 months

The following plannersmanagers have the following to disclose- Kelly J Clark MD MBA FASAM DFAPA ndash

Consulting fees Braeburn Indivior

Rx Summit wwwNationalRxDrugAbuseSummitorg

Learning Objectives

Describe the process to develop CDC and state case definitions

Identify patterns of recent nonfatal heroin and opioid drug overdoses across 12 states

Identify drugs involved in deaths and circumstances precipitating the deaths based on data

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)

Puja Seth PhDAlana Vivolo-Kantor PhD

Julie OrsquoDonnell PhD

Division of Unintentional Injury PreventionCenters for Disease Control and Prevention

Rx Summit wwwNationalRxDrugAbuseSummitorg

Disclosure Statement

Puja Seth PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services

Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control

Rx Summit wwwNationalRxDrugAbuseSummitorg

Goals

Describe CDCrsquos new opioid overdose surveillance program Discuss how rapidly available data can be used to inform

overdose response and prevention efforts Overview of emergency department and emergency medical

services data for use in tracking opioid overdose trends Describe the development of case definitions for opioid and

heroin overdose in emergency department and emergency medical services data

Overview of data available for fatal opioid overdoses and associated risk factors and its use in informing prevention and response recommendations

Rx Summit wwwNationalRxDrugAbuseSummitorg

Opioid Overdoses Treated in Emergency Departments

Vivolo-Kantor AM Seth P Gladden RM Mattson CL Baldwin GT Kite-Powell A Coletta MA Vital Signs Trends in Emergency Department Visits for Suspected Opioid Overdoses mdash United States July 2016ndashSeptember 2017(httpswwwcdcgovmmwrvolumes67wrmm6709e1htm) MMWR Morb Mortal Wkly Rep201867

Rx Summit wwwNationalRxDrugAbuseSummitorg

Learning Objectives

Describe the process to develop CDC and state case definitions

Identify patterns of recent nonfatal heroin and opioid drug overdoses across 12 states

Identify drugs involved in deaths and circumstances precipitating the deaths based on data

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)

Puja Seth PhDAlana Vivolo-Kantor PhD

Julie OrsquoDonnell PhD

Division of Unintentional Injury PreventionCenters for Disease Control and Prevention

Rx Summit wwwNationalRxDrugAbuseSummitorg

Disclosure Statement

Puja Seth PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services

Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control

Rx Summit wwwNationalRxDrugAbuseSummitorg

Goals

Describe CDCrsquos new opioid overdose surveillance program Discuss how rapidly available data can be used to inform

overdose response and prevention efforts Overview of emergency department and emergency medical

services data for use in tracking opioid overdose trends Describe the development of case definitions for opioid and

heroin overdose in emergency department and emergency medical services data

Overview of data available for fatal opioid overdoses and associated risk factors and its use in informing prevention and response recommendations

Rx Summit wwwNationalRxDrugAbuseSummitorg

Opioid Overdoses Treated in Emergency Departments

Vivolo-Kantor AM Seth P Gladden RM Mattson CL Baldwin GT Kite-Powell A Coletta MA Vital Signs Trends in Emergency Department Visits for Suspected Opioid Overdoses mdash United States July 2016ndashSeptember 2017(httpswwwcdcgovmmwrvolumes67wrmm6709e1htm) MMWR Morb Mortal Wkly Rep201867

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)

Puja Seth PhDAlana Vivolo-Kantor PhD

Julie OrsquoDonnell PhD

Division of Unintentional Injury PreventionCenters for Disease Control and Prevention

Rx Summit wwwNationalRxDrugAbuseSummitorg

Disclosure Statement

Puja Seth PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services

Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control

Rx Summit wwwNationalRxDrugAbuseSummitorg

Goals

Describe CDCrsquos new opioid overdose surveillance program Discuss how rapidly available data can be used to inform

overdose response and prevention efforts Overview of emergency department and emergency medical

services data for use in tracking opioid overdose trends Describe the development of case definitions for opioid and

heroin overdose in emergency department and emergency medical services data

Overview of data available for fatal opioid overdoses and associated risk factors and its use in informing prevention and response recommendations

Rx Summit wwwNationalRxDrugAbuseSummitorg

Opioid Overdoses Treated in Emergency Departments

Vivolo-Kantor AM Seth P Gladden RM Mattson CL Baldwin GT Kite-Powell A Coletta MA Vital Signs Trends in Emergency Department Visits for Suspected Opioid Overdoses mdash United States July 2016ndashSeptember 2017(httpswwwcdcgovmmwrvolumes67wrmm6709e1htm) MMWR Morb Mortal Wkly Rep201867

Rx Summit wwwNationalRxDrugAbuseSummitorg

Disclosure Statement

Puja Seth PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services

Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control

Rx Summit wwwNationalRxDrugAbuseSummitorg

Goals

Describe CDCrsquos new opioid overdose surveillance program Discuss how rapidly available data can be used to inform

overdose response and prevention efforts Overview of emergency department and emergency medical

services data for use in tracking opioid overdose trends Describe the development of case definitions for opioid and

heroin overdose in emergency department and emergency medical services data

Overview of data available for fatal opioid overdoses and associated risk factors and its use in informing prevention and response recommendations

Rx Summit wwwNationalRxDrugAbuseSummitorg

Opioid Overdoses Treated in Emergency Departments

Vivolo-Kantor AM Seth P Gladden RM Mattson CL Baldwin GT Kite-Powell A Coletta MA Vital Signs Trends in Emergency Department Visits for Suspected Opioid Overdoses mdash United States July 2016ndashSeptember 2017(httpswwwcdcgovmmwrvolumes67wrmm6709e1htm) MMWR Morb Mortal Wkly Rep201867

Rx Summit wwwNationalRxDrugAbuseSummitorg

Goals

Describe CDCrsquos new opioid overdose surveillance program Discuss how rapidly available data can be used to inform

overdose response and prevention efforts Overview of emergency department and emergency medical

services data for use in tracking opioid overdose trends Describe the development of case definitions for opioid and

heroin overdose in emergency department and emergency medical services data

Overview of data available for fatal opioid overdoses and associated risk factors and its use in informing prevention and response recommendations

Rx Summit wwwNationalRxDrugAbuseSummitorg

Opioid Overdoses Treated in Emergency Departments

Vivolo-Kantor AM Seth P Gladden RM Mattson CL Baldwin GT Kite-Powell A Coletta MA Vital Signs Trends in Emergency Department Visits for Suspected Opioid Overdoses mdash United States July 2016ndashSeptember 2017(httpswwwcdcgovmmwrvolumes67wrmm6709e1htm) MMWR Morb Mortal Wkly Rep201867

Rx Summit wwwNationalRxDrugAbuseSummitorg

Opioid Overdoses Treated in Emergency Departments

Vivolo-Kantor AM Seth P Gladden RM Mattson CL Baldwin GT Kite-Powell A Coletta MA Vital Signs Trends in Emergency Department Visits for Suspected Opioid Overdoses mdash United States July 2016ndashSeptember 2017(httpswwwcdcgovmmwrvolumes67wrmm6709e1htm) MMWR Morb Mortal Wkly Rep201867

Rx Summit wwwNationalRxDrugAbuseSummitorg

Vivolo-Kantor AM Seth P Gladden RM Mattson CL Baldwin GT Kite-Powell A Coletta MA Vital Signs Trends in Emergency Department Visits for Suspected Opioid Overdoses mdash United States July 2016ndashSeptember 2017(httpswwwcdcgovmmwrvolumes67wrmm6709e1htm) MMWR Morb Mortal Wkly Rep201867

Rx Summit wwwNationalRxDrugAbuseSummitorg

2000 Rapid Increase in Drug Overdose Death Rates by County

SOURCE NCHS Data Visualization Gallery

Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery

2005 Rapid Increase in Drug Overdose Death Rates by County

Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery

2010 Rapid Increase in Drug Overdose Death Rates by County

Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery

2016 Rapid Increase in Drug Overdose Death Rates by County

Rx Summit wwwNationalRxDrugAbuseSummitorg

RISE IN OPIOID DEATHS

Overlapping Entangled but Distinct Epidemics

Natural and semi-synthetic opioidslike oxycodone or hydrocodone

Methadone

Heroin

SOURCE National Vital Statistics System Mortality File

Dea

ths

per 1

000

00 p

opul

atio

n

Chart1

Synthetic opioidslike fentanyl

3 Waves

Almost 351630 people have died from an opioid overdose during 1999-2016

Natural and semi-synthetic opioid analgesic

Methadone

Synthetic opioid analgesic excluding methadone

Heroin

1

03

03

07

12

05

03

06

17

1

05

07

19

15

06

07

27

18

07

08

31

15

1

11

37

14

08

14

35

11

1

27

39

1

31

41

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

CDCrsquos Pillars on Opioids Conducting surveillance and research

Building state local and tribal prevention efforts

Supporting healthcare providers and health systems

Partnering with public safety officials

Encouraging consumers to make safe choices about opioids raising awareness about prescription opioid misuse and overdose

Rx Summit wwwNationalRxDrugAbuseSummitorg

Enhanced State Opioid Overdose Surveillance (ESOOS) 12 states funded in September 2016 20 additional states and the

District of Columbia funded in September 2017 (through September 2019)

Strategy One Increase timeliness of non-fatal opioid overdose reporting- Use syndromic surveillance to establish an early warning system to

detect sharp increases or decreases in non-fatal opioid overdoses - Three indicators suspected all-drug opioid and heroin

Alaska California Connecticut Delaware DC Florida Georgia Illinois Indiana Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Nevada New Hampshire New Jersey New Mexico North Carolina Ohio Oklahoma Pennsylvania Rhode Island Tennessee Utah Vermont Virginia Washington West Virginia Wisconsin

Column1		Any opioid		Natural and semi-synthetic opioid analgesic		Methadone		Synthetic opioid analgesic excluding methadone		Heroin
1999			1		03		03		07
	21		1		04		03		07
2001		24		12		05		03		06
	32		15		08		04		07
2003		35		17		1		05		07
	39		18		13		06		06
2005		43		19		15		06		07
	51		23		18		09		07
2007		54		27		18		07		08
	57		3		16		08		1
2009		59		31		15		1		11
	62		35		15		1		1
2011		66		37		14		08		14
	67		35		12		08		19
2013		74		35		11		1		27
	86		38		11		18		34
2015		104		39		1		31		41
	133		44		1		62		49

1999		1999		1999		1999
1		04		03		07
2001		2001		2001		2001
15		08		04		07
2003		2003		2003		2003
18		13		06		06
2005		2005		2005		2005
23		18		09		07
2007		2007		2007		2007
3		16		08		1
2009		2009		2009		2009
35		15		1		1
2011		2011		2011		2011
35		12		08		19
2013		2013		2013		2013
38		11		18		34
2015		2015		2015		2015
44		1		62		49

Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery

2005 Rapid Increase in Drug Overdose Death Rates by County

Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery

2010 Rapid Increase in Drug Overdose Death Rates by County

Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery

2016 Rapid Increase in Drug Overdose Death Rates by County

Rx Summit wwwNationalRxDrugAbuseSummitorg

RISE IN OPIOID DEATHS

Overlapping Entangled but Distinct Epidemics

Natural and semi-synthetic opioidslike oxycodone or hydrocodone

Methadone

Heroin

SOURCE National Vital Statistics System Mortality File

Dea

ths

per 1

000

00 p

opul

atio

n

Chart1

Synthetic opioidslike fentanyl

3 Waves

Almost 351630 people have died from an opioid overdose during 1999-2016

Natural and semi-synthetic opioid analgesic

Methadone

Synthetic opioid analgesic excluding methadone

Heroin

1

03

03

07

12

05

03

06

17

1

05

07

19

15

06

07

27

18

07

08

31

15

1

11

37

14

08

14

35

11

1

27

39

1

31

41

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

CDCrsquos Pillars on Opioids Conducting surveillance and research

Building state local and tribal prevention efforts

Supporting healthcare providers and health systems

Partnering with public safety officials

Encouraging consumers to make safe choices about opioids raising awareness about prescription opioid misuse and overdose

Rx Summit wwwNationalRxDrugAbuseSummitorg

Enhanced State Opioid Overdose Surveillance (ESOOS) 12 states funded in September 2016 20 additional states and the

District of Columbia funded in September 2017 (through September 2019)

Strategy One Increase timeliness of non-fatal opioid overdose reporting- Use syndromic surveillance to establish an early warning system to

detect sharp increases or decreases in non-fatal opioid overdoses - Three indicators suspected all-drug opioid and heroin

Alaska California Connecticut Delaware DC Florida Georgia Illinois Indiana Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Nevada New Hampshire New Jersey New Mexico North Carolina Ohio Oklahoma Pennsylvania Rhode Island Tennessee Utah Vermont Virginia Washington West Virginia Wisconsin

Column1		Any opioid		Natural and semi-synthetic opioid analgesic		Methadone		Synthetic opioid analgesic excluding methadone		Heroin
1999			1		03		03		07
	21		1		04		03		07
2001		24		12		05		03		06
	32		15		08		04		07
2003		35		17		1		05		07
	39		18		13		06		06
2005		43		19		15		06		07
	51		23		18		09		07
2007		54		27		18		07		08
	57		3		16		08		1
2009		59		31		15		1		11
	62		35		15		1		1
2011		66		37		14		08		14
	67		35		12		08		19
2013		74		35		11		1		27
	86		38		11		18		34
2015		104		39		1		31		41
	133		44		1		62		49

1999		1999		1999		1999
1		04		03		07
2001		2001		2001		2001
15		08		04		07
2003		2003		2003		2003
18		13		06		06
2005		2005		2005		2005
23		18		09		07
2007		2007		2007		2007
3		16		08		1
2009		2009		2009		2009
35		15		1		1
2011		2011		2011		2011
35		12		08		19
2013		2013		2013		2013
38		11		18		34
2015		2015		2015		2015
44		1		62		49

Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery

2010 Rapid Increase in Drug Overdose Death Rates by County

Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery

2016 Rapid Increase in Drug Overdose Death Rates by County

Rx Summit wwwNationalRxDrugAbuseSummitorg

RISE IN OPIOID DEATHS

Overlapping Entangled but Distinct Epidemics

Natural and semi-synthetic opioidslike oxycodone or hydrocodone

Methadone

Heroin

SOURCE National Vital Statistics System Mortality File

Dea

ths

per 1

000

00 p

opul

atio

n

Chart1

Synthetic opioidslike fentanyl

3 Waves

Almost 351630 people have died from an opioid overdose during 1999-2016

Natural and semi-synthetic opioid analgesic

Methadone

Synthetic opioid analgesic excluding methadone

Heroin

1

03

03

07

12

05

03

06

17

1

05

07

19

15

06

07

27

18

07

08

31

15

1

11

37

14

08

14

35

11

1

27

39

1

31

41

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

CDCrsquos Pillars on Opioids Conducting surveillance and research

Building state local and tribal prevention efforts

Supporting healthcare providers and health systems

Partnering with public safety officials

Encouraging consumers to make safe choices about opioids raising awareness about prescription opioid misuse and overdose

Rx Summit wwwNationalRxDrugAbuseSummitorg

Enhanced State Opioid Overdose Surveillance (ESOOS) 12 states funded in September 2016 20 additional states and the

District of Columbia funded in September 2017 (through September 2019)

Strategy One Increase timeliness of non-fatal opioid overdose reporting- Use syndromic surveillance to establish an early warning system to

detect sharp increases or decreases in non-fatal opioid overdoses - Three indicators suspected all-drug opioid and heroin

Alaska California Connecticut Delaware DC Florida Georgia Illinois Indiana Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Nevada New Hampshire New Jersey New Mexico North Carolina Ohio Oklahoma Pennsylvania Rhode Island Tennessee Utah Vermont Virginia Washington West Virginia Wisconsin

Column1		Any opioid		Natural and semi-synthetic opioid analgesic		Methadone		Synthetic opioid analgesic excluding methadone		Heroin
1999			1		03		03		07
	21		1		04		03		07
2001		24		12		05		03		06
	32		15		08		04		07
2003		35		17		1		05		07
	39		18		13		06		06
2005		43		19		15		06		07
	51		23		18		09		07
2007		54		27		18		07		08
	57		3		16		08		1
2009		59		31		15		1		11
	62		35		15		1		1
2011		66		37		14		08		14
	67		35		12		08		19
2013		74		35		11		1		27
	86		38		11		18		34
2015		104		39		1		31		41
	133		44		1		62		49

1999		1999		1999		1999
1		04		03		07
2001		2001		2001		2001
15		08		04		07
2003		2003		2003		2003
18		13		06		06
2005		2005		2005		2005
23		18		09		07
2007		2007		2007		2007
3		16		08		1
2009		2009		2009		2009
35		15		1		1
2011		2011		2011		2011
35		12		08		19
2013		2013		2013		2013
38		11		18		34
2015		2015		2015		2015
44		1		62		49

Rx Summit wwwNationalRxDrugAbuseSummitorgSOURCE NCHS Data Visualization Gallery

2016 Rapid Increase in Drug Overdose Death Rates by County

Rx Summit wwwNationalRxDrugAbuseSummitorg

RISE IN OPIOID DEATHS

Overlapping Entangled but Distinct Epidemics

Natural and semi-synthetic opioidslike oxycodone or hydrocodone

Methadone

Heroin

SOURCE National Vital Statistics System Mortality File

Dea

ths

per 1

000

00 p

opul

atio

n

Chart1

Synthetic opioidslike fentanyl

3 Waves

Almost 351630 people have died from an opioid overdose during 1999-2016

Natural and semi-synthetic opioid analgesic

Methadone

Synthetic opioid analgesic excluding methadone

Heroin

1

03

03

07

12

05

03

06

17

1

05

07

19

15

06

07

27

18

07

08

31

15

1

11

37

14

08

14

35

11

1

27

39

1

31

41

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

CDCrsquos Pillars on Opioids Conducting surveillance and research

Building state local and tribal prevention efforts

Supporting healthcare providers and health systems

Partnering with public safety officials

Encouraging consumers to make safe choices about opioids raising awareness about prescription opioid misuse and overdose

Rx Summit wwwNationalRxDrugAbuseSummitorg

Enhanced State Opioid Overdose Surveillance (ESOOS) 12 states funded in September 2016 20 additional states and the

District of Columbia funded in September 2017 (through September 2019)

Strategy One Increase timeliness of non-fatal opioid overdose reporting- Use syndromic surveillance to establish an early warning system to

detect sharp increases or decreases in non-fatal opioid overdoses - Three indicators suspected all-drug opioid and heroin

Alaska California Connecticut Delaware DC Florida Georgia Illinois Indiana Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Nevada New Hampshire New Jersey New Mexico North Carolina Ohio Oklahoma Pennsylvania Rhode Island Tennessee Utah Vermont Virginia Washington West Virginia Wisconsin

Column1		Any opioid		Natural and semi-synthetic opioid analgesic		Methadone		Synthetic opioid analgesic excluding methadone		Heroin
1999			1		03		03		07
	21		1		04		03		07
2001		24		12		05		03		06
	32		15		08		04		07
2003		35		17		1		05		07
	39		18		13		06		06
2005		43		19		15		06		07
	51		23		18		09		07
2007		54		27		18		07		08
	57		3		16		08		1
2009		59		31		15		1		11
	62		35		15		1		1
2011		66		37		14		08		14
	67		35		12		08		19
2013		74		35		11		1		27
	86		38		11		18		34
2015		104		39		1		31		41
	133		44		1		62		49

1999		1999		1999		1999
1		04		03		07
2001		2001		2001		2001
15		08		04		07
2003		2003		2003		2003
18		13		06		06
2005		2005		2005		2005
23		18		09		07
2007		2007		2007		2007
3		16		08		1
2009		2009		2009		2009
35		15		1		1
2011		2011		2011		2011
35		12		08		19
2013		2013		2013		2013
38		11		18		34
2015		2015		2015		2015
44		1		62		49

Rx Summit wwwNationalRxDrugAbuseSummitorg

RISE IN OPIOID DEATHS

Overlapping Entangled but Distinct Epidemics

Natural and semi-synthetic opioidslike oxycodone or hydrocodone

Methadone

Heroin

SOURCE National Vital Statistics System Mortality File

Dea

ths

per 1

000

00 p

opul

atio

n

Chart1

Synthetic opioidslike fentanyl

3 Waves

Almost 351630 people have died from an opioid overdose during 1999-2016

Natural and semi-synthetic opioid analgesic

Methadone

Synthetic opioid analgesic excluding methadone

Heroin

1

03

03

07

12

05

03

06

17

1

05

07

19

15

06

07

27

18

07

08

31

15

1

11

37

14

08

14

35

11

1

27

39

1

31

41

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

CDCrsquos Pillars on Opioids Conducting surveillance and research

Building state local and tribal prevention efforts

Supporting healthcare providers and health systems

Partnering with public safety officials

Encouraging consumers to make safe choices about opioids raising awareness about prescription opioid misuse and overdose

Rx Summit wwwNationalRxDrugAbuseSummitorg

Enhanced State Opioid Overdose Surveillance (ESOOS) 12 states funded in September 2016 20 additional states and the

District of Columbia funded in September 2017 (through September 2019)

Strategy One Increase timeliness of non-fatal opioid overdose reporting- Use syndromic surveillance to establish an early warning system to

detect sharp increases or decreases in non-fatal opioid overdoses - Three indicators suspected all-drug opioid and heroin

Alaska California Connecticut Delaware DC Florida Georgia Illinois Indiana Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Nevada New Hampshire New Jersey New Mexico North Carolina Ohio Oklahoma Pennsylvania Rhode Island Tennessee Utah Vermont Virginia Washington West Virginia Wisconsin

Column1		Any opioid		Natural and semi-synthetic opioid analgesic		Methadone		Synthetic opioid analgesic excluding methadone		Heroin
1999			1		03		03		07
	21		1		04		03		07
2001		24		12		05		03		06
	32		15		08		04		07
2003		35		17		1		05		07
	39		18		13		06		06
2005		43		19		15		06		07
	51		23		18		09		07
2007		54		27		18		07		08
	57		3		16		08		1
2009		59		31		15		1		11
	62		35		15		1		1
2011		66		37		14		08		14
	67		35		12		08		19
2013		74		35		11		1		27
	86		38		11		18		34
2015		104		39		1		31		41
	133		44		1		62		49

1999		1999		1999		1999
1		04		03		07
2001		2001		2001		2001
15		08		04		07
2003		2003		2003		2003
18		13		06		06
2005		2005		2005		2005
23		18		09		07
2007		2007		2007		2007
3		16		08		1
2009		2009		2009		2009
35		15		1		1
2011		2011		2011		2011
35		12		08		19
2013		2013		2013		2013
38		11		18		34
2015		2015		2015		2015
44		1		62		49

Chart1

Synthetic opioidslike fentanyl

3 Waves

Almost 351630 people have died from an opioid overdose during 1999-2016

Natural and semi-synthetic opioid analgesic

Methadone

Synthetic opioid analgesic excluding methadone

Heroin

1

03

03

07

12

05

03

06

17

1

05

07

19

15

06

07

27

18

07

08

31

15

1

11

37

14

08

14

35

11

1

27

39

1

31

41

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

CDCrsquos Pillars on Opioids Conducting surveillance and research

Building state local and tribal prevention efforts

Supporting healthcare providers and health systems

Partnering with public safety officials

Encouraging consumers to make safe choices about opioids raising awareness about prescription opioid misuse and overdose

Rx Summit wwwNationalRxDrugAbuseSummitorg

Enhanced State Opioid Overdose Surveillance (ESOOS) 12 states funded in September 2016 20 additional states and the

District of Columbia funded in September 2017 (through September 2019)

Strategy One Increase timeliness of non-fatal opioid overdose reporting- Use syndromic surveillance to establish an early warning system to

detect sharp increases or decreases in non-fatal opioid overdoses - Three indicators suspected all-drug opioid and heroin

Alaska California Connecticut Delaware DC Florida Georgia Illinois Indiana Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Nevada New Hampshire New Jersey New Mexico North Carolina Ohio Oklahoma Pennsylvania Rhode Island Tennessee Utah Vermont Virginia Washington West Virginia Wisconsin

Column1		Any opioid		Natural and semi-synthetic opioid analgesic		Methadone		Synthetic opioid analgesic excluding methadone		Heroin
1999			1		03		03		07
	21		1		04		03		07
2001		24		12		05		03		06
	32		15		08		04		07
2003		35		17		1		05		07
	39		18		13		06		06
2005		43		19		15		06		07
	51		23		18		09		07
2007		54		27		18		07		08
	57		3		16		08		1
2009		59		31		15		1		11
	62		35		15		1		1
2011		66		37		14		08		14
	67		35		12		08		19
2013		74		35		11		1		27
	86		38		11		18		34
2015		104		39		1		31		41
	133		44		1		62		49

1999		1999		1999		1999
1		04		03		07
2001		2001		2001		2001
15		08		04		07
2003		2003		2003		2003
18		13		06		06
2005		2005		2005		2005
23		18		09		07
2007		2007		2007		2007
3		16		08		1
2009		2009		2009		2009
35		15		1		1
2011		2011		2011		2011
35		12		08		19
2013		2013		2013		2013
38		11		18		34
2015		2015		2015		2015
44		1		62		49

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

CDCrsquos Pillars on Opioids Conducting surveillance and research

Building state local and tribal prevention efforts

Supporting healthcare providers and health systems

Partnering with public safety officials

Encouraging consumers to make safe choices about opioids raising awareness about prescription opioid misuse and overdose

Rx Summit wwwNationalRxDrugAbuseSummitorg

Enhanced State Opioid Overdose Surveillance (ESOOS) 12 states funded in September 2016 20 additional states and the

District of Columbia funded in September 2017 (through September 2019)

Strategy One Increase timeliness of non-fatal opioid overdose reporting- Use syndromic surveillance to establish an early warning system to

detect sharp increases or decreases in non-fatal opioid overdoses - Three indicators suspected all-drug opioid and heroin

Alaska California Connecticut Delaware DC Florida Georgia Illinois Indiana Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Nevada New Hampshire New Jersey New Mexico North Carolina Ohio Oklahoma Pennsylvania Rhode Island Tennessee Utah Vermont Virginia Washington West Virginia Wisconsin

Column1		Any opioid		Natural and semi-synthetic opioid analgesic		Methadone		Synthetic opioid analgesic excluding methadone		Heroin
1999			1		03		03		07
	21		1		04		03		07
2001		24		12		05		03		06
	32		15		08		04		07
2003		35		17		1		05		07
	39		18		13		06		06
2005		43		19		15		06		07
	51		23		18		09		07
2007		54		27		18		07		08
	57		3		16		08		1
2009		59		31		15		1		11
	62		35		15		1		1
2011		66		37		14		08		14
	67		35		12		08		19
2013		74		35		11		1		27
	86		38		11		18		34
2015		104		39		1		31		41
	133		44		1		62		49

Rx Summit wwwNationalRxDrugAbuseSummitorg

CDCrsquos Pillars on Opioids Conducting surveillance and research

Building state local and tribal prevention efforts

Supporting healthcare providers and health systems

Partnering with public safety officials

Encouraging consumers to make safe choices about opioids raising awareness about prescription opioid misuse and overdose

Rx Summit wwwNationalRxDrugAbuseSummitorg

Enhanced State Opioid Overdose Surveillance (ESOOS) 12 states funded in September 2016 20 additional states and the

District of Columbia funded in September 2017 (through September 2019)

Strategy One Increase timeliness of non-fatal opioid overdose reporting- Use syndromic surveillance to establish an early warning system to

detect sharp increases or decreases in non-fatal opioid overdoses - Three indicators suspected all-drug opioid and heroin

Alaska California Connecticut Delaware DC Florida Georgia Illinois Indiana Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Nevada New Hampshire New Jersey New Mexico North Carolina Ohio Oklahoma Pennsylvania Rhode Island Tennessee Utah Vermont Virginia Washington West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

Enhanced State Opioid Overdose Surveillance (ESOOS) 12 states funded in September 2016 20 additional states and the

District of Columbia funded in September 2017 (through September 2019)

Strategy One Increase timeliness of non-fatal opioid overdose reporting- Use syndromic surveillance to establish an early warning system to

detect sharp increases or decreases in non-fatal opioid overdoses - Three indicators suspected all-drug opioid and heroin

Alaska California Connecticut Delaware DC Florida Georgia Illinois Indiana Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Nevada New Hampshire New Jersey New Mexico North Carolina Ohio Oklahoma Pennsylvania Rhode Island Tennessee Utah Vermont Virginia Washington West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

Enhanced State Opioid Overdose Surveillance (ESOOS) Strategy Two Increase timeliness of fatal opioid overdose

reporting- Capture detailed information on toxicology death scene

investigations and other risk factors that may be associated with a fatal overdose

Strategy Three widespread dissemination- Rapidly disseminate surveillance findings to key stakeholders

working to prevent or respond to opioid overdoses

ESOOS program expansion in September 2017- At least 60 for comprehensive toxicology testing for opioid-

involved deaths

Rx Summit wwwNationalRxDrugAbuseSummitorg

Funded ESOOS states

Rx Summit wwwNationalRxDrugAbuseSummitorg

Enhanced State Opioid Overdose Surveillance (ESOOS)

Nonfatal Opioid Overdoses Reported

Quarterly

Emergency Department Visits EMS Transports

Fatal Opioid Overdoses Reported within 8 months

of death

Death CertificatesMEC reports

Toxicology reports

Rx Summit wwwNationalRxDrugAbuseSummitorg

Next Two Presentationshellip

The Utilization of Emergency Department Syndromic Surveillance and Emergency Medical Services Data to Monitor Nonfatal Opioid Overdoses ndash Dr Alana Vivolo-Kantor

Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System ndash Dr Julie OrsquoDonnell

Rx Summit wwwNationalRxDrugAbuseSummitorg

The utilization of emergency department syndromic surveillance

and emergency medical services data to monitor nonfatal opioid

overdosesPresenter Alana Vivolo-Kantor PhD

Behavioral ScientistCenters for Disease Control and Prevention

Co-authors Christine Mattson Puja Seth Julie OrsquoDonnell R Matthew Gladden

Rx Summit wwwNationalRxDrugAbuseSummitorg

Disclosure Statement

Alana Vivolo-Kantor PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services

Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control

Rx Summit wwwNationalRxDrugAbuseSummitorg

Why Emergency Department and Emergency Medical Service Data for Surveillance

Need- Identify areas experiencing rapid increases in opioid overdoses to

inform responses- More quickly identify promising practices to reduce opioid overdoses

Proven utility to public health and scalable- Local jurisdictions already using it to track and respond to drug

overdoses- Findings from Epi-Aid investigations and collaborative work with states- Leverage existing state and national resources (BioSenseESSENCE)

Action at local and national level- Track quarterly trends across the nation to inform national policy- Improve more rapid local and state public health response

Rx Summit wwwNationalRxDrugAbuseSummitorg

Our Philosophy

Focus on detecting change- Pushing system by looking at trend data over quarters- Some jurisdictions may be able to get and report preliminary

burden estimates

Jurisdiction-driven definitions will outperform national definitions- Local flexibility enhances quality and utility by accounting for large

variance in text entries and coding

National guidance- National definition will provide a good starting place- Guidance to encourage common conceptual definition (eg no

withdrawaldetox) and learn from previous work

Rx Summit wwwNationalRxDrugAbuseSummitorg

Our approach

Non-fatal overdoses

Emergency Department

Near real-time ED collection (ie

syndromic ESSENCE)

Case-level or aggregate data shared

through ESSENCE (BioSense) or directly

with CDC

DischargeBilling Data

Case-level or aggregate data shared

directly with CDC

Emergency Medical Services

Case-level or aggregate data shared

directly with CDC

Includes breakdown by

sex age group and county of residence

Raceethnicity is optional

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency Department Data

Two sources- Near real-time syndromic data (visit information within 24-48 hours)- Lagged hospital billing or claims data (usually within 3-4 weeks)

Different variables used- Discharge diagnosis codes (eg ICD-10-CM) ndash available in billing

data and sometimes in syndromic- Free text fields (eg chief complaint provided by Doctor) ndash

available only in syndromic

Rx Summit wwwNationalRxDrugAbuseSummitorg

Case definitions for suspected overdose

If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and

SNOMED) and free text fields such as chief complaint or triage notes

- Free text searches use common terms slang and misspellings (eg herion instead of heroin)

If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and

SNOMED)

Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency medical services data

Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on

the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)

Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following

Naloxone administration)

Rx Summit wwwNationalRxDrugAbuseSummitorg

Challenges in EMS data

Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp

v340)

Different case definitions in different versions

Missing data feeds

Not all EMS agencies share data

Varying time frame in when data is received- lt24 hours to 6 months

Rx Summit wwwNationalRxDrugAbuseSummitorg

Data submission process

Rx Summit wwwNationalRxDrugAbuseSummitorg

Sample quality control report

ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)

TOTAL ED VISITS (AGE)

1XX 2017 1 ED Visits mismatch 98287 98309

2XX 2017 2 ED Visits mismatch 98195 98230

3XX 2017 3 ED Visits mismatch 99167 99205

Rx Summit wwwNationalRxDrugAbuseSummitorg

Sample site report

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results All drug (11 sites)

0

10

20

30

40

50

60

70

80

90

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d al

l dru

g ov

erdo

se ra

tes

by

100

00 E

D v

isits

Quarter year

-2000

-1000

000

1000

2000

3000

4000

5000

6000

7000

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results Opioid (11 sites)

0

5

10

15

20

25

30

35

40

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d op

ioid

ove

rdos

e ra

tes

by

100

00 E

D v

isits

Quarter year

-10

-5

0

5

10

15

20

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results Heroin (11 sites)

0

5

10

15

20

25

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d op

ioid

ove

rdos

e ra

tes

by

100

00 E

D v

isits

Quarter year

-15

-10

-5

0

5

10

15

20

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

Annual percentage changes (11 sites)

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Chart1

All drug

Heroin

Opioid

889150252325

302341597796

208009807928

1075831326045

476222826087

283004552352

167997701832

215786123488

271305063812

table with overall

table with overall

All drug

Suspected all drug overdose rates by 10000 ED visits

Sheet1

All drug

table by sex

Opioid

Quarter year

Suspected opioid overdose rates by 10000 ED visits

table by age

Opioid

table by state

Heroin

Quarter year

Suspected opioid overdose rates by 10000 ED visits

Heroin

All drug

Heroin

Opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Summary

Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017

Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin

Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency department data dissemination efforts

ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Maine		1941		-1273		225		278		1523		-201		3951		-692		257		-813		2945		981		793		656		-299		-2255		3199		2197
Massachusetts		na		na		na		na		na		na		1561		-157		-848		-1148		311		1897		553		-31		-13		-1632		456		2146
New Hampshire		511		1514		-1438		-832		2583		-961		318		64		-433		-1791		2967		-876		825		-184		-1002		-2016		3363		-17
Pennsylvania		na		na		869		-102		1211		-116		na		na		2979		1751		2589		-594		na		na		2601		1534		2735		-735
Rhode Island		na		na		735		-790		1002		-1594		na		na		28		454		544		-1191		na		na		121		1057		566		-3262
West Virginia		-1596		875		2978		-1543		409		-1651		-367		995		4331		-1664		402		-2377		-769		1847		4571		-1584		-199		-3022
Kentucky		-102		1242		-1707		2211		1092		-1468		1095		5192		-2694		4045		352		-2002		-043		5541		-3206		5012		-408		-1624
New Mexico		2932		283		521		-078		445		-716		255		-1298		2611		151		-501		-1093		-487		-3061		3227		987		-1715		323
Missouri		068		-304		754		028		114		421		292		827		477		-177		954		767		-046		1839		096		-512		966		125
Ohio		na		na		107		1216		1596		-1865		na		na		2274		2567		2167		-3194		na		na		2182		2254		2086		-3348
Wisconsin		-229		1388		861		2928		888		931		-948		986		1712		6728		322		314		-1457		91		983		9621		196		668
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		1514		2112		1966		2017		1853		2398		2634
Massachusetts		7036		8133		8006		7327		6486		6687		7956
New Hampshire		3806		3927		4179		3998		3282		4255		3882
Pennsylvania		na		na		1265		1641		1929		2428		2284
Rhode Island		na		na		1498		154		161		1698		1496
West Virginia		2258		2176		2392		3428		2857		2972		2266
Kentucky		2095		2325		3532		258		3624		3752		3001
New Mexico		1927		1976		1719		2168		2201		2091		1862
Missouri		1472		1515		1641		1719		1688		185		1991
Ohio		na		na		236		2897		3641		443		3015
Wisconsin		664		601		66		773		1294		1336		1377
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		502		9		959		931		721		952		1161
Massachusetts		4035		4258		4126		359		3004		3141		3815
New Hampshire		2514		2721		2671		2403		1919		2564		2128
Pennsylvania		na		na		1013		1277		1473		1876		1738
Rhode Island		na		na		803		812		898		949		639
West Virginia		1496		1381		1636		2384		2006		1966		1372
Kentucky		1772		1764		2741		1863		2796		2682		2247
New Mexico		902		858		595		787		865		717		74
Missouri		1002		997		118		1192		1131		124		1255
Ohio		na		na		1804		2198		2693		3254		2165
Wisconsin		286		244		267		293		575		586		625
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		5609		6697		5845		5976		6142		7078		6936
Massachusetts		na		na		na		na		na		na		na
New Hampshire		5678		5968		6872		5883		5394		6787		6135
Pennsylvania		na		na		8374		9102		9010		10100		9983
Rhode Island		na		na		3567		3829		3527		3880		3262
West Virginia		4628		3889		4229		5489		4642		4832		4034
Kentucky		6756		6687		7517		6234		7613		8444		7205
New Mexico		5291		6842		7036		7402		7345		7672		7123
Missouri		3213		3235		3137		3373		3383		3421		3565
Ohio		na		na		8696		8789		9859		11432		9300
Wisconsin		2724		2661		3031		3291		4255		4633		5064

all drug

all opioids

heroin

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

15 to 24

25 to 34

35 to 54

55 and up

all drug

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

opioid

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

heroin

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Male		-140		7355		827		901		1286		-927		742		-758		1157		1241		1306		-829		146		301		1082		1242		1306		-1249
Female		841		5151		103		733		1257		-1521		659		-922		533		1204		1494		-1014		-132		1299		229		1331		1617		-1214
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		4888		4820		8365		9057		9873		11142		10110
Female		3201		3470		5257		5312		5701		6418		5442
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		3611		3879		3585		40		4496		5083		4662
Female		159		1695		1538		162		1816		2087		1875
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		2295		2328		2399		2658		2988		3379		2957
Female		839		828		936		957		1085		126		1107

	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017		q1		q2		q3
All drug		3948		4061		6589		6894		7458		8430		7696		889150252325		1075831326045		167997701832
Heroin		1452		1472		1571		1681		1891		2173		191		302341597796		476222826087		215786123488
Opioid		2447		2636		2429		2636		2956		3382		3088		208009807928		283004552352		271305063812
	Q12016-Q12017		Q22016-Q22017		Q32016-Q32017
All drug		889150252325		1075831326045		167997701832
Heroin		302341597796		476222826087		215786123488
Opioid		208009807928		283004552352		271305063812

	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
Heroin		136		674		701		1251		1486		-1209
Opioid		77		-785		853		1212		1442		-868
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
Heroin		1452		1472		1571		1681		1891		2173		191
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Heroin		1452		1472		1571		1681		1891		2173		191
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Opioid		77		-785		853		1212		1442		-868
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Heroin		136		674		701		1251		1486		-1209

Q12016-Q12017		Q12016-Q12017		Q12016-Q12017
Q22016-Q22017		Q22016-Q22017		Q22016-Q22017
Q32016-Q32017		Q32016-Q32017		Q32016-Q32017

Rx Summit wwwNationalRxDrugAbuseSummitorg

Enhanced State Opioid Overdose Surveillance (ESOOS)

Nonfatal Opioid Overdoses Reported

Quarterly

Emergency Department Visits EMS Transports

Fatal Opioid Overdoses Reported within 8 months

of death

Death CertificatesMEC reports

Toxicology reports

Rx Summit wwwNationalRxDrugAbuseSummitorg

Next Two Presentationshellip

The Utilization of Emergency Department Syndromic Surveillance and Emergency Medical Services Data to Monitor Nonfatal Opioid Overdoses ndash Dr Alana Vivolo-Kantor

Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System ndash Dr Julie OrsquoDonnell

Rx Summit wwwNationalRxDrugAbuseSummitorg

The utilization of emergency department syndromic surveillance

and emergency medical services data to monitor nonfatal opioid

overdosesPresenter Alana Vivolo-Kantor PhD

Behavioral ScientistCenters for Disease Control and Prevention

Co-authors Christine Mattson Puja Seth Julie OrsquoDonnell R Matthew Gladden

Rx Summit wwwNationalRxDrugAbuseSummitorg

Disclosure Statement

Alana Vivolo-Kantor PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services

Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control

Rx Summit wwwNationalRxDrugAbuseSummitorg

Why Emergency Department and Emergency Medical Service Data for Surveillance

Need- Identify areas experiencing rapid increases in opioid overdoses to

inform responses- More quickly identify promising practices to reduce opioid overdoses

Proven utility to public health and scalable- Local jurisdictions already using it to track and respond to drug

overdoses- Findings from Epi-Aid investigations and collaborative work with states- Leverage existing state and national resources (BioSenseESSENCE)

Action at local and national level- Track quarterly trends across the nation to inform national policy- Improve more rapid local and state public health response

Rx Summit wwwNationalRxDrugAbuseSummitorg

Our Philosophy

Focus on detecting change- Pushing system by looking at trend data over quarters- Some jurisdictions may be able to get and report preliminary

burden estimates

Jurisdiction-driven definitions will outperform national definitions- Local flexibility enhances quality and utility by accounting for large

variance in text entries and coding

National guidance- National definition will provide a good starting place- Guidance to encourage common conceptual definition (eg no

withdrawaldetox) and learn from previous work

Rx Summit wwwNationalRxDrugAbuseSummitorg

Our approach

Non-fatal overdoses

Emergency Department

Near real-time ED collection (ie

syndromic ESSENCE)

Case-level or aggregate data shared

through ESSENCE (BioSense) or directly

with CDC

DischargeBilling Data

Case-level or aggregate data shared

directly with CDC

Emergency Medical Services

Case-level or aggregate data shared

directly with CDC

Includes breakdown by

sex age group and county of residence

Raceethnicity is optional

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency Department Data

Two sources- Near real-time syndromic data (visit information within 24-48 hours)- Lagged hospital billing or claims data (usually within 3-4 weeks)

Different variables used- Discharge diagnosis codes (eg ICD-10-CM) ndash available in billing

data and sometimes in syndromic- Free text fields (eg chief complaint provided by Doctor) ndash

available only in syndromic

Rx Summit wwwNationalRxDrugAbuseSummitorg

Case definitions for suspected overdose

If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and

SNOMED) and free text fields such as chief complaint or triage notes

- Free text searches use common terms slang and misspellings (eg herion instead of heroin)

If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and

SNOMED)

Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency medical services data

Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on

the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)

Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following

Naloxone administration)

Rx Summit wwwNationalRxDrugAbuseSummitorg

Challenges in EMS data

Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp

v340)

Different case definitions in different versions

Missing data feeds

Not all EMS agencies share data

Varying time frame in when data is received- lt24 hours to 6 months

Rx Summit wwwNationalRxDrugAbuseSummitorg

Data submission process

Rx Summit wwwNationalRxDrugAbuseSummitorg

Sample quality control report

ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)

TOTAL ED VISITS (AGE)

1XX 2017 1 ED Visits mismatch 98287 98309

2XX 2017 2 ED Visits mismatch 98195 98230

3XX 2017 3 ED Visits mismatch 99167 99205

Rx Summit wwwNationalRxDrugAbuseSummitorg

Sample site report

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results All drug (11 sites)

0

10

20

30

40

50

60

70

80

90

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d al

l dru

g ov

erdo

se ra

tes

by

100

00 E

D v

isits

Quarter year

-2000

-1000

000

1000

2000

3000

4000

5000

6000

7000

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results Opioid (11 sites)

0

5

10

15

20

25

30

35

40

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d op

ioid

ove

rdos

e ra

tes

by

100

00 E

D v

isits

Quarter year

-10

-5

0

5

10

15

20

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results Heroin (11 sites)

0

5

10

15

20

25

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d op

ioid

ove

rdos

e ra

tes

by

100

00 E

D v

isits

Quarter year

-15

-10

-5

0

5

10

15

20

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

Annual percentage changes (11 sites)

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Chart1

All drug

Heroin

Opioid

889150252325

302341597796

208009807928

1075831326045

476222826087

283004552352

167997701832

215786123488

271305063812

table with overall

table with overall

All drug

Suspected all drug overdose rates by 10000 ED visits

Sheet1

All drug

table by sex

Opioid

Quarter year

Suspected opioid overdose rates by 10000 ED visits

table by age

Opioid

table by state

Heroin

Quarter year

Suspected opioid overdose rates by 10000 ED visits

Heroin

All drug

Heroin

Opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Summary

Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017

Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin

Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency department data dissemination efforts

ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Maine		1941		-1273		225		278		1523		-201		3951		-692		257		-813		2945		981		793		656		-299		-2255		3199		2197
Massachusetts		na		na		na		na		na		na		1561		-157		-848		-1148		311		1897		553		-31		-13		-1632		456		2146
New Hampshire		511		1514		-1438		-832		2583		-961		318		64		-433		-1791		2967		-876		825		-184		-1002		-2016		3363		-17
Pennsylvania		na		na		869		-102		1211		-116		na		na		2979		1751		2589		-594		na		na		2601		1534		2735		-735
Rhode Island		na		na		735		-790		1002		-1594		na		na		28		454		544		-1191		na		na		121		1057		566		-3262
West Virginia		-1596		875		2978		-1543		409		-1651		-367		995		4331		-1664		402		-2377		-769		1847		4571		-1584		-199		-3022
Kentucky		-102		1242		-1707		2211		1092		-1468		1095		5192		-2694		4045		352		-2002		-043		5541		-3206		5012		-408		-1624
New Mexico		2932		283		521		-078		445		-716		255		-1298		2611		151		-501		-1093		-487		-3061		3227		987		-1715		323
Missouri		068		-304		754		028		114		421		292		827		477		-177		954		767		-046		1839		096		-512		966		125
Ohio		na		na		107		1216		1596		-1865		na		na		2274		2567		2167		-3194		na		na		2182		2254		2086		-3348
Wisconsin		-229		1388		861		2928		888		931		-948		986		1712		6728		322		314		-1457		91		983		9621		196		668
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		1514		2112		1966		2017		1853		2398		2634
Massachusetts		7036		8133		8006		7327		6486		6687		7956
New Hampshire		3806		3927		4179		3998		3282		4255		3882
Pennsylvania		na		na		1265		1641		1929		2428		2284
Rhode Island		na		na		1498		154		161		1698		1496
West Virginia		2258		2176		2392		3428		2857		2972		2266
Kentucky		2095		2325		3532		258		3624		3752		3001
New Mexico		1927		1976		1719		2168		2201		2091		1862
Missouri		1472		1515		1641		1719		1688		185		1991
Ohio		na		na		236		2897		3641		443		3015
Wisconsin		664		601		66		773		1294		1336		1377
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		502		9		959		931		721		952		1161
Massachusetts		4035		4258		4126		359		3004		3141		3815
New Hampshire		2514		2721		2671		2403		1919		2564		2128
Pennsylvania		na		na		1013		1277		1473		1876		1738
Rhode Island		na		na		803		812		898		949		639
West Virginia		1496		1381		1636		2384		2006		1966		1372
Kentucky		1772		1764		2741		1863		2796		2682		2247
New Mexico		902		858		595		787		865		717		74
Missouri		1002		997		118		1192		1131		124		1255
Ohio		na		na		1804		2198		2693		3254		2165
Wisconsin		286		244		267		293		575		586		625
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		5609		6697		5845		5976		6142		7078		6936
Massachusetts		na		na		na		na		na		na		na
New Hampshire		5678		5968		6872		5883		5394		6787		6135
Pennsylvania		na		na		8374		9102		9010		10100		9983
Rhode Island		na		na		3567		3829		3527		3880		3262
West Virginia		4628		3889		4229		5489		4642		4832		4034
Kentucky		6756		6687		7517		6234		7613		8444		7205
New Mexico		5291		6842		7036		7402		7345		7672		7123
Missouri		3213		3235		3137		3373		3383		3421		3565
Ohio		na		na		8696		8789		9859		11432		9300
Wisconsin		2724		2661		3031		3291		4255		4633		5064

all drug

all opioids

heroin

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

15 to 24

25 to 34

35 to 54

55 and up

all drug

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

opioid

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

heroin

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Male		-140		7355		827		901		1286		-927		742		-758		1157		1241		1306		-829		146		301		1082		1242		1306		-1249
Female		841		5151		103		733		1257		-1521		659		-922		533		1204		1494		-1014		-132		1299		229		1331		1617		-1214
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		4888		4820		8365		9057		9873		11142		10110
Female		3201		3470		5257		5312		5701		6418		5442
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		3611		3879		3585		40		4496		5083		4662
Female		159		1695		1538		162		1816		2087		1875
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		2295		2328		2399		2658		2988		3379		2957
Female		839		828		936		957		1085		126		1107

	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017		q1		q2		q3
All drug		3948		4061		6589		6894		7458		8430		7696		889150252325		1075831326045		167997701832
Heroin		1452		1472		1571		1681		1891		2173		191		302341597796		476222826087		215786123488
Opioid		2447		2636		2429		2636		2956		3382		3088		208009807928		283004552352		271305063812
	Q12016-Q12017		Q22016-Q22017		Q32016-Q32017
All drug		889150252325		1075831326045		167997701832
Heroin		302341597796		476222826087		215786123488
Opioid		208009807928		283004552352		271305063812

	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
Heroin		136		674		701		1251		1486		-1209
Opioid		77		-785		853		1212		1442		-868
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
Heroin		1452		1472		1571		1681		1891		2173		191
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Heroin		1452		1472		1571		1681		1891		2173		191
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Opioid		77		-785		853		1212		1442		-868
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Heroin		136		674		701		1251		1486		-1209

Q12016-Q12017		Q12016-Q12017		Q12016-Q12017
Q22016-Q22017		Q22016-Q22017		Q22016-Q22017
Q32016-Q32017		Q32016-Q32017		Q32016-Q32017

Rx Summit wwwNationalRxDrugAbuseSummitorg

Next Two Presentationshellip

The Utilization of Emergency Department Syndromic Surveillance and Emergency Medical Services Data to Monitor Nonfatal Opioid Overdoses ndash Dr Alana Vivolo-Kantor

Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System ndash Dr Julie OrsquoDonnell

Rx Summit wwwNationalRxDrugAbuseSummitorg

The utilization of emergency department syndromic surveillance

and emergency medical services data to monitor nonfatal opioid

overdosesPresenter Alana Vivolo-Kantor PhD

Behavioral ScientistCenters for Disease Control and Prevention

Co-authors Christine Mattson Puja Seth Julie OrsquoDonnell R Matthew Gladden

Rx Summit wwwNationalRxDrugAbuseSummitorg

Disclosure Statement

Alana Vivolo-Kantor PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services

Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control

Rx Summit wwwNationalRxDrugAbuseSummitorg

Why Emergency Department and Emergency Medical Service Data for Surveillance

Need- Identify areas experiencing rapid increases in opioid overdoses to

inform responses- More quickly identify promising practices to reduce opioid overdoses

Proven utility to public health and scalable- Local jurisdictions already using it to track and respond to drug

overdoses- Findings from Epi-Aid investigations and collaborative work with states- Leverage existing state and national resources (BioSenseESSENCE)

Action at local and national level- Track quarterly trends across the nation to inform national policy- Improve more rapid local and state public health response

Rx Summit wwwNationalRxDrugAbuseSummitorg

Our Philosophy

Focus on detecting change- Pushing system by looking at trend data over quarters- Some jurisdictions may be able to get and report preliminary

burden estimates

Jurisdiction-driven definitions will outperform national definitions- Local flexibility enhances quality and utility by accounting for large

variance in text entries and coding

National guidance- National definition will provide a good starting place- Guidance to encourage common conceptual definition (eg no

withdrawaldetox) and learn from previous work

Rx Summit wwwNationalRxDrugAbuseSummitorg

Our approach

Non-fatal overdoses

Emergency Department

Near real-time ED collection (ie

syndromic ESSENCE)

Case-level or aggregate data shared

through ESSENCE (BioSense) or directly

with CDC

DischargeBilling Data

Case-level or aggregate data shared

directly with CDC

Emergency Medical Services

Case-level or aggregate data shared

directly with CDC

Includes breakdown by

sex age group and county of residence

Raceethnicity is optional

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency Department Data

Two sources- Near real-time syndromic data (visit information within 24-48 hours)- Lagged hospital billing or claims data (usually within 3-4 weeks)

Different variables used- Discharge diagnosis codes (eg ICD-10-CM) ndash available in billing

data and sometimes in syndromic- Free text fields (eg chief complaint provided by Doctor) ndash

available only in syndromic

Rx Summit wwwNationalRxDrugAbuseSummitorg

Case definitions for suspected overdose

If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and

SNOMED) and free text fields such as chief complaint or triage notes

- Free text searches use common terms slang and misspellings (eg herion instead of heroin)

If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and

SNOMED)

Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency medical services data

Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on

the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)

Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following

Naloxone administration)

Rx Summit wwwNationalRxDrugAbuseSummitorg

Challenges in EMS data

Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp

v340)

Different case definitions in different versions

Missing data feeds

Not all EMS agencies share data

Varying time frame in when data is received- lt24 hours to 6 months

Rx Summit wwwNationalRxDrugAbuseSummitorg

Data submission process

Rx Summit wwwNationalRxDrugAbuseSummitorg

Sample quality control report

ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)

TOTAL ED VISITS (AGE)

1XX 2017 1 ED Visits mismatch 98287 98309

2XX 2017 2 ED Visits mismatch 98195 98230

3XX 2017 3 ED Visits mismatch 99167 99205

Rx Summit wwwNationalRxDrugAbuseSummitorg

Sample site report

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results All drug (11 sites)

0

10

20

30

40

50

60

70

80

90

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d al

l dru

g ov

erdo

se ra

tes

by

100

00 E

D v

isits

Quarter year

-2000

-1000

000

1000

2000

3000

4000

5000

6000

7000

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results Opioid (11 sites)

0

5

10

15

20

25

30

35

40

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d op

ioid

ove

rdos

e ra

tes

by

100

00 E

D v

isits

Quarter year

-10

-5

0

5

10

15

20

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results Heroin (11 sites)

0

5

10

15

20

25

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d op

ioid

ove

rdos

e ra

tes

by

100

00 E

D v

isits

Quarter year

-15

-10

-5

0

5

10

15

20

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

Annual percentage changes (11 sites)

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Chart1

All drug

Heroin

Opioid

889150252325

302341597796

208009807928

1075831326045

476222826087

283004552352

167997701832

215786123488

271305063812

table with overall

table with overall

All drug

Suspected all drug overdose rates by 10000 ED visits

Sheet1

All drug

table by sex

Opioid

Quarter year

Suspected opioid overdose rates by 10000 ED visits

table by age

Opioid

table by state

Heroin

Quarter year

Suspected opioid overdose rates by 10000 ED visits

Heroin

All drug

Heroin

Opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Summary

Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017

Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin

Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency department data dissemination efforts

ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Maine		1941		-1273		225		278		1523		-201		3951		-692		257		-813		2945		981		793		656		-299		-2255		3199		2197
Massachusetts		na		na		na		na		na		na		1561		-157		-848		-1148		311		1897		553		-31		-13		-1632		456		2146
New Hampshire		511		1514		-1438		-832		2583		-961		318		64		-433		-1791		2967		-876		825		-184		-1002		-2016		3363		-17
Pennsylvania		na		na		869		-102		1211		-116		na		na		2979		1751		2589		-594		na		na		2601		1534		2735		-735
Rhode Island		na		na		735		-790		1002		-1594		na		na		28		454		544		-1191		na		na		121		1057		566		-3262
West Virginia		-1596		875		2978		-1543		409		-1651		-367		995		4331		-1664		402		-2377		-769		1847		4571		-1584		-199		-3022
Kentucky		-102		1242		-1707		2211		1092		-1468		1095		5192		-2694		4045		352		-2002		-043		5541		-3206		5012		-408		-1624
New Mexico		2932		283		521		-078		445		-716		255		-1298		2611		151		-501		-1093		-487		-3061		3227		987		-1715		323
Missouri		068		-304		754		028		114		421		292		827		477		-177		954		767		-046		1839		096		-512		966		125
Ohio		na		na		107		1216		1596		-1865		na		na		2274		2567		2167		-3194		na		na		2182		2254		2086		-3348
Wisconsin		-229		1388		861		2928		888		931		-948		986		1712		6728		322		314		-1457		91		983		9621		196		668
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		1514		2112		1966		2017		1853		2398		2634
Massachusetts		7036		8133		8006		7327		6486		6687		7956
New Hampshire		3806		3927		4179		3998		3282		4255		3882
Pennsylvania		na		na		1265		1641		1929		2428		2284
Rhode Island		na		na		1498		154		161		1698		1496
West Virginia		2258		2176		2392		3428		2857		2972		2266
Kentucky		2095		2325		3532		258		3624		3752		3001
New Mexico		1927		1976		1719		2168		2201		2091		1862
Missouri		1472		1515		1641		1719		1688		185		1991
Ohio		na		na		236		2897		3641		443		3015
Wisconsin		664		601		66		773		1294		1336		1377
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		502		9		959		931		721		952		1161
Massachusetts		4035		4258		4126		359		3004		3141		3815
New Hampshire		2514		2721		2671		2403		1919		2564		2128
Pennsylvania		na		na		1013		1277		1473		1876		1738
Rhode Island		na		na		803		812		898		949		639
West Virginia		1496		1381		1636		2384		2006		1966		1372
Kentucky		1772		1764		2741		1863		2796		2682		2247
New Mexico		902		858		595		787		865		717		74
Missouri		1002		997		118		1192		1131		124		1255
Ohio		na		na		1804		2198		2693		3254		2165
Wisconsin		286		244		267		293		575		586		625
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		5609		6697		5845		5976		6142		7078		6936
Massachusetts		na		na		na		na		na		na		na
New Hampshire		5678		5968		6872		5883		5394		6787		6135
Pennsylvania		na		na		8374		9102		9010		10100		9983
Rhode Island		na		na		3567		3829		3527		3880		3262
West Virginia		4628		3889		4229		5489		4642		4832		4034
Kentucky		6756		6687		7517		6234		7613		8444		7205
New Mexico		5291		6842		7036		7402		7345		7672		7123
Missouri		3213		3235		3137		3373		3383		3421		3565
Ohio		na		na		8696		8789		9859		11432		9300
Wisconsin		2724		2661		3031		3291		4255		4633		5064

all drug

all opioids

heroin

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

15 to 24

25 to 34

35 to 54

55 and up

all drug

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

opioid

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

heroin

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Male		-140		7355		827		901		1286		-927		742		-758		1157		1241		1306		-829		146		301		1082		1242		1306		-1249
Female		841		5151		103		733		1257		-1521		659		-922		533		1204		1494		-1014		-132		1299		229		1331		1617		-1214
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		4888		4820		8365		9057		9873		11142		10110
Female		3201		3470		5257		5312		5701		6418		5442
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		3611		3879		3585		40		4496		5083		4662
Female		159		1695		1538		162		1816		2087		1875
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		2295		2328		2399		2658		2988		3379		2957
Female		839		828		936		957		1085		126		1107

	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017		q1		q2		q3
All drug		3948		4061		6589		6894		7458		8430		7696		889150252325		1075831326045		167997701832
Heroin		1452		1472		1571		1681		1891		2173		191		302341597796		476222826087		215786123488
Opioid		2447		2636		2429		2636		2956		3382		3088		208009807928		283004552352		271305063812
	Q12016-Q12017		Q22016-Q22017		Q32016-Q32017
All drug		889150252325		1075831326045		167997701832
Heroin		302341597796		476222826087		215786123488
Opioid		208009807928		283004552352		271305063812

	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
Heroin		136		674		701		1251		1486		-1209
Opioid		77		-785		853		1212		1442		-868
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
Heroin		1452		1472		1571		1681		1891		2173		191
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Heroin		1452		1472		1571		1681		1891		2173		191
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Opioid		77		-785		853		1212		1442		-868
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Heroin		136		674		701		1251		1486		-1209

Q12016-Q12017		Q12016-Q12017		Q12016-Q12017
Q22016-Q22017		Q22016-Q22017		Q22016-Q22017
Q32016-Q32017		Q32016-Q32017		Q32016-Q32017

Rx Summit wwwNationalRxDrugAbuseSummitorg

The utilization of emergency department syndromic surveillance

and emergency medical services data to monitor nonfatal opioid

overdosesPresenter Alana Vivolo-Kantor PhD

Behavioral ScientistCenters for Disease Control and Prevention

Co-authors Christine Mattson Puja Seth Julie OrsquoDonnell R Matthew Gladden

Rx Summit wwwNationalRxDrugAbuseSummitorg

Disclosure Statement

Alana Vivolo-Kantor PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services

Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control

Rx Summit wwwNationalRxDrugAbuseSummitorg

Why Emergency Department and Emergency Medical Service Data for Surveillance

Need- Identify areas experiencing rapid increases in opioid overdoses to

inform responses- More quickly identify promising practices to reduce opioid overdoses

Proven utility to public health and scalable- Local jurisdictions already using it to track and respond to drug

overdoses- Findings from Epi-Aid investigations and collaborative work with states- Leverage existing state and national resources (BioSenseESSENCE)

Action at local and national level- Track quarterly trends across the nation to inform national policy- Improve more rapid local and state public health response

Rx Summit wwwNationalRxDrugAbuseSummitorg

Our Philosophy

Focus on detecting change- Pushing system by looking at trend data over quarters- Some jurisdictions may be able to get and report preliminary

burden estimates

Jurisdiction-driven definitions will outperform national definitions- Local flexibility enhances quality and utility by accounting for large

variance in text entries and coding

National guidance- National definition will provide a good starting place- Guidance to encourage common conceptual definition (eg no

withdrawaldetox) and learn from previous work

Rx Summit wwwNationalRxDrugAbuseSummitorg

Our approach

Non-fatal overdoses

Emergency Department

Near real-time ED collection (ie

syndromic ESSENCE)

Case-level or aggregate data shared

through ESSENCE (BioSense) or directly

with CDC

DischargeBilling Data

Case-level or aggregate data shared

directly with CDC

Emergency Medical Services

Case-level or aggregate data shared

directly with CDC

Includes breakdown by

sex age group and county of residence

Raceethnicity is optional

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency Department Data

Two sources- Near real-time syndromic data (visit information within 24-48 hours)- Lagged hospital billing or claims data (usually within 3-4 weeks)

Different variables used- Discharge diagnosis codes (eg ICD-10-CM) ndash available in billing

data and sometimes in syndromic- Free text fields (eg chief complaint provided by Doctor) ndash

available only in syndromic

Rx Summit wwwNationalRxDrugAbuseSummitorg

Case definitions for suspected overdose

If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and

SNOMED) and free text fields such as chief complaint or triage notes

- Free text searches use common terms slang and misspellings (eg herion instead of heroin)

If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and

SNOMED)

Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency medical services data

Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on

the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)

Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following

Naloxone administration)

Rx Summit wwwNationalRxDrugAbuseSummitorg

Challenges in EMS data

Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp

v340)

Different case definitions in different versions

Missing data feeds

Not all EMS agencies share data

Varying time frame in when data is received- lt24 hours to 6 months

Rx Summit wwwNationalRxDrugAbuseSummitorg

Data submission process

Rx Summit wwwNationalRxDrugAbuseSummitorg

Sample quality control report

ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)

TOTAL ED VISITS (AGE)

1XX 2017 1 ED Visits mismatch 98287 98309

2XX 2017 2 ED Visits mismatch 98195 98230

3XX 2017 3 ED Visits mismatch 99167 99205

Rx Summit wwwNationalRxDrugAbuseSummitorg

Sample site report

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results All drug (11 sites)

0

10

20

30

40

50

60

70

80

90

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d al

l dru

g ov

erdo

se ra

tes

by

100

00 E

D v

isits

Quarter year

-2000

-1000

000

1000

2000

3000

4000

5000

6000

7000

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results Opioid (11 sites)

0

5

10

15

20

25

30

35

40

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d op

ioid

ove

rdos

e ra

tes

by

100

00 E

D v

isits

Quarter year

-10

-5

0

5

10

15

20

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results Heroin (11 sites)

0

5

10

15

20

25

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d op

ioid

ove

rdos

e ra

tes

by

100

00 E

D v

isits

Quarter year

-15

-10

-5

0

5

10

15

20

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

Annual percentage changes (11 sites)

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Chart1

All drug

Heroin

Opioid

889150252325

302341597796

208009807928

1075831326045

476222826087

283004552352

167997701832

215786123488

271305063812

table with overall

table with overall

All drug

Suspected all drug overdose rates by 10000 ED visits

Sheet1

All drug

table by sex

Opioid

Quarter year

Suspected opioid overdose rates by 10000 ED visits

table by age

Opioid

table by state

Heroin

Quarter year

Suspected opioid overdose rates by 10000 ED visits

Heroin

All drug

Heroin

Opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Summary

Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017

Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin

Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency department data dissemination efforts

ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Maine		1941		-1273		225		278		1523		-201		3951		-692		257		-813		2945		981		793		656		-299		-2255		3199		2197
Massachusetts		na		na		na		na		na		na		1561		-157		-848		-1148		311		1897		553		-31		-13		-1632		456		2146
New Hampshire		511		1514		-1438		-832		2583		-961		318		64		-433		-1791		2967		-876		825		-184		-1002		-2016		3363		-17
Pennsylvania		na		na		869		-102		1211		-116		na		na		2979		1751		2589		-594		na		na		2601		1534		2735		-735
Rhode Island		na		na		735		-790		1002		-1594		na		na		28		454		544		-1191		na		na		121		1057		566		-3262
West Virginia		-1596		875		2978		-1543		409		-1651		-367		995		4331		-1664		402		-2377		-769		1847		4571		-1584		-199		-3022
Kentucky		-102		1242		-1707		2211		1092		-1468		1095		5192		-2694		4045		352		-2002		-043		5541		-3206		5012		-408		-1624
New Mexico		2932		283		521		-078		445		-716		255		-1298		2611		151		-501		-1093		-487		-3061		3227		987		-1715		323
Missouri		068		-304		754		028		114		421		292		827		477		-177		954		767		-046		1839		096		-512		966		125
Ohio		na		na		107		1216		1596		-1865		na		na		2274		2567		2167		-3194		na		na		2182		2254		2086		-3348
Wisconsin		-229		1388		861		2928		888		931		-948		986		1712		6728		322		314		-1457		91		983		9621		196		668
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		1514		2112		1966		2017		1853		2398		2634
Massachusetts		7036		8133		8006		7327		6486		6687		7956
New Hampshire		3806		3927		4179		3998		3282		4255		3882
Pennsylvania		na		na		1265		1641		1929		2428		2284
Rhode Island		na		na		1498		154		161		1698		1496
West Virginia		2258		2176		2392		3428		2857		2972		2266
Kentucky		2095		2325		3532		258		3624		3752		3001
New Mexico		1927		1976		1719		2168		2201		2091		1862
Missouri		1472		1515		1641		1719		1688		185		1991
Ohio		na		na		236		2897		3641		443		3015
Wisconsin		664		601		66		773		1294		1336		1377
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		502		9		959		931		721		952		1161
Massachusetts		4035		4258		4126		359		3004		3141		3815
New Hampshire		2514		2721		2671		2403		1919		2564		2128
Pennsylvania		na		na		1013		1277		1473		1876		1738
Rhode Island		na		na		803		812		898		949		639
West Virginia		1496		1381		1636		2384		2006		1966		1372
Kentucky		1772		1764		2741		1863		2796		2682		2247
New Mexico		902		858		595		787		865		717		74
Missouri		1002		997		118		1192		1131		124		1255
Ohio		na		na		1804		2198		2693		3254		2165
Wisconsin		286		244		267		293		575		586		625
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		5609		6697		5845		5976		6142		7078		6936
Massachusetts		na		na		na		na		na		na		na
New Hampshire		5678		5968		6872		5883		5394		6787		6135
Pennsylvania		na		na		8374		9102		9010		10100		9983
Rhode Island		na		na		3567		3829		3527		3880		3262
West Virginia		4628		3889		4229		5489		4642		4832		4034
Kentucky		6756		6687		7517		6234		7613		8444		7205
New Mexico		5291		6842		7036		7402		7345		7672		7123
Missouri		3213		3235		3137		3373		3383		3421		3565
Ohio		na		na		8696		8789		9859		11432		9300
Wisconsin		2724		2661		3031		3291		4255		4633		5064

all drug

all opioids

heroin

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

15 to 24

25 to 34

35 to 54

55 and up

all drug

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

opioid

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

heroin

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Male		-140		7355		827		901		1286		-927		742		-758		1157		1241		1306		-829		146		301		1082		1242		1306		-1249
Female		841		5151		103		733		1257		-1521		659		-922		533		1204		1494		-1014		-132		1299		229		1331		1617		-1214
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		4888		4820		8365		9057		9873		11142		10110
Female		3201		3470		5257		5312		5701		6418		5442
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		3611		3879		3585		40		4496		5083		4662
Female		159		1695		1538		162		1816		2087		1875
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		2295		2328		2399		2658		2988		3379		2957
Female		839		828		936		957		1085		126		1107

	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017		q1		q2		q3
All drug		3948		4061		6589		6894		7458		8430		7696		889150252325		1075831326045		167997701832
Heroin		1452		1472		1571		1681		1891		2173		191		302341597796		476222826087		215786123488
Opioid		2447		2636		2429		2636		2956		3382		3088		208009807928		283004552352		271305063812
	Q12016-Q12017		Q22016-Q22017		Q32016-Q32017
All drug		889150252325		1075831326045		167997701832
Heroin		302341597796		476222826087		215786123488
Opioid		208009807928		283004552352		271305063812

	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
Heroin		136		674		701		1251		1486		-1209
Opioid		77		-785		853		1212		1442		-868
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
Heroin		1452		1472		1571		1681		1891		2173		191
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Heroin		1452		1472		1571		1681		1891		2173		191
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Opioid		77		-785		853		1212		1442		-868
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Heroin		136		674		701		1251		1486		-1209

Q12016-Q12017		Q12016-Q12017		Q12016-Q12017
Q22016-Q22017		Q22016-Q22017		Q22016-Q22017
Q32016-Q32017		Q32016-Q32017		Q32016-Q32017

Rx Summit wwwNationalRxDrugAbuseSummitorg

Disclosure Statement

Alana Vivolo-Kantor PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services

Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control

Rx Summit wwwNationalRxDrugAbuseSummitorg

Why Emergency Department and Emergency Medical Service Data for Surveillance

Need- Identify areas experiencing rapid increases in opioid overdoses to

inform responses- More quickly identify promising practices to reduce opioid overdoses

Proven utility to public health and scalable- Local jurisdictions already using it to track and respond to drug

overdoses- Findings from Epi-Aid investigations and collaborative work with states- Leverage existing state and national resources (BioSenseESSENCE)

Action at local and national level- Track quarterly trends across the nation to inform national policy- Improve more rapid local and state public health response

Rx Summit wwwNationalRxDrugAbuseSummitorg

Our Philosophy

Focus on detecting change- Pushing system by looking at trend data over quarters- Some jurisdictions may be able to get and report preliminary

burden estimates

Jurisdiction-driven definitions will outperform national definitions- Local flexibility enhances quality and utility by accounting for large

variance in text entries and coding

National guidance- National definition will provide a good starting place- Guidance to encourage common conceptual definition (eg no

withdrawaldetox) and learn from previous work

Rx Summit wwwNationalRxDrugAbuseSummitorg

Our approach

Non-fatal overdoses

Emergency Department

Near real-time ED collection (ie

syndromic ESSENCE)

Case-level or aggregate data shared

through ESSENCE (BioSense) or directly

with CDC

DischargeBilling Data

Case-level or aggregate data shared

directly with CDC

Emergency Medical Services

Case-level or aggregate data shared

directly with CDC

Includes breakdown by

sex age group and county of residence

Raceethnicity is optional

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency Department Data

Two sources- Near real-time syndromic data (visit information within 24-48 hours)- Lagged hospital billing or claims data (usually within 3-4 weeks)

Different variables used- Discharge diagnosis codes (eg ICD-10-CM) ndash available in billing

data and sometimes in syndromic- Free text fields (eg chief complaint provided by Doctor) ndash

available only in syndromic

Rx Summit wwwNationalRxDrugAbuseSummitorg

Case definitions for suspected overdose

If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and

SNOMED) and free text fields such as chief complaint or triage notes

- Free text searches use common terms slang and misspellings (eg herion instead of heroin)

If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and

SNOMED)

Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency medical services data

Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on

the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)

Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following

Naloxone administration)

Rx Summit wwwNationalRxDrugAbuseSummitorg

Challenges in EMS data

Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp

v340)

Different case definitions in different versions

Missing data feeds

Not all EMS agencies share data

Varying time frame in when data is received- lt24 hours to 6 months

Rx Summit wwwNationalRxDrugAbuseSummitorg

Data submission process

Rx Summit wwwNationalRxDrugAbuseSummitorg

Sample quality control report

ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)

TOTAL ED VISITS (AGE)

1XX 2017 1 ED Visits mismatch 98287 98309

2XX 2017 2 ED Visits mismatch 98195 98230

3XX 2017 3 ED Visits mismatch 99167 99205

Rx Summit wwwNationalRxDrugAbuseSummitorg

Sample site report

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results All drug (11 sites)

0

10

20

30

40

50

60

70

80

90

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d al

l dru

g ov

erdo

se ra

tes

by

100

00 E

D v

isits

Quarter year

-2000

-1000

000

1000

2000

3000

4000

5000

6000

7000

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results Opioid (11 sites)

0

5

10

15

20

25

30

35

40

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d op

ioid

ove

rdos

e ra

tes

by

100

00 E

D v

isits

Quarter year

-10

-5

0

5

10

15

20

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results Heroin (11 sites)

0

5

10

15

20

25

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d op

ioid

ove

rdos

e ra

tes

by

100

00 E

D v

isits

Quarter year

-15

-10

-5

0

5

10

15

20

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

Annual percentage changes (11 sites)

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Chart1

All drug

Heroin

Opioid

889150252325

302341597796

208009807928

1075831326045

476222826087

283004552352

167997701832

215786123488

271305063812

table with overall

table with overall

All drug

Suspected all drug overdose rates by 10000 ED visits

Sheet1

All drug

table by sex

Opioid

Quarter year

Suspected opioid overdose rates by 10000 ED visits

table by age

Opioid

table by state

Heroin

Quarter year

Suspected opioid overdose rates by 10000 ED visits

Heroin

All drug

Heroin

Opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Summary

Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017

Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin

Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency department data dissemination efforts

ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Maine		1941		-1273		225		278		1523		-201		3951		-692		257		-813		2945		981		793		656		-299		-2255		3199		2197
Massachusetts		na		na		na		na		na		na		1561		-157		-848		-1148		311		1897		553		-31		-13		-1632		456		2146
New Hampshire		511		1514		-1438		-832		2583		-961		318		64		-433		-1791		2967		-876		825		-184		-1002		-2016		3363		-17
Pennsylvania		na		na		869		-102		1211		-116		na		na		2979		1751		2589		-594		na		na		2601		1534		2735		-735
Rhode Island		na		na		735		-790		1002		-1594		na		na		28		454		544		-1191		na		na		121		1057		566		-3262
West Virginia		-1596		875		2978		-1543		409		-1651		-367		995		4331		-1664		402		-2377		-769		1847		4571		-1584		-199		-3022
Kentucky		-102		1242		-1707		2211		1092		-1468		1095		5192		-2694		4045		352		-2002		-043		5541		-3206		5012		-408		-1624
New Mexico		2932		283		521		-078		445		-716		255		-1298		2611		151		-501		-1093		-487		-3061		3227		987		-1715		323
Missouri		068		-304		754		028		114		421		292		827		477		-177		954		767		-046		1839		096		-512		966		125
Ohio		na		na		107		1216		1596		-1865		na		na		2274		2567		2167		-3194		na		na		2182		2254		2086		-3348
Wisconsin		-229		1388		861		2928		888		931		-948		986		1712		6728		322		314		-1457		91		983		9621		196		668
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		1514		2112		1966		2017		1853		2398		2634
Massachusetts		7036		8133		8006		7327		6486		6687		7956
New Hampshire		3806		3927		4179		3998		3282		4255		3882
Pennsylvania		na		na		1265		1641		1929		2428		2284
Rhode Island		na		na		1498		154		161		1698		1496
West Virginia		2258		2176		2392		3428		2857		2972		2266
Kentucky		2095		2325		3532		258		3624		3752		3001
New Mexico		1927		1976		1719		2168		2201		2091		1862
Missouri		1472		1515		1641		1719		1688		185		1991
Ohio		na		na		236		2897		3641		443		3015
Wisconsin		664		601		66		773		1294		1336		1377
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		502		9		959		931		721		952		1161
Massachusetts		4035		4258		4126		359		3004		3141		3815
New Hampshire		2514		2721		2671		2403		1919		2564		2128
Pennsylvania		na		na		1013		1277		1473		1876		1738
Rhode Island		na		na		803		812		898		949		639
West Virginia		1496		1381		1636		2384		2006		1966		1372
Kentucky		1772		1764		2741		1863		2796		2682		2247
New Mexico		902		858		595		787		865		717		74
Missouri		1002		997		118		1192		1131		124		1255
Ohio		na		na		1804		2198		2693		3254		2165
Wisconsin		286		244		267		293		575		586		625
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		5609		6697		5845		5976		6142		7078		6936
Massachusetts		na		na		na		na		na		na		na
New Hampshire		5678		5968		6872		5883		5394		6787		6135
Pennsylvania		na		na		8374		9102		9010		10100		9983
Rhode Island		na		na		3567		3829		3527		3880		3262
West Virginia		4628		3889		4229		5489		4642		4832		4034
Kentucky		6756		6687		7517		6234		7613		8444		7205
New Mexico		5291		6842		7036		7402		7345		7672		7123
Missouri		3213		3235		3137		3373		3383		3421		3565
Ohio		na		na		8696		8789		9859		11432		9300
Wisconsin		2724		2661		3031		3291		4255		4633		5064

all drug

all opioids

heroin

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

15 to 24

25 to 34

35 to 54

55 and up

all drug

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

opioid

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

heroin

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Male		-140		7355		827		901		1286		-927		742		-758		1157		1241		1306		-829		146		301		1082		1242		1306		-1249
Female		841		5151		103		733		1257		-1521		659		-922		533		1204		1494		-1014		-132		1299		229		1331		1617		-1214
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		4888		4820		8365		9057		9873		11142		10110
Female		3201		3470		5257		5312		5701		6418		5442
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		3611		3879		3585		40		4496		5083		4662
Female		159		1695		1538		162		1816		2087		1875
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		2295		2328		2399		2658		2988		3379		2957
Female		839		828		936		957		1085		126		1107

	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017		q1		q2		q3
All drug		3948		4061		6589		6894		7458		8430		7696		889150252325		1075831326045		167997701832
Heroin		1452		1472		1571		1681		1891		2173		191		302341597796		476222826087		215786123488
Opioid		2447		2636		2429		2636		2956		3382		3088		208009807928		283004552352		271305063812
	Q12016-Q12017		Q22016-Q22017		Q32016-Q32017
All drug		889150252325		1075831326045		167997701832
Heroin		302341597796		476222826087		215786123488
Opioid		208009807928		283004552352		271305063812

	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
Heroin		136		674		701		1251		1486		-1209
Opioid		77		-785		853		1212		1442		-868
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
Heroin		1452		1472		1571		1681		1891		2173		191
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Heroin		1452		1472		1571		1681		1891		2173		191
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Opioid		77		-785		853		1212		1442		-868
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Heroin		136		674		701		1251		1486		-1209

Q12016-Q12017		Q12016-Q12017		Q12016-Q12017
Q22016-Q22017		Q22016-Q22017		Q22016-Q22017
Q32016-Q32017		Q32016-Q32017		Q32016-Q32017

Rx Summit wwwNationalRxDrugAbuseSummitorg

Why Emergency Department and Emergency Medical Service Data for Surveillance

Need- Identify areas experiencing rapid increases in opioid overdoses to

inform responses- More quickly identify promising practices to reduce opioid overdoses

Proven utility to public health and scalable- Local jurisdictions already using it to track and respond to drug

overdoses- Findings from Epi-Aid investigations and collaborative work with states- Leverage existing state and national resources (BioSenseESSENCE)

Action at local and national level- Track quarterly trends across the nation to inform national policy- Improve more rapid local and state public health response

Rx Summit wwwNationalRxDrugAbuseSummitorg

Our Philosophy

Focus on detecting change- Pushing system by looking at trend data over quarters- Some jurisdictions may be able to get and report preliminary

burden estimates

Jurisdiction-driven definitions will outperform national definitions- Local flexibility enhances quality and utility by accounting for large

variance in text entries and coding

National guidance- National definition will provide a good starting place- Guidance to encourage common conceptual definition (eg no

withdrawaldetox) and learn from previous work

Rx Summit wwwNationalRxDrugAbuseSummitorg

Our approach

Non-fatal overdoses

Emergency Department

Near real-time ED collection (ie

syndromic ESSENCE)

Case-level or aggregate data shared

through ESSENCE (BioSense) or directly

with CDC

DischargeBilling Data

Case-level or aggregate data shared

directly with CDC

Emergency Medical Services

Case-level or aggregate data shared

directly with CDC

Includes breakdown by

sex age group and county of residence

Raceethnicity is optional

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency Department Data

Two sources- Near real-time syndromic data (visit information within 24-48 hours)- Lagged hospital billing or claims data (usually within 3-4 weeks)

Different variables used- Discharge diagnosis codes (eg ICD-10-CM) ndash available in billing

data and sometimes in syndromic- Free text fields (eg chief complaint provided by Doctor) ndash

available only in syndromic

Rx Summit wwwNationalRxDrugAbuseSummitorg

Case definitions for suspected overdose

If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and

SNOMED) and free text fields such as chief complaint or triage notes

- Free text searches use common terms slang and misspellings (eg herion instead of heroin)

If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and

SNOMED)

Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency medical services data

Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on

the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)

Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following

Naloxone administration)

Rx Summit wwwNationalRxDrugAbuseSummitorg

Challenges in EMS data

Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp

v340)

Different case definitions in different versions

Missing data feeds

Not all EMS agencies share data

Varying time frame in when data is received- lt24 hours to 6 months

Rx Summit wwwNationalRxDrugAbuseSummitorg

Data submission process

Rx Summit wwwNationalRxDrugAbuseSummitorg

Sample quality control report

ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)

TOTAL ED VISITS (AGE)

1XX 2017 1 ED Visits mismatch 98287 98309

2XX 2017 2 ED Visits mismatch 98195 98230

3XX 2017 3 ED Visits mismatch 99167 99205

Rx Summit wwwNationalRxDrugAbuseSummitorg

Sample site report

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results All drug (11 sites)

0

10

20

30

40

50

60

70

80

90

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d al

l dru

g ov

erdo

se ra

tes

by

100

00 E

D v

isits

Quarter year

-2000

-1000

000

1000

2000

3000

4000

5000

6000

7000

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results Opioid (11 sites)

0

5

10

15

20

25

30

35

40

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d op

ioid

ove

rdos

e ra

tes

by

100

00 E

D v

isits

Quarter year

-10

-5

0

5

10

15

20

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results Heroin (11 sites)

0

5

10

15

20

25

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d op

ioid

ove

rdos

e ra

tes

by

100

00 E

D v

isits

Quarter year

-15

-10

-5

0

5

10

15

20

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

Annual percentage changes (11 sites)

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Chart1

All drug

Heroin

Opioid

889150252325

302341597796

208009807928

1075831326045

476222826087

283004552352

167997701832

215786123488

271305063812

table with overall

table with overall

All drug

Suspected all drug overdose rates by 10000 ED visits

Sheet1

All drug

table by sex

Opioid

Quarter year

Suspected opioid overdose rates by 10000 ED visits

table by age

Opioid

table by state

Heroin

Quarter year

Suspected opioid overdose rates by 10000 ED visits

Heroin

All drug

Heroin

Opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Summary

Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017

Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin

Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency department data dissemination efforts

ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Maine		1941		-1273		225		278		1523		-201		3951		-692		257		-813		2945		981		793		656		-299		-2255		3199		2197
Massachusetts		na		na		na		na		na		na		1561		-157		-848		-1148		311		1897		553		-31		-13		-1632		456		2146
New Hampshire		511		1514		-1438		-832		2583		-961		318		64		-433		-1791		2967		-876		825		-184		-1002		-2016		3363		-17
Pennsylvania		na		na		869		-102		1211		-116		na		na		2979		1751		2589		-594		na		na		2601		1534		2735		-735
Rhode Island		na		na		735		-790		1002		-1594		na		na		28		454		544		-1191		na		na		121		1057		566		-3262
West Virginia		-1596		875		2978		-1543		409		-1651		-367		995		4331		-1664		402		-2377		-769		1847		4571		-1584		-199		-3022
Kentucky		-102		1242		-1707		2211		1092		-1468		1095		5192		-2694		4045		352		-2002		-043		5541		-3206		5012		-408		-1624
New Mexico		2932		283		521		-078		445		-716		255		-1298		2611		151		-501		-1093		-487		-3061		3227		987		-1715		323
Missouri		068		-304		754		028		114		421		292		827		477		-177		954		767		-046		1839		096		-512		966		125
Ohio		na		na		107		1216		1596		-1865		na		na		2274		2567		2167		-3194		na		na		2182		2254		2086		-3348
Wisconsin		-229		1388		861		2928		888		931		-948		986		1712		6728		322		314		-1457		91		983		9621		196		668
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		1514		2112		1966		2017		1853		2398		2634
Massachusetts		7036		8133		8006		7327		6486		6687		7956
New Hampshire		3806		3927		4179		3998		3282		4255		3882
Pennsylvania		na		na		1265		1641		1929		2428		2284
Rhode Island		na		na		1498		154		161		1698		1496
West Virginia		2258		2176		2392		3428		2857		2972		2266
Kentucky		2095		2325		3532		258		3624		3752		3001
New Mexico		1927		1976		1719		2168		2201		2091		1862
Missouri		1472		1515		1641		1719		1688		185		1991
Ohio		na		na		236		2897		3641		443		3015
Wisconsin		664		601		66		773		1294		1336		1377
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		502		9		959		931		721		952		1161
Massachusetts		4035		4258		4126		359		3004		3141		3815
New Hampshire		2514		2721		2671		2403		1919		2564		2128
Pennsylvania		na		na		1013		1277		1473		1876		1738
Rhode Island		na		na		803		812		898		949		639
West Virginia		1496		1381		1636		2384		2006		1966		1372
Kentucky		1772		1764		2741		1863		2796		2682		2247
New Mexico		902		858		595		787		865		717		74
Missouri		1002		997		118		1192		1131		124		1255
Ohio		na		na		1804		2198		2693		3254		2165
Wisconsin		286		244		267		293		575		586		625
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		5609		6697		5845		5976		6142		7078		6936
Massachusetts		na		na		na		na		na		na		na
New Hampshire		5678		5968		6872		5883		5394		6787		6135
Pennsylvania		na		na		8374		9102		9010		10100		9983
Rhode Island		na		na		3567		3829		3527		3880		3262
West Virginia		4628		3889		4229		5489		4642		4832		4034
Kentucky		6756		6687		7517		6234		7613		8444		7205
New Mexico		5291		6842		7036		7402		7345		7672		7123
Missouri		3213		3235		3137		3373		3383		3421		3565
Ohio		na		na		8696		8789		9859		11432		9300
Wisconsin		2724		2661		3031		3291		4255		4633		5064

all drug

all opioids

heroin

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

15 to 24

25 to 34

35 to 54

55 and up

all drug

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

opioid

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

heroin

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Male		-140		7355		827		901		1286		-927		742		-758		1157		1241		1306		-829		146		301		1082		1242		1306		-1249
Female		841		5151		103		733		1257		-1521		659		-922		533		1204		1494		-1014		-132		1299		229		1331		1617		-1214
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		4888		4820		8365		9057		9873		11142		10110
Female		3201		3470		5257		5312		5701		6418		5442
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		3611		3879		3585		40		4496		5083		4662
Female		159		1695		1538		162		1816		2087		1875
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		2295		2328		2399		2658		2988		3379		2957
Female		839		828		936		957		1085		126		1107

	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017		q1		q2		q3
All drug		3948		4061		6589		6894		7458		8430		7696		889150252325		1075831326045		167997701832
Heroin		1452		1472		1571		1681		1891		2173		191		302341597796		476222826087		215786123488
Opioid		2447		2636		2429		2636		2956		3382		3088		208009807928		283004552352		271305063812
	Q12016-Q12017		Q22016-Q22017		Q32016-Q32017
All drug		889150252325		1075831326045		167997701832
Heroin		302341597796		476222826087		215786123488
Opioid		208009807928		283004552352		271305063812

	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
Heroin		136		674		701		1251		1486		-1209
Opioid		77		-785		853		1212		1442		-868
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
Heroin		1452		1472		1571		1681		1891		2173		191
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Heroin		1452		1472		1571		1681		1891		2173		191
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Opioid		77		-785		853		1212		1442		-868
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Heroin		136		674		701		1251		1486		-1209

Q12016-Q12017		Q12016-Q12017		Q12016-Q12017
Q22016-Q22017		Q22016-Q22017		Q22016-Q22017
Q32016-Q32017		Q32016-Q32017		Q32016-Q32017

Rx Summit wwwNationalRxDrugAbuseSummitorg

Our Philosophy

Focus on detecting change- Pushing system by looking at trend data over quarters- Some jurisdictions may be able to get and report preliminary

burden estimates

Jurisdiction-driven definitions will outperform national definitions- Local flexibility enhances quality and utility by accounting for large

variance in text entries and coding

National guidance- National definition will provide a good starting place- Guidance to encourage common conceptual definition (eg no

withdrawaldetox) and learn from previous work

Rx Summit wwwNationalRxDrugAbuseSummitorg

Our approach

Non-fatal overdoses

Emergency Department

Near real-time ED collection (ie

syndromic ESSENCE)

Case-level or aggregate data shared

through ESSENCE (BioSense) or directly

with CDC

DischargeBilling Data

Case-level or aggregate data shared

directly with CDC

Emergency Medical Services

Case-level or aggregate data shared

directly with CDC

Includes breakdown by

sex age group and county of residence

Raceethnicity is optional

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency Department Data

Two sources- Near real-time syndromic data (visit information within 24-48 hours)- Lagged hospital billing or claims data (usually within 3-4 weeks)

Different variables used- Discharge diagnosis codes (eg ICD-10-CM) ndash available in billing

data and sometimes in syndromic- Free text fields (eg chief complaint provided by Doctor) ndash

available only in syndromic

Rx Summit wwwNationalRxDrugAbuseSummitorg

Case definitions for suspected overdose

If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and

SNOMED) and free text fields such as chief complaint or triage notes

- Free text searches use common terms slang and misspellings (eg herion instead of heroin)

If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and

SNOMED)

Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency medical services data

Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on

the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)

Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following

Naloxone administration)

Rx Summit wwwNationalRxDrugAbuseSummitorg

Challenges in EMS data

Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp

v340)

Different case definitions in different versions

Missing data feeds

Not all EMS agencies share data

Varying time frame in when data is received- lt24 hours to 6 months

Rx Summit wwwNationalRxDrugAbuseSummitorg

Data submission process

Rx Summit wwwNationalRxDrugAbuseSummitorg

Sample quality control report

ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)

TOTAL ED VISITS (AGE)

1XX 2017 1 ED Visits mismatch 98287 98309

2XX 2017 2 ED Visits mismatch 98195 98230

3XX 2017 3 ED Visits mismatch 99167 99205

Rx Summit wwwNationalRxDrugAbuseSummitorg

Sample site report

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results All drug (11 sites)

0

10

20

30

40

50

60

70

80

90

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d al

l dru

g ov

erdo

se ra

tes

by

100

00 E

D v

isits

Quarter year

-2000

-1000

000

1000

2000

3000

4000

5000

6000

7000

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results Opioid (11 sites)

0

5

10

15

20

25

30

35

40

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d op

ioid

ove

rdos

e ra

tes

by

100

00 E

D v

isits

Quarter year

-10

-5

0

5

10

15

20

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results Heroin (11 sites)

0

5

10

15

20

25

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d op

ioid

ove

rdos

e ra

tes

by

100

00 E

D v

isits

Quarter year

-15

-10

-5

0

5

10

15

20

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

Annual percentage changes (11 sites)

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Chart1

All drug

Heroin

Opioid

889150252325

302341597796

208009807928

1075831326045

476222826087

283004552352

167997701832

215786123488

271305063812

table with overall

table with overall

All drug

Suspected all drug overdose rates by 10000 ED visits

Sheet1

All drug

table by sex

Opioid

Quarter year

Suspected opioid overdose rates by 10000 ED visits

table by age

Opioid

table by state

Heroin

Quarter year

Suspected opioid overdose rates by 10000 ED visits

Heroin

All drug

Heroin

Opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Summary

Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017

Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin

Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency department data dissemination efforts

ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Maine		1941		-1273		225		278		1523		-201		3951		-692		257		-813		2945		981		793		656		-299		-2255		3199		2197
Massachusetts		na		na		na		na		na		na		1561		-157		-848		-1148		311		1897		553		-31		-13		-1632		456		2146
New Hampshire		511		1514		-1438		-832		2583		-961		318		64		-433		-1791		2967		-876		825		-184		-1002		-2016		3363		-17
Pennsylvania		na		na		869		-102		1211		-116		na		na		2979		1751		2589		-594		na		na		2601		1534		2735		-735
Rhode Island		na		na		735		-790		1002		-1594		na		na		28		454		544		-1191		na		na		121		1057		566		-3262
West Virginia		-1596		875		2978		-1543		409		-1651		-367		995		4331		-1664		402		-2377		-769		1847		4571		-1584		-199		-3022
Kentucky		-102		1242		-1707		2211		1092		-1468		1095		5192		-2694		4045		352		-2002		-043		5541		-3206		5012		-408		-1624
New Mexico		2932		283		521		-078		445		-716		255		-1298		2611		151		-501		-1093		-487		-3061		3227		987		-1715		323
Missouri		068		-304		754		028		114		421		292		827		477		-177		954		767		-046		1839		096		-512		966		125
Ohio		na		na		107		1216		1596		-1865		na		na		2274		2567		2167		-3194		na		na		2182		2254		2086		-3348
Wisconsin		-229		1388		861		2928		888		931		-948		986		1712		6728		322		314		-1457		91		983		9621		196		668
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		1514		2112		1966		2017		1853		2398		2634
Massachusetts		7036		8133		8006		7327		6486		6687		7956
New Hampshire		3806		3927		4179		3998		3282		4255		3882
Pennsylvania		na		na		1265		1641		1929		2428		2284
Rhode Island		na		na		1498		154		161		1698		1496
West Virginia		2258		2176		2392		3428		2857		2972		2266
Kentucky		2095		2325		3532		258		3624		3752		3001
New Mexico		1927		1976		1719		2168		2201		2091		1862
Missouri		1472		1515		1641		1719		1688		185		1991
Ohio		na		na		236		2897		3641		443		3015
Wisconsin		664		601		66		773		1294		1336		1377
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		502		9		959		931		721		952		1161
Massachusetts		4035		4258		4126		359		3004		3141		3815
New Hampshire		2514		2721		2671		2403		1919		2564		2128
Pennsylvania		na		na		1013		1277		1473		1876		1738
Rhode Island		na		na		803		812		898		949		639
West Virginia		1496		1381		1636		2384		2006		1966		1372
Kentucky		1772		1764		2741		1863		2796		2682		2247
New Mexico		902		858		595		787		865		717		74
Missouri		1002		997		118		1192		1131		124		1255
Ohio		na		na		1804		2198		2693		3254		2165
Wisconsin		286		244		267		293		575		586		625
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		5609		6697		5845		5976		6142		7078		6936
Massachusetts		na		na		na		na		na		na		na
New Hampshire		5678		5968		6872		5883		5394		6787		6135
Pennsylvania		na		na		8374		9102		9010		10100		9983
Rhode Island		na		na		3567		3829		3527		3880		3262
West Virginia		4628		3889		4229		5489		4642		4832		4034
Kentucky		6756		6687		7517		6234		7613		8444		7205
New Mexico		5291		6842		7036		7402		7345		7672		7123
Missouri		3213		3235		3137		3373		3383		3421		3565
Ohio		na		na		8696		8789		9859		11432		9300
Wisconsin		2724		2661		3031		3291		4255		4633		5064

all drug

all opioids

heroin

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

15 to 24

25 to 34

35 to 54

55 and up

all drug

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

opioid

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

heroin

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Male		-140		7355		827		901		1286		-927		742		-758		1157		1241		1306		-829		146		301		1082		1242		1306		-1249
Female		841		5151		103		733		1257		-1521		659		-922		533		1204		1494		-1014		-132		1299		229		1331		1617		-1214
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		4888		4820		8365		9057		9873		11142		10110
Female		3201		3470		5257		5312		5701		6418		5442
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		3611		3879		3585		40		4496		5083		4662
Female		159		1695		1538		162		1816		2087		1875
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		2295		2328		2399		2658		2988		3379		2957
Female		839		828		936		957		1085		126		1107

	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017		q1		q2		q3
All drug		3948		4061		6589		6894		7458		8430		7696		889150252325		1075831326045		167997701832
Heroin		1452		1472		1571		1681		1891		2173		191		302341597796		476222826087		215786123488
Opioid		2447		2636		2429		2636		2956		3382		3088		208009807928		283004552352		271305063812
	Q12016-Q12017		Q22016-Q22017		Q32016-Q32017
All drug		889150252325		1075831326045		167997701832
Heroin		302341597796		476222826087		215786123488
Opioid		208009807928		283004552352		271305063812

	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
Heroin		136		674		701		1251		1486		-1209
Opioid		77		-785		853		1212		1442		-868
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
Heroin		1452		1472		1571		1681		1891		2173		191
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Heroin		1452		1472		1571		1681		1891		2173		191
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Opioid		77		-785		853		1212		1442		-868
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Heroin		136		674		701		1251		1486		-1209

Q12016-Q12017		Q12016-Q12017		Q12016-Q12017
Q22016-Q22017		Q22016-Q22017		Q22016-Q22017
Q32016-Q32017		Q32016-Q32017		Q32016-Q32017

Rx Summit wwwNationalRxDrugAbuseSummitorg

Our approach

Non-fatal overdoses

Emergency Department

Near real-time ED collection (ie

syndromic ESSENCE)

Case-level or aggregate data shared

through ESSENCE (BioSense) or directly

with CDC

DischargeBilling Data

Case-level or aggregate data shared

directly with CDC

Emergency Medical Services

Case-level or aggregate data shared

directly with CDC

Includes breakdown by

sex age group and county of residence

Raceethnicity is optional

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency Department Data

Two sources- Near real-time syndromic data (visit information within 24-48 hours)- Lagged hospital billing or claims data (usually within 3-4 weeks)

Different variables used- Discharge diagnosis codes (eg ICD-10-CM) ndash available in billing

data and sometimes in syndromic- Free text fields (eg chief complaint provided by Doctor) ndash

available only in syndromic

Rx Summit wwwNationalRxDrugAbuseSummitorg

Case definitions for suspected overdose

If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and

SNOMED) and free text fields such as chief complaint or triage notes

- Free text searches use common terms slang and misspellings (eg herion instead of heroin)

If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and

SNOMED)

Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency medical services data

Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on

the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)

Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following

Naloxone administration)

Rx Summit wwwNationalRxDrugAbuseSummitorg

Challenges in EMS data

Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp

v340)

Different case definitions in different versions

Missing data feeds

Not all EMS agencies share data

Varying time frame in when data is received- lt24 hours to 6 months

Rx Summit wwwNationalRxDrugAbuseSummitorg

Data submission process

Rx Summit wwwNationalRxDrugAbuseSummitorg

Sample quality control report

ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)

TOTAL ED VISITS (AGE)

1XX 2017 1 ED Visits mismatch 98287 98309

2XX 2017 2 ED Visits mismatch 98195 98230

3XX 2017 3 ED Visits mismatch 99167 99205

Rx Summit wwwNationalRxDrugAbuseSummitorg

Sample site report

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results All drug (11 sites)

0

10

20

30

40

50

60

70

80

90

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d al

l dru

g ov

erdo

se ra

tes

by

100

00 E

D v

isits

Quarter year

-2000

-1000

000

1000

2000

3000

4000

5000

6000

7000

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results Opioid (11 sites)

0

5

10

15

20

25

30

35

40

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d op

ioid

ove

rdos

e ra

tes

by

100

00 E

D v

isits

Quarter year

-10

-5

0

5

10

15

20

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results Heroin (11 sites)

0

5

10

15

20

25

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d op

ioid

ove

rdos

e ra

tes

by

100

00 E

D v

isits

Quarter year

-15

-10

-5

0

5

10

15

20

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

Annual percentage changes (11 sites)

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Chart1

All drug

Heroin

Opioid

889150252325

302341597796

208009807928

1075831326045

476222826087

283004552352

167997701832

215786123488

271305063812

table with overall

table with overall

All drug

Suspected all drug overdose rates by 10000 ED visits

Sheet1

All drug

table by sex

Opioid

Quarter year

Suspected opioid overdose rates by 10000 ED visits

table by age

Opioid

table by state

Heroin

Quarter year

Suspected opioid overdose rates by 10000 ED visits

Heroin

All drug

Heroin

Opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Summary

Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017

Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin

Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency department data dissemination efforts

ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Maine		1941		-1273		225		278		1523		-201		3951		-692		257		-813		2945		981		793		656		-299		-2255		3199		2197
Massachusetts		na		na		na		na		na		na		1561		-157		-848		-1148		311		1897		553		-31		-13		-1632		456		2146
New Hampshire		511		1514		-1438		-832		2583		-961		318		64		-433		-1791		2967		-876		825		-184		-1002		-2016		3363		-17
Pennsylvania		na		na		869		-102		1211		-116		na		na		2979		1751		2589		-594		na		na		2601		1534		2735		-735
Rhode Island		na		na		735		-790		1002		-1594		na		na		28		454		544		-1191		na		na		121		1057		566		-3262
West Virginia		-1596		875		2978		-1543		409		-1651		-367		995		4331		-1664		402		-2377		-769		1847		4571		-1584		-199		-3022
Kentucky		-102		1242		-1707		2211		1092		-1468		1095		5192		-2694		4045		352		-2002		-043		5541		-3206		5012		-408		-1624
New Mexico		2932		283		521		-078		445		-716		255		-1298		2611		151		-501		-1093		-487		-3061		3227		987		-1715		323
Missouri		068		-304		754		028		114		421		292		827		477		-177		954		767		-046		1839		096		-512		966		125
Ohio		na		na		107		1216		1596		-1865		na		na		2274		2567		2167		-3194		na		na		2182		2254		2086		-3348
Wisconsin		-229		1388		861		2928		888		931		-948		986		1712		6728		322		314		-1457		91		983		9621		196		668
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		1514		2112		1966		2017		1853		2398		2634
Massachusetts		7036		8133		8006		7327		6486		6687		7956
New Hampshire		3806		3927		4179		3998		3282		4255		3882
Pennsylvania		na		na		1265		1641		1929		2428		2284
Rhode Island		na		na		1498		154		161		1698		1496
West Virginia		2258		2176		2392		3428		2857		2972		2266
Kentucky		2095		2325		3532		258		3624		3752		3001
New Mexico		1927		1976		1719		2168		2201		2091		1862
Missouri		1472		1515		1641		1719		1688		185		1991
Ohio		na		na		236		2897		3641		443		3015
Wisconsin		664		601		66		773		1294		1336		1377
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		502		9		959		931		721		952		1161
Massachusetts		4035		4258		4126		359		3004		3141		3815
New Hampshire		2514		2721		2671		2403		1919		2564		2128
Pennsylvania		na		na		1013		1277		1473		1876		1738
Rhode Island		na		na		803		812		898		949		639
West Virginia		1496		1381		1636		2384		2006		1966		1372
Kentucky		1772		1764		2741		1863		2796		2682		2247
New Mexico		902		858		595		787		865		717		74
Missouri		1002		997		118		1192		1131		124		1255
Ohio		na		na		1804		2198		2693		3254		2165
Wisconsin		286		244		267		293		575		586		625
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		5609		6697		5845		5976		6142		7078		6936
Massachusetts		na		na		na		na		na		na		na
New Hampshire		5678		5968		6872		5883		5394		6787		6135
Pennsylvania		na		na		8374		9102		9010		10100		9983
Rhode Island		na		na		3567		3829		3527		3880		3262
West Virginia		4628		3889		4229		5489		4642		4832		4034
Kentucky		6756		6687		7517		6234		7613		8444		7205
New Mexico		5291		6842		7036		7402		7345		7672		7123
Missouri		3213		3235		3137		3373		3383		3421		3565
Ohio		na		na		8696		8789		9859		11432		9300
Wisconsin		2724		2661		3031		3291		4255		4633		5064

all drug

all opioids

heroin

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

15 to 24

25 to 34

35 to 54

55 and up

all drug

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

opioid

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

heroin

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Male		-140		7355		827		901		1286		-927		742		-758		1157		1241		1306		-829		146		301		1082		1242		1306		-1249
Female		841		5151		103		733		1257		-1521		659		-922		533		1204		1494		-1014		-132		1299		229		1331		1617		-1214
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		4888		4820		8365		9057		9873		11142		10110
Female		3201		3470		5257		5312		5701		6418		5442
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		3611		3879		3585		40		4496		5083		4662
Female		159		1695		1538		162		1816		2087		1875
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		2295		2328		2399		2658		2988		3379		2957
Female		839		828		936		957		1085		126		1107

	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017		q1		q2		q3
All drug		3948		4061		6589		6894		7458		8430		7696		889150252325		1075831326045		167997701832
Heroin		1452		1472		1571		1681		1891		2173		191		302341597796		476222826087		215786123488
Opioid		2447		2636		2429		2636		2956		3382		3088		208009807928		283004552352		271305063812
	Q12016-Q12017		Q22016-Q22017		Q32016-Q32017
All drug		889150252325		1075831326045		167997701832
Heroin		302341597796		476222826087		215786123488
Opioid		208009807928		283004552352		271305063812

	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
Heroin		136		674		701		1251		1486		-1209
Opioid		77		-785		853		1212		1442		-868
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
Heroin		1452		1472		1571		1681		1891		2173		191
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Heroin		1452		1472		1571		1681		1891		2173		191
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Opioid		77		-785		853		1212		1442		-868
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Heroin		136		674		701		1251		1486		-1209

Q12016-Q12017		Q12016-Q12017		Q12016-Q12017
Q22016-Q22017		Q22016-Q22017		Q22016-Q22017
Q32016-Q32017		Q32016-Q32017		Q32016-Q32017

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency Department Data

Two sources- Near real-time syndromic data (visit information within 24-48 hours)- Lagged hospital billing or claims data (usually within 3-4 weeks)

Different variables used- Discharge diagnosis codes (eg ICD-10-CM) ndash available in billing

data and sometimes in syndromic- Free text fields (eg chief complaint provided by Doctor) ndash

available only in syndromic

Rx Summit wwwNationalRxDrugAbuseSummitorg

Case definitions for suspected overdose

If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and

SNOMED) and free text fields such as chief complaint or triage notes

- Free text searches use common terms slang and misspellings (eg herion instead of heroin)

If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and

SNOMED)

Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency medical services data

Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on

the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)

Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following

Naloxone administration)

Rx Summit wwwNationalRxDrugAbuseSummitorg

Challenges in EMS data

Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp

v340)

Different case definitions in different versions

Missing data feeds

Not all EMS agencies share data

Varying time frame in when data is received- lt24 hours to 6 months

Rx Summit wwwNationalRxDrugAbuseSummitorg

Data submission process

Rx Summit wwwNationalRxDrugAbuseSummitorg

Sample quality control report

ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)

TOTAL ED VISITS (AGE)

1XX 2017 1 ED Visits mismatch 98287 98309

2XX 2017 2 ED Visits mismatch 98195 98230

3XX 2017 3 ED Visits mismatch 99167 99205

Rx Summit wwwNationalRxDrugAbuseSummitorg

Sample site report

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results All drug (11 sites)

0

10

20

30

40

50

60

70

80

90

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d al

l dru

g ov

erdo

se ra

tes

by

100

00 E

D v

isits

Quarter year

-2000

-1000

000

1000

2000

3000

4000

5000

6000

7000

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results Opioid (11 sites)

0

5

10

15

20

25

30

35

40

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d op

ioid

ove

rdos

e ra

tes

by

100

00 E

D v

isits

Quarter year

-10

-5

0

5

10

15

20

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results Heroin (11 sites)

0

5

10

15

20

25

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d op

ioid

ove

rdos

e ra

tes

by

100

00 E

D v

isits

Quarter year

-15

-10

-5

0

5

10

15

20

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

Annual percentage changes (11 sites)

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Chart1

All drug

Heroin

Opioid

889150252325

302341597796

208009807928

1075831326045

476222826087

283004552352

167997701832

215786123488

271305063812

table with overall

table with overall

All drug

Suspected all drug overdose rates by 10000 ED visits

Sheet1

All drug

table by sex

Opioid

Quarter year

Suspected opioid overdose rates by 10000 ED visits

table by age

Opioid

table by state

Heroin

Quarter year

Suspected opioid overdose rates by 10000 ED visits

Heroin

All drug

Heroin

Opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Summary

Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017

Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin

Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency department data dissemination efforts

ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Maine		1941		-1273		225		278		1523		-201		3951		-692		257		-813		2945		981		793		656		-299		-2255		3199		2197
Massachusetts		na		na		na		na		na		na		1561		-157		-848		-1148		311		1897		553		-31		-13		-1632		456		2146
New Hampshire		511		1514		-1438		-832		2583		-961		318		64		-433		-1791		2967		-876		825		-184		-1002		-2016		3363		-17
Pennsylvania		na		na		869		-102		1211		-116		na		na		2979		1751		2589		-594		na		na		2601		1534		2735		-735
Rhode Island		na		na		735		-790		1002		-1594		na		na		28		454		544		-1191		na		na		121		1057		566		-3262
West Virginia		-1596		875		2978		-1543		409		-1651		-367		995		4331		-1664		402		-2377		-769		1847		4571		-1584		-199		-3022
Kentucky		-102		1242		-1707		2211		1092		-1468		1095		5192		-2694		4045		352		-2002		-043		5541		-3206		5012		-408		-1624
New Mexico		2932		283		521		-078		445		-716		255		-1298		2611		151		-501		-1093		-487		-3061		3227		987		-1715		323
Missouri		068		-304		754		028		114		421		292		827		477		-177		954		767		-046		1839		096		-512		966		125
Ohio		na		na		107		1216		1596		-1865		na		na		2274		2567		2167		-3194		na		na		2182		2254		2086		-3348
Wisconsin		-229		1388		861		2928		888		931		-948		986		1712		6728		322		314		-1457		91		983		9621		196		668
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		1514		2112		1966		2017		1853		2398		2634
Massachusetts		7036		8133		8006		7327		6486		6687		7956
New Hampshire		3806		3927		4179		3998		3282		4255		3882
Pennsylvania		na		na		1265		1641		1929		2428		2284
Rhode Island		na		na		1498		154		161		1698		1496
West Virginia		2258		2176		2392		3428		2857		2972		2266
Kentucky		2095		2325		3532		258		3624		3752		3001
New Mexico		1927		1976		1719		2168		2201		2091		1862
Missouri		1472		1515		1641		1719		1688		185		1991
Ohio		na		na		236		2897		3641		443		3015
Wisconsin		664		601		66		773		1294		1336		1377
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		502		9		959		931		721		952		1161
Massachusetts		4035		4258		4126		359		3004		3141		3815
New Hampshire		2514		2721		2671		2403		1919		2564		2128
Pennsylvania		na		na		1013		1277		1473		1876		1738
Rhode Island		na		na		803		812		898		949		639
West Virginia		1496		1381		1636		2384		2006		1966		1372
Kentucky		1772		1764		2741		1863		2796		2682		2247
New Mexico		902		858		595		787		865		717		74
Missouri		1002		997		118		1192		1131		124		1255
Ohio		na		na		1804		2198		2693		3254		2165
Wisconsin		286		244		267		293		575		586		625
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		5609		6697		5845		5976		6142		7078		6936
Massachusetts		na		na		na		na		na		na		na
New Hampshire		5678		5968		6872		5883		5394		6787		6135
Pennsylvania		na		na		8374		9102		9010		10100		9983
Rhode Island		na		na		3567		3829		3527		3880		3262
West Virginia		4628		3889		4229		5489		4642		4832		4034
Kentucky		6756		6687		7517		6234		7613		8444		7205
New Mexico		5291		6842		7036		7402		7345		7672		7123
Missouri		3213		3235		3137		3373		3383		3421		3565
Ohio		na		na		8696		8789		9859		11432		9300
Wisconsin		2724		2661		3031		3291		4255		4633		5064

all drug

all opioids

heroin

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

15 to 24

25 to 34

35 to 54

55 and up

all drug

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

opioid

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

heroin

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Male		-140		7355		827		901		1286		-927		742		-758		1157		1241		1306		-829		146		301		1082		1242		1306		-1249
Female		841		5151		103		733		1257		-1521		659		-922		533		1204		1494		-1014		-132		1299		229		1331		1617		-1214
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		4888		4820		8365		9057		9873		11142		10110
Female		3201		3470		5257		5312		5701		6418		5442
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		3611		3879		3585		40		4496		5083		4662
Female		159		1695		1538		162		1816		2087		1875
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		2295		2328		2399		2658		2988		3379		2957
Female		839		828		936		957		1085		126		1107

	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017		q1		q2		q3
All drug		3948		4061		6589		6894		7458		8430		7696		889150252325		1075831326045		167997701832
Heroin		1452		1472		1571		1681		1891		2173		191		302341597796		476222826087		215786123488
Opioid		2447		2636		2429		2636		2956		3382		3088		208009807928		283004552352		271305063812
	Q12016-Q12017		Q22016-Q22017		Q32016-Q32017
All drug		889150252325		1075831326045		167997701832
Heroin		302341597796		476222826087		215786123488
Opioid		208009807928		283004552352		271305063812

	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
Heroin		136		674		701		1251		1486		-1209
Opioid		77		-785		853		1212		1442		-868
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
Heroin		1452		1472		1571		1681		1891		2173		191
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Heroin		1452		1472		1571		1681		1891		2173		191
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Opioid		77		-785		853		1212		1442		-868
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Heroin		136		674		701		1251		1486		-1209

Q12016-Q12017		Q12016-Q12017		Q12016-Q12017
Q22016-Q22017		Q22016-Q22017		Q22016-Q22017
Q32016-Q32017		Q32016-Q32017		Q32016-Q32017

Rx Summit wwwNationalRxDrugAbuseSummitorg

Case definitions for suspected overdose

If syndromic- Uses both discharge codes (ie ICD-9-CM ICD-10-CM and

SNOMED) and free text fields such as chief complaint or triage notes

- Free text searches use common terms slang and misspellings (eg herion instead of heroin)

If hospital billing or claimshellip- Uses only discharge codes (ie ICD-9-CM ICD-10-CM and

SNOMED)

Discharge codes use are for acute unintentional or undetermined drug poisoning (eg T401X1A in ICD-10-CM) and may also include some substance useabuse codes (ie F11 in ICD-10-CM)

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency medical services data

Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on

the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)

Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following

Naloxone administration)

Rx Summit wwwNationalRxDrugAbuseSummitorg

Challenges in EMS data

Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp

v340)

Different case definitions in different versions

Missing data feeds

Not all EMS agencies share data

Varying time frame in when data is received- lt24 hours to 6 months

Rx Summit wwwNationalRxDrugAbuseSummitorg

Data submission process

Rx Summit wwwNationalRxDrugAbuseSummitorg

Sample quality control report

ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)

TOTAL ED VISITS (AGE)

1XX 2017 1 ED Visits mismatch 98287 98309

2XX 2017 2 ED Visits mismatch 98195 98230

3XX 2017 3 ED Visits mismatch 99167 99205

Rx Summit wwwNationalRxDrugAbuseSummitorg

Sample site report

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results All drug (11 sites)

0

10

20

30

40

50

60

70

80

90

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d al

l dru

g ov

erdo

se ra

tes

by

100

00 E

D v

isits

Quarter year

-2000

-1000

000

1000

2000

3000

4000

5000

6000

7000

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results Opioid (11 sites)

0

5

10

15

20

25

30

35

40

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d op

ioid

ove

rdos

e ra

tes

by

100

00 E

D v

isits

Quarter year

-10

-5

0

5

10

15

20

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results Heroin (11 sites)

0

5

10

15

20

25

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d op

ioid

ove

rdos

e ra

tes

by

100

00 E

D v

isits

Quarter year

-15

-10

-5

0

5

10

15

20

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

Annual percentage changes (11 sites)

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Chart1

All drug

Heroin

Opioid

889150252325

302341597796

208009807928

1075831326045

476222826087

283004552352

167997701832

215786123488

271305063812

table with overall

table with overall

All drug

Suspected all drug overdose rates by 10000 ED visits

Sheet1

All drug

table by sex

Opioid

Quarter year

Suspected opioid overdose rates by 10000 ED visits

table by age

Opioid

table by state

Heroin

Quarter year

Suspected opioid overdose rates by 10000 ED visits

Heroin

All drug

Heroin

Opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Summary

Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017

Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin

Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency department data dissemination efforts

ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Maine		1941		-1273		225		278		1523		-201		3951		-692		257		-813		2945		981		793		656		-299		-2255		3199		2197
Massachusetts		na		na		na		na		na		na		1561		-157		-848		-1148		311		1897		553		-31		-13		-1632		456		2146
New Hampshire		511		1514		-1438		-832		2583		-961		318		64		-433		-1791		2967		-876		825		-184		-1002		-2016		3363		-17
Pennsylvania		na		na		869		-102		1211		-116		na		na		2979		1751		2589		-594		na		na		2601		1534		2735		-735
Rhode Island		na		na		735		-790		1002		-1594		na		na		28		454		544		-1191		na		na		121		1057		566		-3262
West Virginia		-1596		875		2978		-1543		409		-1651		-367		995		4331		-1664		402		-2377		-769		1847		4571		-1584		-199		-3022
Kentucky		-102		1242		-1707		2211		1092		-1468		1095		5192		-2694		4045		352		-2002		-043		5541		-3206		5012		-408		-1624
New Mexico		2932		283		521		-078		445		-716		255		-1298		2611		151		-501		-1093		-487		-3061		3227		987		-1715		323
Missouri		068		-304		754		028		114		421		292		827		477		-177		954		767		-046		1839		096		-512		966		125
Ohio		na		na		107		1216		1596		-1865		na		na		2274		2567		2167		-3194		na		na		2182		2254		2086		-3348
Wisconsin		-229		1388		861		2928		888		931		-948		986		1712		6728		322		314		-1457		91		983		9621		196		668
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		1514		2112		1966		2017		1853		2398		2634
Massachusetts		7036		8133		8006		7327		6486		6687		7956
New Hampshire		3806		3927		4179		3998		3282		4255		3882
Pennsylvania		na		na		1265		1641		1929		2428		2284
Rhode Island		na		na		1498		154		161		1698		1496
West Virginia		2258		2176		2392		3428		2857		2972		2266
Kentucky		2095		2325		3532		258		3624		3752		3001
New Mexico		1927		1976		1719		2168		2201		2091		1862
Missouri		1472		1515		1641		1719		1688		185		1991
Ohio		na		na		236		2897		3641		443		3015
Wisconsin		664		601		66		773		1294		1336		1377
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		502		9		959		931		721		952		1161
Massachusetts		4035		4258		4126		359		3004		3141		3815
New Hampshire		2514		2721		2671		2403		1919		2564		2128
Pennsylvania		na		na		1013		1277		1473		1876		1738
Rhode Island		na		na		803		812		898		949		639
West Virginia		1496		1381		1636		2384		2006		1966		1372
Kentucky		1772		1764		2741		1863		2796		2682		2247
New Mexico		902		858		595		787		865		717		74
Missouri		1002		997		118		1192		1131		124		1255
Ohio		na		na		1804		2198		2693		3254		2165
Wisconsin		286		244		267		293		575		586		625
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		5609		6697		5845		5976		6142		7078		6936
Massachusetts		na		na		na		na		na		na		na
New Hampshire		5678		5968		6872		5883		5394		6787		6135
Pennsylvania		na		na		8374		9102		9010		10100		9983
Rhode Island		na		na		3567		3829		3527		3880		3262
West Virginia		4628		3889		4229		5489		4642		4832		4034
Kentucky		6756		6687		7517		6234		7613		8444		7205
New Mexico		5291		6842		7036		7402		7345		7672		7123
Missouri		3213		3235		3137		3373		3383		3421		3565
Ohio		na		na		8696		8789		9859		11432		9300
Wisconsin		2724		2661		3031		3291		4255		4633		5064

all drug

all opioids

heroin

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

15 to 24

25 to 34

35 to 54

55 and up

all drug

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

opioid

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

heroin

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Male		-140		7355		827		901		1286		-927		742		-758		1157		1241		1306		-829		146		301		1082		1242		1306		-1249
Female		841		5151		103		733		1257		-1521		659		-922		533		1204		1494		-1014		-132		1299		229		1331		1617		-1214
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		4888		4820		8365		9057		9873		11142		10110
Female		3201		3470		5257		5312		5701		6418		5442
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		3611		3879		3585		40		4496		5083		4662
Female		159		1695		1538		162		1816		2087		1875
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		2295		2328		2399		2658		2988		3379		2957
Female		839		828		936		957		1085		126		1107

	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017		q1		q2		q3
All drug		3948		4061		6589		6894		7458		8430		7696		889150252325		1075831326045		167997701832
Heroin		1452		1472		1571		1681		1891		2173		191		302341597796		476222826087		215786123488
Opioid		2447		2636		2429		2636		2956		3382		3088		208009807928		283004552352		271305063812
	Q12016-Q12017		Q22016-Q22017		Q32016-Q32017
All drug		889150252325		1075831326045		167997701832
Heroin		302341597796		476222826087		215786123488
Opioid		208009807928		283004552352		271305063812

	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
Heroin		136		674		701		1251		1486		-1209
Opioid		77		-785		853		1212		1442		-868
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
Heroin		1452		1472		1571		1681		1891		2173		191
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Heroin		1452		1472		1571		1681		1891		2173		191
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Opioid		77		-785		853		1212		1442		-868
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Heroin		136		674		701		1251		1486		-1209

Q12016-Q12017		Q12016-Q12017		Q12016-Q12017
Q22016-Q22017		Q22016-Q22017		Q22016-Q22017
Q32016-Q32017		Q32016-Q32017		Q32016-Q32017

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency medical services data

Capture potential EMS transports to EDs- Excludes instances where individual is pronounced deceased on

the scene inter-facility transports and when EMTs provide no ldquotreatmentrdquo (eg patient refused or required no treatment or transport)

Different variables used- Chief Complaint Secondary complaint- Narrative- Provider Impression- ICD-1O-CM codes- Medication administered (ie Naloxone)- Response to medication administered (ie awake following

Naloxone administration)

Rx Summit wwwNationalRxDrugAbuseSummitorg

Challenges in EMS data

Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp

v340)

Different case definitions in different versions

Missing data feeds

Not all EMS agencies share data

Varying time frame in when data is received- lt24 hours to 6 months

Rx Summit wwwNationalRxDrugAbuseSummitorg

Data submission process

Rx Summit wwwNationalRxDrugAbuseSummitorg

Sample quality control report

ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)

TOTAL ED VISITS (AGE)

1XX 2017 1 ED Visits mismatch 98287 98309

2XX 2017 2 ED Visits mismatch 98195 98230

3XX 2017 3 ED Visits mismatch 99167 99205

Rx Summit wwwNationalRxDrugAbuseSummitorg

Sample site report

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results All drug (11 sites)

0

10

20

30

40

50

60

70

80

90

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d al

l dru

g ov

erdo

se ra

tes

by

100

00 E

D v

isits

Quarter year

-2000

-1000

000

1000

2000

3000

4000

5000

6000

7000

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results Opioid (11 sites)

0

5

10

15

20

25

30

35

40

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d op

ioid

ove

rdos

e ra

tes

by

100

00 E

D v

isits

Quarter year

-10

-5

0

5

10

15

20

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results Heroin (11 sites)

0

5

10

15

20

25

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d op

ioid

ove

rdos

e ra

tes

by

100

00 E

D v

isits

Quarter year

-15

-10

-5

0

5

10

15

20

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

Annual percentage changes (11 sites)

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Chart1

All drug

Heroin

Opioid

889150252325

302341597796

208009807928

1075831326045

476222826087

283004552352

167997701832

215786123488

271305063812

table with overall

table with overall

All drug

Suspected all drug overdose rates by 10000 ED visits

Sheet1

All drug

table by sex

Opioid

Quarter year

Suspected opioid overdose rates by 10000 ED visits

table by age

Opioid

table by state

Heroin

Quarter year

Suspected opioid overdose rates by 10000 ED visits

Heroin

All drug

Heroin

Opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Summary

Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017

Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin

Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency department data dissemination efforts

ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Maine		1941		-1273		225		278		1523		-201		3951		-692		257		-813		2945		981		793		656		-299		-2255		3199		2197
Massachusetts		na		na		na		na		na		na		1561		-157		-848		-1148		311		1897		553		-31		-13		-1632		456		2146
New Hampshire		511		1514		-1438		-832		2583		-961		318		64		-433		-1791		2967		-876		825		-184		-1002		-2016		3363		-17
Pennsylvania		na		na		869		-102		1211		-116		na		na		2979		1751		2589		-594		na		na		2601		1534		2735		-735
Rhode Island		na		na		735		-790		1002		-1594		na		na		28		454		544		-1191		na		na		121		1057		566		-3262
West Virginia		-1596		875		2978		-1543		409		-1651		-367		995		4331		-1664		402		-2377		-769		1847		4571		-1584		-199		-3022
Kentucky		-102		1242		-1707		2211		1092		-1468		1095		5192		-2694		4045		352		-2002		-043		5541		-3206		5012		-408		-1624
New Mexico		2932		283		521		-078		445		-716		255		-1298		2611		151		-501		-1093		-487		-3061		3227		987		-1715		323
Missouri		068		-304		754		028		114		421		292		827		477		-177		954		767		-046		1839		096		-512		966		125
Ohio		na		na		107		1216		1596		-1865		na		na		2274		2567		2167		-3194		na		na		2182		2254		2086		-3348
Wisconsin		-229		1388		861		2928		888		931		-948		986		1712		6728		322		314		-1457		91		983		9621		196		668
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		1514		2112		1966		2017		1853		2398		2634
Massachusetts		7036		8133		8006		7327		6486		6687		7956
New Hampshire		3806		3927		4179		3998		3282		4255		3882
Pennsylvania		na		na		1265		1641		1929		2428		2284
Rhode Island		na		na		1498		154		161		1698		1496
West Virginia		2258		2176		2392		3428		2857		2972		2266
Kentucky		2095		2325		3532		258		3624		3752		3001
New Mexico		1927		1976		1719		2168		2201		2091		1862
Missouri		1472		1515		1641		1719		1688		185		1991
Ohio		na		na		236		2897		3641		443		3015
Wisconsin		664		601		66		773		1294		1336		1377
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		502		9		959		931		721		952		1161
Massachusetts		4035		4258		4126		359		3004		3141		3815
New Hampshire		2514		2721		2671		2403		1919		2564		2128
Pennsylvania		na		na		1013		1277		1473		1876		1738
Rhode Island		na		na		803		812		898		949		639
West Virginia		1496		1381		1636		2384		2006		1966		1372
Kentucky		1772		1764		2741		1863		2796		2682		2247
New Mexico		902		858		595		787		865		717		74
Missouri		1002		997		118		1192		1131		124		1255
Ohio		na		na		1804		2198		2693		3254		2165
Wisconsin		286		244		267		293		575		586		625
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		5609		6697		5845		5976		6142		7078		6936
Massachusetts		na		na		na		na		na		na		na
New Hampshire		5678		5968		6872		5883		5394		6787		6135
Pennsylvania		na		na		8374		9102		9010		10100		9983
Rhode Island		na		na		3567		3829		3527		3880		3262
West Virginia		4628		3889		4229		5489		4642		4832		4034
Kentucky		6756		6687		7517		6234		7613		8444		7205
New Mexico		5291		6842		7036		7402		7345		7672		7123
Missouri		3213		3235		3137		3373		3383		3421		3565
Ohio		na		na		8696		8789		9859		11432		9300
Wisconsin		2724		2661		3031		3291		4255		4633		5064

all drug

all opioids

heroin

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

15 to 24

25 to 34

35 to 54

55 and up

all drug

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

opioid

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

heroin

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Male		-140		7355		827		901		1286		-927		742		-758		1157		1241		1306		-829		146		301		1082		1242		1306		-1249
Female		841		5151		103		733		1257		-1521		659		-922		533		1204		1494		-1014		-132		1299		229		1331		1617		-1214
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		4888		4820		8365		9057		9873		11142		10110
Female		3201		3470		5257		5312		5701		6418		5442
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		3611		3879		3585		40		4496		5083		4662
Female		159		1695		1538		162		1816		2087		1875
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		2295		2328		2399		2658		2988		3379		2957
Female		839		828		936		957		1085		126		1107

	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017		q1		q2		q3
All drug		3948		4061		6589		6894		7458		8430		7696		889150252325		1075831326045		167997701832
Heroin		1452		1472		1571		1681		1891		2173		191		302341597796		476222826087		215786123488
Opioid		2447		2636		2429		2636		2956		3382		3088		208009807928		283004552352		271305063812
	Q12016-Q12017		Q22016-Q22017		Q32016-Q32017
All drug		889150252325		1075831326045		167997701832
Heroin		302341597796		476222826087		215786123488
Opioid		208009807928		283004552352		271305063812

	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
Heroin		136		674		701		1251		1486		-1209
Opioid		77		-785		853		1212		1442		-868
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
Heroin		1452		1472		1571		1681		1891		2173		191
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Heroin		1452		1472		1571		1681		1891		2173		191
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Opioid		77		-785		853		1212		1442		-868
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Heroin		136		674		701		1251		1486		-1209

Q12016-Q12017		Q12016-Q12017		Q12016-Q12017
Q22016-Q22017		Q22016-Q22017		Q22016-Q22017
Q32016-Q32017		Q32016-Q32017		Q32016-Q32017

Rx Summit wwwNationalRxDrugAbuseSummitorg

Challenges in EMS data

Transition to newer versions of NEMSIS- Some states working in up to three versions (v221 v334 amp

v340)

Different case definitions in different versions

Missing data feeds

Not all EMS agencies share data

Varying time frame in when data is received- lt24 hours to 6 months

Rx Summit wwwNationalRxDrugAbuseSummitorg

Data submission process

Rx Summit wwwNationalRxDrugAbuseSummitorg

Sample quality control report

ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)

TOTAL ED VISITS (AGE)

1XX 2017 1 ED Visits mismatch 98287 98309

2XX 2017 2 ED Visits mismatch 98195 98230

3XX 2017 3 ED Visits mismatch 99167 99205

Rx Summit wwwNationalRxDrugAbuseSummitorg

Sample site report

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results All drug (11 sites)

0

10

20

30

40

50

60

70

80

90

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d al

l dru

g ov

erdo

se ra

tes

by

100

00 E

D v

isits

Quarter year

-2000

-1000

000

1000

2000

3000

4000

5000

6000

7000

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results Opioid (11 sites)

0

5

10

15

20

25

30

35

40

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d op

ioid

ove

rdos

e ra

tes

by

100

00 E

D v

isits

Quarter year

-10

-5

0

5

10

15

20

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results Heroin (11 sites)

0

5

10

15

20

25

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d op

ioid

ove

rdos

e ra

tes

by

100

00 E

D v

isits

Quarter year

-15

-10

-5

0

5

10

15

20

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

Annual percentage changes (11 sites)

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Chart1

All drug

Heroin

Opioid

889150252325

302341597796

208009807928

1075831326045

476222826087

283004552352

167997701832

215786123488

271305063812

table with overall

table with overall

All drug

Suspected all drug overdose rates by 10000 ED visits

Sheet1

All drug

table by sex

Opioid

Quarter year

Suspected opioid overdose rates by 10000 ED visits

table by age

Opioid

table by state

Heroin

Quarter year

Suspected opioid overdose rates by 10000 ED visits

Heroin

All drug

Heroin

Opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Summary

Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017

Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin

Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency department data dissemination efforts

ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Maine		1941		-1273		225		278		1523		-201		3951		-692		257		-813		2945		981		793		656		-299		-2255		3199		2197
Massachusetts		na		na		na		na		na		na		1561		-157		-848		-1148		311		1897		553		-31		-13		-1632		456		2146
New Hampshire		511		1514		-1438		-832		2583		-961		318		64		-433		-1791		2967		-876		825		-184		-1002		-2016		3363		-17
Pennsylvania		na		na		869		-102		1211		-116		na		na		2979		1751		2589		-594		na		na		2601		1534		2735		-735
Rhode Island		na		na		735		-790		1002		-1594		na		na		28		454		544		-1191		na		na		121		1057		566		-3262
West Virginia		-1596		875		2978		-1543		409		-1651		-367		995		4331		-1664		402		-2377		-769		1847		4571		-1584		-199		-3022
Kentucky		-102		1242		-1707		2211		1092		-1468		1095		5192		-2694		4045		352		-2002		-043		5541		-3206		5012		-408		-1624
New Mexico		2932		283		521		-078		445		-716		255		-1298		2611		151		-501		-1093		-487		-3061		3227		987		-1715		323
Missouri		068		-304		754		028		114		421		292		827		477		-177		954		767		-046		1839		096		-512		966		125
Ohio		na		na		107		1216		1596		-1865		na		na		2274		2567		2167		-3194		na		na		2182		2254		2086		-3348
Wisconsin		-229		1388		861		2928		888		931		-948		986		1712		6728		322		314		-1457		91		983		9621		196		668
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		1514		2112		1966		2017		1853		2398		2634
Massachusetts		7036		8133		8006		7327		6486		6687		7956
New Hampshire		3806		3927		4179		3998		3282		4255		3882
Pennsylvania		na		na		1265		1641		1929		2428		2284
Rhode Island		na		na		1498		154		161		1698		1496
West Virginia		2258		2176		2392		3428		2857		2972		2266
Kentucky		2095		2325		3532		258		3624		3752		3001
New Mexico		1927		1976		1719		2168		2201		2091		1862
Missouri		1472		1515		1641		1719		1688		185		1991
Ohio		na		na		236		2897		3641		443		3015
Wisconsin		664		601		66		773		1294		1336		1377
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		502		9		959		931		721		952		1161
Massachusetts		4035		4258		4126		359		3004		3141		3815
New Hampshire		2514		2721		2671		2403		1919		2564		2128
Pennsylvania		na		na		1013		1277		1473		1876		1738
Rhode Island		na		na		803		812		898		949		639
West Virginia		1496		1381		1636		2384		2006		1966		1372
Kentucky		1772		1764		2741		1863		2796		2682		2247
New Mexico		902		858		595		787		865		717		74
Missouri		1002		997		118		1192		1131		124		1255
Ohio		na		na		1804		2198		2693		3254		2165
Wisconsin		286		244		267		293		575		586		625
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		5609		6697		5845		5976		6142		7078		6936
Massachusetts		na		na		na		na		na		na		na
New Hampshire		5678		5968		6872		5883		5394		6787		6135
Pennsylvania		na		na		8374		9102		9010		10100		9983
Rhode Island		na		na		3567		3829		3527		3880		3262
West Virginia		4628		3889		4229		5489		4642		4832		4034
Kentucky		6756		6687		7517		6234		7613		8444		7205
New Mexico		5291		6842		7036		7402		7345		7672		7123
Missouri		3213		3235		3137		3373		3383		3421		3565
Ohio		na		na		8696		8789		9859		11432		9300
Wisconsin		2724		2661		3031		3291		4255		4633		5064

all drug

all opioids

heroin

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

15 to 24

25 to 34

35 to 54

55 and up

all drug

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

opioid

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

heroin

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Male		-140		7355		827		901		1286		-927		742		-758		1157		1241		1306		-829		146		301		1082		1242		1306		-1249
Female		841		5151		103		733		1257		-1521		659		-922		533		1204		1494		-1014		-132		1299		229		1331		1617		-1214
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		4888		4820		8365		9057		9873		11142		10110
Female		3201		3470		5257		5312		5701		6418		5442
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		3611		3879		3585		40		4496		5083		4662
Female		159		1695		1538		162		1816		2087		1875
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		2295		2328		2399		2658		2988		3379		2957
Female		839		828		936		957		1085		126		1107

	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017		q1		q2		q3
All drug		3948		4061		6589		6894		7458		8430		7696		889150252325		1075831326045		167997701832
Heroin		1452		1472		1571		1681		1891		2173		191		302341597796		476222826087		215786123488
Opioid		2447		2636		2429		2636		2956		3382		3088		208009807928		283004552352		271305063812
	Q12016-Q12017		Q22016-Q22017		Q32016-Q32017
All drug		889150252325		1075831326045		167997701832
Heroin		302341597796		476222826087		215786123488
Opioid		208009807928		283004552352		271305063812

	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
Heroin		136		674		701		1251		1486		-1209
Opioid		77		-785		853		1212		1442		-868
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
Heroin		1452		1472		1571		1681		1891		2173		191
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Heroin		1452		1472		1571		1681		1891		2173		191
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Opioid		77		-785		853		1212		1442		-868
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Heroin		136		674		701		1251		1486		-1209

Q12016-Q12017		Q12016-Q12017		Q12016-Q12017
Q22016-Q22017		Q22016-Q22017		Q22016-Q22017
Q32016-Q32017		Q32016-Q32017		Q32016-Q32017

Rx Summit wwwNationalRxDrugAbuseSummitorg

Data submission process

Rx Summit wwwNationalRxDrugAbuseSummitorg

Sample quality control report

ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)

TOTAL ED VISITS (AGE)

1XX 2017 1 ED Visits mismatch 98287 98309

2XX 2017 2 ED Visits mismatch 98195 98230

3XX 2017 3 ED Visits mismatch 99167 99205

Rx Summit wwwNationalRxDrugAbuseSummitorg

Sample site report

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results All drug (11 sites)

0

10

20

30

40

50

60

70

80

90

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d al

l dru

g ov

erdo

se ra

tes

by

100

00 E

D v

isits

Quarter year

-2000

-1000

000

1000

2000

3000

4000

5000

6000

7000

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results Opioid (11 sites)

0

5

10

15

20

25

30

35

40

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d op

ioid

ove

rdos

e ra

tes

by

100

00 E

D v

isits

Quarter year

-10

-5

0

5

10

15

20

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results Heroin (11 sites)

0

5

10

15

20

25

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d op

ioid

ove

rdos

e ra

tes

by

100

00 E

D v

isits

Quarter year

-15

-10

-5

0

5

10

15

20

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

Annual percentage changes (11 sites)

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Chart1

All drug

Heroin

Opioid

889150252325

302341597796

208009807928

1075831326045

476222826087

283004552352

167997701832

215786123488

271305063812

table with overall

table with overall

All drug

Suspected all drug overdose rates by 10000 ED visits

Sheet1

All drug

table by sex

Opioid

Quarter year

Suspected opioid overdose rates by 10000 ED visits

table by age

Opioid

table by state

Heroin

Quarter year

Suspected opioid overdose rates by 10000 ED visits

Heroin

All drug

Heroin

Opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Summary

Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017

Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin

Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency department data dissemination efforts

ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Maine		1941		-1273		225		278		1523		-201		3951		-692		257		-813		2945		981		793		656		-299		-2255		3199		2197
Massachusetts		na		na		na		na		na		na		1561		-157		-848		-1148		311		1897		553		-31		-13		-1632		456		2146
New Hampshire		511		1514		-1438		-832		2583		-961		318		64		-433		-1791		2967		-876		825		-184		-1002		-2016		3363		-17
Pennsylvania		na		na		869		-102		1211		-116		na		na		2979		1751		2589		-594		na		na		2601		1534		2735		-735
Rhode Island		na		na		735		-790		1002		-1594		na		na		28		454		544		-1191		na		na		121		1057		566		-3262
West Virginia		-1596		875		2978		-1543		409		-1651		-367		995		4331		-1664		402		-2377		-769		1847		4571		-1584		-199		-3022
Kentucky		-102		1242		-1707		2211		1092		-1468		1095		5192		-2694		4045		352		-2002		-043		5541		-3206		5012		-408		-1624
New Mexico		2932		283		521		-078		445		-716		255		-1298		2611		151		-501		-1093		-487		-3061		3227		987		-1715		323
Missouri		068		-304		754		028		114		421		292		827		477		-177		954		767		-046		1839		096		-512		966		125
Ohio		na		na		107		1216		1596		-1865		na		na		2274		2567		2167		-3194		na		na		2182		2254		2086		-3348
Wisconsin		-229		1388		861		2928		888		931		-948		986		1712		6728		322		314		-1457		91		983		9621		196		668
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		1514		2112		1966		2017		1853		2398		2634
Massachusetts		7036		8133		8006		7327		6486		6687		7956
New Hampshire		3806		3927		4179		3998		3282		4255		3882
Pennsylvania		na		na		1265		1641		1929		2428		2284
Rhode Island		na		na		1498		154		161		1698		1496
West Virginia		2258		2176		2392		3428		2857		2972		2266
Kentucky		2095		2325		3532		258		3624		3752		3001
New Mexico		1927		1976		1719		2168		2201		2091		1862
Missouri		1472		1515		1641		1719		1688		185		1991
Ohio		na		na		236		2897		3641		443		3015
Wisconsin		664		601		66		773		1294		1336		1377
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		502		9		959		931		721		952		1161
Massachusetts		4035		4258		4126		359		3004		3141		3815
New Hampshire		2514		2721		2671		2403		1919		2564		2128
Pennsylvania		na		na		1013		1277		1473		1876		1738
Rhode Island		na		na		803		812		898		949		639
West Virginia		1496		1381		1636		2384		2006		1966		1372
Kentucky		1772		1764		2741		1863		2796		2682		2247
New Mexico		902		858		595		787		865		717		74
Missouri		1002		997		118		1192		1131		124		1255
Ohio		na		na		1804		2198		2693		3254		2165
Wisconsin		286		244		267		293		575		586		625
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		5609		6697		5845		5976		6142		7078		6936
Massachusetts		na		na		na		na		na		na		na
New Hampshire		5678		5968		6872		5883		5394		6787		6135
Pennsylvania		na		na		8374		9102		9010		10100		9983
Rhode Island		na		na		3567		3829		3527		3880		3262
West Virginia		4628		3889		4229		5489		4642		4832		4034
Kentucky		6756		6687		7517		6234		7613		8444		7205
New Mexico		5291		6842		7036		7402		7345		7672		7123
Missouri		3213		3235		3137		3373		3383		3421		3565
Ohio		na		na		8696		8789		9859		11432		9300
Wisconsin		2724		2661		3031		3291		4255		4633		5064

all drug

all opioids

heroin

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

15 to 24

25 to 34

35 to 54

55 and up

all drug

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

opioid

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

heroin

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Male		-140		7355		827		901		1286		-927		742		-758		1157		1241		1306		-829		146		301		1082		1242		1306		-1249
Female		841		5151		103		733		1257		-1521		659		-922		533		1204		1494		-1014		-132		1299		229		1331		1617		-1214
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		4888		4820		8365		9057		9873		11142		10110
Female		3201		3470		5257		5312		5701		6418		5442
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		3611		3879		3585		40		4496		5083		4662
Female		159		1695		1538		162		1816		2087		1875
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		2295		2328		2399		2658		2988		3379		2957
Female		839		828		936		957		1085		126		1107

	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017		q1		q2		q3
All drug		3948		4061		6589		6894		7458		8430		7696		889150252325		1075831326045		167997701832
Heroin		1452		1472		1571		1681		1891		2173		191		302341597796		476222826087		215786123488
Opioid		2447		2636		2429		2636		2956		3382		3088		208009807928		283004552352		271305063812
	Q12016-Q12017		Q22016-Q22017		Q32016-Q32017
All drug		889150252325		1075831326045		167997701832
Heroin		302341597796		476222826087		215786123488
Opioid		208009807928		283004552352		271305063812

	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
Heroin		136		674		701		1251		1486		-1209
Opioid		77		-785		853		1212		1442		-868
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
Heroin		1452		1472		1571		1681		1891		2173		191
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Heroin		1452		1472		1571		1681		1891		2173		191
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Opioid		77		-785		853		1212		1442		-868
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Heroin		136		674		701		1251		1486		-1209

Q12016-Q12017		Q12016-Q12017		Q12016-Q12017
Q22016-Q22017		Q22016-Q22017		Q22016-Q22017
Q32016-Q32017		Q32016-Q32017		Q32016-Q32017

Rx Summit wwwNationalRxDrugAbuseSummitorg

Sample quality control report

ObsSTATE YEAR QUARTER ERROR_TEXTTOTAL ED VISITS (GENDER)

TOTAL ED VISITS (AGE)

1XX 2017 1 ED Visits mismatch 98287 98309

2XX 2017 2 ED Visits mismatch 98195 98230

3XX 2017 3 ED Visits mismatch 99167 99205

Rx Summit wwwNationalRxDrugAbuseSummitorg

Sample site report

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results All drug (11 sites)

0

10

20

30

40

50

60

70

80

90

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d al

l dru

g ov

erdo

se ra

tes

by

100

00 E

D v

isits

Quarter year

-2000

-1000

000

1000

2000

3000

4000

5000

6000

7000

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results Opioid (11 sites)

0

5

10

15

20

25

30

35

40

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d op

ioid

ove

rdos

e ra

tes

by

100

00 E

D v

isits

Quarter year

-10

-5

0

5

10

15

20

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results Heroin (11 sites)

0

5

10

15

20

25

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d op

ioid

ove

rdos

e ra

tes

by

100

00 E

D v

isits

Quarter year

-15

-10

-5

0

5

10

15

20

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

Annual percentage changes (11 sites)

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Chart1

All drug

Heroin

Opioid

889150252325

302341597796

208009807928

1075831326045

476222826087

283004552352

167997701832

215786123488

271305063812

table with overall

table with overall

All drug

Suspected all drug overdose rates by 10000 ED visits

Sheet1

All drug

table by sex

Opioid

Quarter year

Suspected opioid overdose rates by 10000 ED visits

table by age

Opioid

table by state

Heroin

Quarter year

Suspected opioid overdose rates by 10000 ED visits

Heroin

All drug

Heroin

Opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Summary

Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017

Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin

Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency department data dissemination efforts

ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Maine		1941		-1273		225		278		1523		-201		3951		-692		257		-813		2945		981		793		656		-299		-2255		3199		2197
Massachusetts		na		na		na		na		na		na		1561		-157		-848		-1148		311		1897		553		-31		-13		-1632		456		2146
New Hampshire		511		1514		-1438		-832		2583		-961		318		64		-433		-1791		2967		-876		825		-184		-1002		-2016		3363		-17
Pennsylvania		na		na		869		-102		1211		-116		na		na		2979		1751		2589		-594		na		na		2601		1534		2735		-735
Rhode Island		na		na		735		-790		1002		-1594		na		na		28		454		544		-1191		na		na		121		1057		566		-3262
West Virginia		-1596		875		2978		-1543		409		-1651		-367		995		4331		-1664		402		-2377		-769		1847		4571		-1584		-199		-3022
Kentucky		-102		1242		-1707		2211		1092		-1468		1095		5192		-2694		4045		352		-2002		-043		5541		-3206		5012		-408		-1624
New Mexico		2932		283		521		-078		445		-716		255		-1298		2611		151		-501		-1093		-487		-3061		3227		987		-1715		323
Missouri		068		-304		754		028		114		421		292		827		477		-177		954		767		-046		1839		096		-512		966		125
Ohio		na		na		107		1216		1596		-1865		na		na		2274		2567		2167		-3194		na		na		2182		2254		2086		-3348
Wisconsin		-229		1388		861		2928		888		931		-948		986		1712		6728		322		314		-1457		91		983		9621		196		668
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		1514		2112		1966		2017		1853		2398		2634
Massachusetts		7036		8133		8006		7327		6486		6687		7956
New Hampshire		3806		3927		4179		3998		3282		4255		3882
Pennsylvania		na		na		1265		1641		1929		2428		2284
Rhode Island		na		na		1498		154		161		1698		1496
West Virginia		2258		2176		2392		3428		2857		2972		2266
Kentucky		2095		2325		3532		258		3624		3752		3001
New Mexico		1927		1976		1719		2168		2201		2091		1862
Missouri		1472		1515		1641		1719		1688		185		1991
Ohio		na		na		236		2897		3641		443		3015
Wisconsin		664		601		66		773		1294		1336		1377
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		502		9		959		931		721		952		1161
Massachusetts		4035		4258		4126		359		3004		3141		3815
New Hampshire		2514		2721		2671		2403		1919		2564		2128
Pennsylvania		na		na		1013		1277		1473		1876		1738
Rhode Island		na		na		803		812		898		949		639
West Virginia		1496		1381		1636		2384		2006		1966		1372
Kentucky		1772		1764		2741		1863		2796		2682		2247
New Mexico		902		858		595		787		865		717		74
Missouri		1002		997		118		1192		1131		124		1255
Ohio		na		na		1804		2198		2693		3254		2165
Wisconsin		286		244		267		293		575		586		625
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		5609		6697		5845		5976		6142		7078		6936
Massachusetts		na		na		na		na		na		na		na
New Hampshire		5678		5968		6872		5883		5394		6787		6135
Pennsylvania		na		na		8374		9102		9010		10100		9983
Rhode Island		na		na		3567		3829		3527		3880		3262
West Virginia		4628		3889		4229		5489		4642		4832		4034
Kentucky		6756		6687		7517		6234		7613		8444		7205
New Mexico		5291		6842		7036		7402		7345		7672		7123
Missouri		3213		3235		3137		3373		3383		3421		3565
Ohio		na		na		8696		8789		9859		11432		9300
Wisconsin		2724		2661		3031		3291		4255		4633		5064

all drug

all opioids

heroin

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

15 to 24

25 to 34

35 to 54

55 and up

all drug

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

opioid

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

heroin

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Male		-140		7355		827		901		1286		-927		742		-758		1157		1241		1306		-829		146		301		1082		1242		1306		-1249
Female		841		5151		103		733		1257		-1521		659		-922		533		1204		1494		-1014		-132		1299		229		1331		1617		-1214
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		4888		4820		8365		9057		9873		11142		10110
Female		3201		3470		5257		5312		5701		6418		5442
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		3611		3879		3585		40		4496		5083		4662
Female		159		1695		1538		162		1816		2087		1875
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		2295		2328		2399		2658		2988		3379		2957
Female		839		828		936		957		1085		126		1107

	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017		q1		q2		q3
All drug		3948		4061		6589		6894		7458		8430		7696		889150252325		1075831326045		167997701832
Heroin		1452		1472		1571		1681		1891		2173		191		302341597796		476222826087		215786123488
Opioid		2447		2636		2429		2636		2956		3382		3088		208009807928		283004552352		271305063812
	Q12016-Q12017		Q22016-Q22017		Q32016-Q32017
All drug		889150252325		1075831326045		167997701832
Heroin		302341597796		476222826087		215786123488
Opioid		208009807928		283004552352		271305063812

	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
Heroin		136		674		701		1251		1486		-1209
Opioid		77		-785		853		1212		1442		-868
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
Heroin		1452		1472		1571		1681		1891		2173		191
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Heroin		1452		1472		1571		1681		1891		2173		191
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Opioid		77		-785		853		1212		1442		-868
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Heroin		136		674		701		1251		1486		-1209

Q12016-Q12017		Q12016-Q12017		Q12016-Q12017
Q22016-Q22017		Q22016-Q22017		Q22016-Q22017
Q32016-Q32017		Q32016-Q32017		Q32016-Q32017

Rx Summit wwwNationalRxDrugAbuseSummitorg

Sample site report

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results All drug (11 sites)

0

10

20

30

40

50

60

70

80

90

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d al

l dru

g ov

erdo

se ra

tes

by

100

00 E

D v

isits

Quarter year

-2000

-1000

000

1000

2000

3000

4000

5000

6000

7000

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results Opioid (11 sites)

0

5

10

15

20

25

30

35

40

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d op

ioid

ove

rdos

e ra

tes

by

100

00 E

D v

isits

Quarter year

-10

-5

0

5

10

15

20

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results Heroin (11 sites)

0

5

10

15

20

25

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d op

ioid

ove

rdos

e ra

tes

by

100

00 E

D v

isits

Quarter year

-15

-10

-5

0

5

10

15

20

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

Annual percentage changes (11 sites)

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Chart1

All drug

Heroin

Opioid

889150252325

302341597796

208009807928

1075831326045

476222826087

283004552352

167997701832

215786123488

271305063812

table with overall

table with overall

All drug

Suspected all drug overdose rates by 10000 ED visits

Sheet1

All drug

table by sex

Opioid

Quarter year

Suspected opioid overdose rates by 10000 ED visits

table by age

Opioid

table by state

Heroin

Quarter year

Suspected opioid overdose rates by 10000 ED visits

Heroin

All drug

Heroin

Opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Summary

Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017

Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin

Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency department data dissemination efforts

ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Maine		1941		-1273		225		278		1523		-201		3951		-692		257		-813		2945		981		793		656		-299		-2255		3199		2197
Massachusetts		na		na		na		na		na		na		1561		-157		-848		-1148		311		1897		553		-31		-13		-1632		456		2146
New Hampshire		511		1514		-1438		-832		2583		-961		318		64		-433		-1791		2967		-876		825		-184		-1002		-2016		3363		-17
Pennsylvania		na		na		869		-102		1211		-116		na		na		2979		1751		2589		-594		na		na		2601		1534		2735		-735
Rhode Island		na		na		735		-790		1002		-1594		na		na		28		454		544		-1191		na		na		121		1057		566		-3262
West Virginia		-1596		875		2978		-1543		409		-1651		-367		995		4331		-1664		402		-2377		-769		1847		4571		-1584		-199		-3022
Kentucky		-102		1242		-1707		2211		1092		-1468		1095		5192		-2694		4045		352		-2002		-043		5541		-3206		5012		-408		-1624
New Mexico		2932		283		521		-078		445		-716		255		-1298		2611		151		-501		-1093		-487		-3061		3227		987		-1715		323
Missouri		068		-304		754		028		114		421		292		827		477		-177		954		767		-046		1839		096		-512		966		125
Ohio		na		na		107		1216		1596		-1865		na		na		2274		2567		2167		-3194		na		na		2182		2254		2086		-3348
Wisconsin		-229		1388		861		2928		888		931		-948		986		1712		6728		322		314		-1457		91		983		9621		196		668
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		1514		2112		1966		2017		1853		2398		2634
Massachusetts		7036		8133		8006		7327		6486		6687		7956
New Hampshire		3806		3927		4179		3998		3282		4255		3882
Pennsylvania		na		na		1265		1641		1929		2428		2284
Rhode Island		na		na		1498		154		161		1698		1496
West Virginia		2258		2176		2392		3428		2857		2972		2266
Kentucky		2095		2325		3532		258		3624		3752		3001
New Mexico		1927		1976		1719		2168		2201		2091		1862
Missouri		1472		1515		1641		1719		1688		185		1991
Ohio		na		na		236		2897		3641		443		3015
Wisconsin		664		601		66		773		1294		1336		1377
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		502		9		959		931		721		952		1161
Massachusetts		4035		4258		4126		359		3004		3141		3815
New Hampshire		2514		2721		2671		2403		1919		2564		2128
Pennsylvania		na		na		1013		1277		1473		1876		1738
Rhode Island		na		na		803		812		898		949		639
West Virginia		1496		1381		1636		2384		2006		1966		1372
Kentucky		1772		1764		2741		1863		2796		2682		2247
New Mexico		902		858		595		787		865		717		74
Missouri		1002		997		118		1192		1131		124		1255
Ohio		na		na		1804		2198		2693		3254		2165
Wisconsin		286		244		267		293		575		586		625
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		5609		6697		5845		5976		6142		7078		6936
Massachusetts		na		na		na		na		na		na		na
New Hampshire		5678		5968		6872		5883		5394		6787		6135
Pennsylvania		na		na		8374		9102		9010		10100		9983
Rhode Island		na		na		3567		3829		3527		3880		3262
West Virginia		4628		3889		4229		5489		4642		4832		4034
Kentucky		6756		6687		7517		6234		7613		8444		7205
New Mexico		5291		6842		7036		7402		7345		7672		7123
Missouri		3213		3235		3137		3373		3383		3421		3565
Ohio		na		na		8696		8789		9859		11432		9300
Wisconsin		2724		2661		3031		3291		4255		4633		5064

all drug

all opioids

heroin

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

15 to 24

25 to 34

35 to 54

55 and up

all drug

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

opioid

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

heroin

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Male		-140		7355		827		901		1286		-927		742		-758		1157		1241		1306		-829		146		301		1082		1242		1306		-1249
Female		841		5151		103		733		1257		-1521		659		-922		533		1204		1494		-1014		-132		1299		229		1331		1617		-1214
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		4888		4820		8365		9057		9873		11142		10110
Female		3201		3470		5257		5312		5701		6418		5442
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		3611		3879		3585		40		4496		5083		4662
Female		159		1695		1538		162		1816		2087		1875
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		2295		2328		2399		2658		2988		3379		2957
Female		839		828		936		957		1085		126		1107

	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017		q1		q2		q3
All drug		3948		4061		6589		6894		7458		8430		7696		889150252325		1075831326045		167997701832
Heroin		1452		1472		1571		1681		1891		2173		191		302341597796		476222826087		215786123488
Opioid		2447		2636		2429		2636		2956		3382		3088		208009807928		283004552352		271305063812
	Q12016-Q12017		Q22016-Q22017		Q32016-Q32017
All drug		889150252325		1075831326045		167997701832
Heroin		302341597796		476222826087		215786123488
Opioid		208009807928		283004552352		271305063812

	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
Heroin		136		674		701		1251		1486		-1209
Opioid		77		-785		853		1212		1442		-868
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
Heroin		1452		1472		1571		1681		1891		2173		191
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Heroin		1452		1472		1571		1681		1891		2173		191
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Opioid		77		-785		853		1212		1442		-868
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Heroin		136		674		701		1251		1486		-1209

Q12016-Q12017		Q12016-Q12017		Q12016-Q12017
Q22016-Q22017		Q22016-Q22017		Q22016-Q22017
Q32016-Q32017		Q32016-Q32017		Q32016-Q32017

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results All drug (11 sites)

0

10

20

30

40

50

60

70

80

90

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d al

l dru

g ov

erdo

se ra

tes

by

100

00 E

D v

isits

Quarter year

-2000

-1000

000

1000

2000

3000

4000

5000

6000

7000

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results Opioid (11 sites)

0

5

10

15

20

25

30

35

40

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d op

ioid

ove

rdos

e ra

tes

by

100

00 E

D v

isits

Quarter year

-10

-5

0

5

10

15

20

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results Heroin (11 sites)

0

5

10

15

20

25

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d op

ioid

ove

rdos

e ra

tes

by

100

00 E

D v

isits

Quarter year

-15

-10

-5

0

5

10

15

20

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

Annual percentage changes (11 sites)

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Chart1

All drug

Heroin

Opioid

889150252325

302341597796

208009807928

1075831326045

476222826087

283004552352

167997701832

215786123488

271305063812

table with overall

table with overall

All drug

Suspected all drug overdose rates by 10000 ED visits

Sheet1

All drug

table by sex

Opioid

Quarter year

Suspected opioid overdose rates by 10000 ED visits

table by age

Opioid

table by state

Heroin

Quarter year

Suspected opioid overdose rates by 10000 ED visits

Heroin

All drug

Heroin

Opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Summary

Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017

Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin

Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency department data dissemination efforts

ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Maine		1941		-1273		225		278		1523		-201		3951		-692		257		-813		2945		981		793		656		-299		-2255		3199		2197
Massachusetts		na		na		na		na		na		na		1561		-157		-848		-1148		311		1897		553		-31		-13		-1632		456		2146
New Hampshire		511		1514		-1438		-832		2583		-961		318		64		-433		-1791		2967		-876		825		-184		-1002		-2016		3363		-17
Pennsylvania		na		na		869		-102		1211		-116		na		na		2979		1751		2589		-594		na		na		2601		1534		2735		-735
Rhode Island		na		na		735		-790		1002		-1594		na		na		28		454		544		-1191		na		na		121		1057		566		-3262
West Virginia		-1596		875		2978		-1543		409		-1651		-367		995		4331		-1664		402		-2377		-769		1847		4571		-1584		-199		-3022
Kentucky		-102		1242		-1707		2211		1092		-1468		1095		5192		-2694		4045		352		-2002		-043		5541		-3206		5012		-408		-1624
New Mexico		2932		283		521		-078		445		-716		255		-1298		2611		151		-501		-1093		-487		-3061		3227		987		-1715		323
Missouri		068		-304		754		028		114		421		292		827		477		-177		954		767		-046		1839		096		-512		966		125
Ohio		na		na		107		1216		1596		-1865		na		na		2274		2567		2167		-3194		na		na		2182		2254		2086		-3348
Wisconsin		-229		1388		861		2928		888		931		-948		986		1712		6728		322		314		-1457		91		983		9621		196		668
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		1514		2112		1966		2017		1853		2398		2634
Massachusetts		7036		8133		8006		7327		6486		6687		7956
New Hampshire		3806		3927		4179		3998		3282		4255		3882
Pennsylvania		na		na		1265		1641		1929		2428		2284
Rhode Island		na		na		1498		154		161		1698		1496
West Virginia		2258		2176		2392		3428		2857		2972		2266
Kentucky		2095		2325		3532		258		3624		3752		3001
New Mexico		1927		1976		1719		2168		2201		2091		1862
Missouri		1472		1515		1641		1719		1688		185		1991
Ohio		na		na		236		2897		3641		443		3015
Wisconsin		664		601		66		773		1294		1336		1377
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		502		9		959		931		721		952		1161
Massachusetts		4035		4258		4126		359		3004		3141		3815
New Hampshire		2514		2721		2671		2403		1919		2564		2128
Pennsylvania		na		na		1013		1277		1473		1876		1738
Rhode Island		na		na		803		812		898		949		639
West Virginia		1496		1381		1636		2384		2006		1966		1372
Kentucky		1772		1764		2741		1863		2796		2682		2247
New Mexico		902		858		595		787		865		717		74
Missouri		1002		997		118		1192		1131		124		1255
Ohio		na		na		1804		2198		2693		3254		2165
Wisconsin		286		244		267		293		575		586		625
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		5609		6697		5845		5976		6142		7078		6936
Massachusetts		na		na		na		na		na		na		na
New Hampshire		5678		5968		6872		5883		5394		6787		6135
Pennsylvania		na		na		8374		9102		9010		10100		9983
Rhode Island		na		na		3567		3829		3527		3880		3262
West Virginia		4628		3889		4229		5489		4642		4832		4034
Kentucky		6756		6687		7517		6234		7613		8444		7205
New Mexico		5291		6842		7036		7402		7345		7672		7123
Missouri		3213		3235		3137		3373		3383		3421		3565
Ohio		na		na		8696		8789		9859		11432		9300
Wisconsin		2724		2661		3031		3291		4255		4633		5064

all drug

all opioids

heroin

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

15 to 24

25 to 34

35 to 54

55 and up

all drug

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

opioid

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

heroin

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Male		-140		7355		827		901		1286		-927		742		-758		1157		1241		1306		-829		146		301		1082		1242		1306		-1249
Female		841		5151		103		733		1257		-1521		659		-922		533		1204		1494		-1014		-132		1299		229		1331		1617		-1214
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		4888		4820		8365		9057		9873		11142		10110
Female		3201		3470		5257		5312		5701		6418		5442
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		3611		3879		3585		40		4496		5083		4662
Female		159		1695		1538		162		1816		2087		1875
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		2295		2328		2399		2658		2988		3379		2957
Female		839		828		936		957		1085		126		1107

	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017		q1		q2		q3
All drug		3948		4061		6589		6894		7458		8430		7696		889150252325		1075831326045		167997701832
Heroin		1452		1472		1571		1681		1891		2173		191		302341597796		476222826087		215786123488
Opioid		2447		2636		2429		2636		2956		3382		3088		208009807928		283004552352		271305063812
	Q12016-Q12017		Q22016-Q22017		Q32016-Q32017
All drug		889150252325		1075831326045		167997701832
Heroin		302341597796		476222826087		215786123488
Opioid		208009807928		283004552352		271305063812

	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
Heroin		136		674		701		1251		1486		-1209
Opioid		77		-785		853		1212		1442		-868
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
Heroin		1452		1472		1571		1681		1891		2173		191
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Heroin		1452		1472		1571		1681		1891		2173		191
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Opioid		77		-785		853		1212		1442		-868
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Heroin		136		674		701		1251		1486		-1209

Q12016-Q12017		Q12016-Q12017		Q12016-Q12017
Q22016-Q22017		Q22016-Q22017		Q22016-Q22017
Q32016-Q32017		Q32016-Q32017		Q32016-Q32017

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results Opioid (11 sites)

0

5

10

15

20

25

30

35

40

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d op

ioid

ove

rdos

e ra

tes

by

100

00 E

D v

isits

Quarter year

-10

-5

0

5

10

15

20

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results Heroin (11 sites)

0

5

10

15

20

25

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d op

ioid

ove

rdos

e ra

tes

by

100

00 E

D v

isits

Quarter year

-15

-10

-5

0

5

10

15

20

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

Annual percentage changes (11 sites)

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Chart1

All drug

Heroin

Opioid

889150252325

302341597796

208009807928

1075831326045

476222826087

283004552352

167997701832

215786123488

271305063812

table with overall

table with overall

All drug

Suspected all drug overdose rates by 10000 ED visits

Sheet1

All drug

table by sex

Opioid

Quarter year

Suspected opioid overdose rates by 10000 ED visits

table by age

Opioid

table by state

Heroin

Quarter year

Suspected opioid overdose rates by 10000 ED visits

Heroin

All drug

Heroin

Opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Summary

Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017

Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin

Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency department data dissemination efforts

ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Maine		1941		-1273		225		278		1523		-201		3951		-692		257		-813		2945		981		793		656		-299		-2255		3199		2197
Massachusetts		na		na		na		na		na		na		1561		-157		-848		-1148		311		1897		553		-31		-13		-1632		456		2146
New Hampshire		511		1514		-1438		-832		2583		-961		318		64		-433		-1791		2967		-876		825		-184		-1002		-2016		3363		-17
Pennsylvania		na		na		869		-102		1211		-116		na		na		2979		1751		2589		-594		na		na		2601		1534		2735		-735
Rhode Island		na		na		735		-790		1002		-1594		na		na		28		454		544		-1191		na		na		121		1057		566		-3262
West Virginia		-1596		875		2978		-1543		409		-1651		-367		995		4331		-1664		402		-2377		-769		1847		4571		-1584		-199		-3022
Kentucky		-102		1242		-1707		2211		1092		-1468		1095		5192		-2694		4045		352		-2002		-043		5541		-3206		5012		-408		-1624
New Mexico		2932		283		521		-078		445		-716		255		-1298		2611		151		-501		-1093		-487		-3061		3227		987		-1715		323
Missouri		068		-304		754		028		114		421		292		827		477		-177		954		767		-046		1839		096		-512		966		125
Ohio		na		na		107		1216		1596		-1865		na		na		2274		2567		2167		-3194		na		na		2182		2254		2086		-3348
Wisconsin		-229		1388		861		2928		888		931		-948		986		1712		6728		322		314		-1457		91		983		9621		196		668
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		1514		2112		1966		2017		1853		2398		2634
Massachusetts		7036		8133		8006		7327		6486		6687		7956
New Hampshire		3806		3927		4179		3998		3282		4255		3882
Pennsylvania		na		na		1265		1641		1929		2428		2284
Rhode Island		na		na		1498		154		161		1698		1496
West Virginia		2258		2176		2392		3428		2857		2972		2266
Kentucky		2095		2325		3532		258		3624		3752		3001
New Mexico		1927		1976		1719		2168		2201		2091		1862
Missouri		1472		1515		1641		1719		1688		185		1991
Ohio		na		na		236		2897		3641		443		3015
Wisconsin		664		601		66		773		1294		1336		1377
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		502		9		959		931		721		952		1161
Massachusetts		4035		4258		4126		359		3004		3141		3815
New Hampshire		2514		2721		2671		2403		1919		2564		2128
Pennsylvania		na		na		1013		1277		1473		1876		1738
Rhode Island		na		na		803		812		898		949		639
West Virginia		1496		1381		1636		2384		2006		1966		1372
Kentucky		1772		1764		2741		1863		2796		2682		2247
New Mexico		902		858		595		787		865		717		74
Missouri		1002		997		118		1192		1131		124		1255
Ohio		na		na		1804		2198		2693		3254		2165
Wisconsin		286		244		267		293		575		586		625
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		5609		6697		5845		5976		6142		7078		6936
Massachusetts		na		na		na		na		na		na		na
New Hampshire		5678		5968		6872		5883		5394		6787		6135
Pennsylvania		na		na		8374		9102		9010		10100		9983
Rhode Island		na		na		3567		3829		3527		3880		3262
West Virginia		4628		3889		4229		5489		4642		4832		4034
Kentucky		6756		6687		7517		6234		7613		8444		7205
New Mexico		5291		6842		7036		7402		7345		7672		7123
Missouri		3213		3235		3137		3373		3383		3421		3565
Ohio		na		na		8696		8789		9859		11432		9300
Wisconsin		2724		2661		3031		3291		4255		4633		5064

all drug

all opioids

heroin

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

15 to 24

25 to 34

35 to 54

55 and up

all drug

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

opioid

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

heroin

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Male		-140		7355		827		901		1286		-927		742		-758		1157		1241		1306		-829		146		301		1082		1242		1306		-1249
Female		841		5151		103		733		1257		-1521		659		-922		533		1204		1494		-1014		-132		1299		229		1331		1617		-1214
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		4888		4820		8365		9057		9873		11142		10110
Female		3201		3470		5257		5312		5701		6418		5442
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		3611		3879		3585		40		4496		5083		4662
Female		159		1695		1538		162		1816		2087		1875
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		2295		2328		2399		2658		2988		3379		2957
Female		839		828		936		957		1085		126		1107

	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017		q1		q2		q3
All drug		3948		4061		6589		6894		7458		8430		7696		889150252325		1075831326045		167997701832
Heroin		1452		1472		1571		1681		1891		2173		191		302341597796		476222826087		215786123488
Opioid		2447		2636		2429		2636		2956		3382		3088		208009807928		283004552352		271305063812
	Q12016-Q12017		Q22016-Q22017		Q32016-Q32017
All drug		889150252325		1075831326045		167997701832
Heroin		302341597796		476222826087		215786123488
Opioid		208009807928		283004552352		271305063812

	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
Heroin		136		674		701		1251		1486		-1209
Opioid		77		-785		853		1212		1442		-868
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
Heroin		1452		1472		1571		1681		1891		2173		191
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Heroin		1452		1472		1571		1681		1891		2173		191
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Opioid		77		-785		853		1212		1442		-868
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Heroin		136		674		701		1251		1486		-1209

Q12016-Q12017		Q12016-Q12017		Q12016-Q12017
Q22016-Q22017		Q22016-Q22017		Q22016-Q22017
Q32016-Q32017		Q32016-Q32017		Q32016-Q32017

Rx Summit wwwNationalRxDrugAbuseSummitorg

ED results Heroin (11 sites)

0

5

10

15

20

25

Q1 2016 Q2 2016 Q3 2016 Q4 2016 Q1 2017 Q2 2017 Q3 2017

Susp

ecte

d op

ioid

ove

rdos

e ra

tes

by

100

00 E

D v

isits

Quarter year

-15

-10

-5

0

5

10

15

20

Δ fromQ1-Q2 2016

Δ fromQ2-Q3 2016

Δ fromQ3-Q4 2016

Δ fromQ4 2016-Q1

2017

Δ fromQ1-Q2 2017

Δ fromQ2-Q3 2017

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Rx Summit wwwNationalRxDrugAbuseSummitorg

Annual percentage changes (11 sites)

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Chart1

All drug

Heroin

Opioid

889150252325

302341597796

208009807928

1075831326045

476222826087

283004552352

167997701832

215786123488

271305063812

table with overall

table with overall

All drug

Suspected all drug overdose rates by 10000 ED visits

Sheet1

All drug

table by sex

Opioid

Quarter year

Suspected opioid overdose rates by 10000 ED visits

table by age

Opioid

table by state

Heroin

Quarter year

Suspected opioid overdose rates by 10000 ED visits

Heroin

All drug

Heroin

Opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Summary

Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017

Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin

Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency department data dissemination efforts

ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Maine		1941		-1273		225		278		1523		-201		3951		-692		257		-813		2945		981		793		656		-299		-2255		3199		2197
Massachusetts		na		na		na		na		na		na		1561		-157		-848		-1148		311		1897		553		-31		-13		-1632		456		2146
New Hampshire		511		1514		-1438		-832		2583		-961		318		64		-433		-1791		2967		-876		825		-184		-1002		-2016		3363		-17
Pennsylvania		na		na		869		-102		1211		-116		na		na		2979		1751		2589		-594		na		na		2601		1534		2735		-735
Rhode Island		na		na		735		-790		1002		-1594		na		na		28		454		544		-1191		na		na		121		1057		566		-3262
West Virginia		-1596		875		2978		-1543		409		-1651		-367		995		4331		-1664		402		-2377		-769		1847		4571		-1584		-199		-3022
Kentucky		-102		1242		-1707		2211		1092		-1468		1095		5192		-2694		4045		352		-2002		-043		5541		-3206		5012		-408		-1624
New Mexico		2932		283		521		-078		445		-716		255		-1298		2611		151		-501		-1093		-487		-3061		3227		987		-1715		323
Missouri		068		-304		754		028		114		421		292		827		477		-177		954		767		-046		1839		096		-512		966		125
Ohio		na		na		107		1216		1596		-1865		na		na		2274		2567		2167		-3194		na		na		2182		2254		2086		-3348
Wisconsin		-229		1388		861		2928		888		931		-948		986		1712		6728		322		314		-1457		91		983		9621		196		668
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		1514		2112		1966		2017		1853		2398		2634
Massachusetts		7036		8133		8006		7327		6486		6687		7956
New Hampshire		3806		3927		4179		3998		3282		4255		3882
Pennsylvania		na		na		1265		1641		1929		2428		2284
Rhode Island		na		na		1498		154		161		1698		1496
West Virginia		2258		2176		2392		3428		2857		2972		2266
Kentucky		2095		2325		3532		258		3624		3752		3001
New Mexico		1927		1976		1719		2168		2201		2091		1862
Missouri		1472		1515		1641		1719		1688		185		1991
Ohio		na		na		236		2897		3641		443		3015
Wisconsin		664		601		66		773		1294		1336		1377
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		502		9		959		931		721		952		1161
Massachusetts		4035		4258		4126		359		3004		3141		3815
New Hampshire		2514		2721		2671		2403		1919		2564		2128
Pennsylvania		na		na		1013		1277		1473		1876		1738
Rhode Island		na		na		803		812		898		949		639
West Virginia		1496		1381		1636		2384		2006		1966		1372
Kentucky		1772		1764		2741		1863		2796		2682		2247
New Mexico		902		858		595		787		865		717		74
Missouri		1002		997		118		1192		1131		124		1255
Ohio		na		na		1804		2198		2693		3254		2165
Wisconsin		286		244		267		293		575		586		625
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		5609		6697		5845		5976		6142		7078		6936
Massachusetts		na		na		na		na		na		na		na
New Hampshire		5678		5968		6872		5883		5394		6787		6135
Pennsylvania		na		na		8374		9102		9010		10100		9983
Rhode Island		na		na		3567		3829		3527		3880		3262
West Virginia		4628		3889		4229		5489		4642		4832		4034
Kentucky		6756		6687		7517		6234		7613		8444		7205
New Mexico		5291		6842		7036		7402		7345		7672		7123
Missouri		3213		3235		3137		3373		3383		3421		3565
Ohio		na		na		8696		8789		9859		11432		9300
Wisconsin		2724		2661		3031		3291		4255		4633		5064

all drug

all opioids

heroin

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

15 to 24

25 to 34

35 to 54

55 and up

all drug

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

opioid

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

heroin

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Male		-140		7355		827		901		1286		-927		742		-758		1157		1241		1306		-829		146		301		1082		1242		1306		-1249
Female		841		5151		103		733		1257		-1521		659		-922		533		1204		1494		-1014		-132		1299		229		1331		1617		-1214
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		4888		4820		8365		9057		9873		11142		10110
Female		3201		3470		5257		5312		5701		6418		5442
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		3611		3879		3585		40		4496		5083		4662
Female		159		1695		1538		162		1816		2087		1875
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		2295		2328		2399		2658		2988		3379		2957
Female		839		828		936		957		1085		126		1107

	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017		q1		q2		q3
All drug		3948		4061		6589		6894		7458		8430		7696		889150252325		1075831326045		167997701832
Heroin		1452		1472		1571		1681		1891		2173		191		302341597796		476222826087		215786123488
Opioid		2447		2636		2429		2636		2956		3382		3088		208009807928		283004552352		271305063812
	Q12016-Q12017		Q22016-Q22017		Q32016-Q32017
All drug		889150252325		1075831326045		167997701832
Heroin		302341597796		476222826087		215786123488
Opioid		208009807928		283004552352		271305063812

	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
Heroin		136		674		701		1251		1486		-1209
Opioid		77		-785		853		1212		1442		-868
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
Heroin		1452		1472		1571		1681		1891		2173		191
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Heroin		1452		1472		1571		1681		1891		2173		191
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Opioid		77		-785		853		1212		1442		-868
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Heroin		136		674		701		1251		1486		-1209

Q12016-Q12017		Q12016-Q12017		Q12016-Q12017
Q22016-Q22017		Q22016-Q22017		Q22016-Q22017
Q32016-Q32017		Q32016-Q32017		Q32016-Q32017

Rx Summit wwwNationalRxDrugAbuseSummitorg

Annual percentage changes (11 sites)

Kentucky Maine Massachusetts Missouri New Hampshire New Mexico Ohio Pennsylvania Rhode Island West Virginia Wisconsin

Chart1

All drug

Heroin

Opioid

889150252325

302341597796

208009807928

1075831326045

476222826087

283004552352

167997701832

215786123488

271305063812

table with overall

table with overall

All drug

Suspected all drug overdose rates by 10000 ED visits

Sheet1

All drug

table by sex

Opioid

Quarter year

Suspected opioid overdose rates by 10000 ED visits

table by age

Opioid

table by state

Heroin

Quarter year

Suspected opioid overdose rates by 10000 ED visits

Heroin

All drug

Heroin

Opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Summary

Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017

Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin

Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency department data dissemination efforts

ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Maine		1941		-1273		225		278		1523		-201		3951		-692		257		-813		2945		981		793		656		-299		-2255		3199		2197
Massachusetts		na		na		na		na		na		na		1561		-157		-848		-1148		311		1897		553		-31		-13		-1632		456		2146
New Hampshire		511		1514		-1438		-832		2583		-961		318		64		-433		-1791		2967		-876		825		-184		-1002		-2016		3363		-17
Pennsylvania		na		na		869		-102		1211		-116		na		na		2979		1751		2589		-594		na		na		2601		1534		2735		-735
Rhode Island		na		na		735		-790		1002		-1594		na		na		28		454		544		-1191		na		na		121		1057		566		-3262
West Virginia		-1596		875		2978		-1543		409		-1651		-367		995		4331		-1664		402		-2377		-769		1847		4571		-1584		-199		-3022
Kentucky		-102		1242		-1707		2211		1092		-1468		1095		5192		-2694		4045		352		-2002		-043		5541		-3206		5012		-408		-1624
New Mexico		2932		283		521		-078		445		-716		255		-1298		2611		151		-501		-1093		-487		-3061		3227		987		-1715		323
Missouri		068		-304		754		028		114		421		292		827		477		-177		954		767		-046		1839		096		-512		966		125
Ohio		na		na		107		1216		1596		-1865		na		na		2274		2567		2167		-3194		na		na		2182		2254		2086		-3348
Wisconsin		-229		1388		861		2928		888		931		-948		986		1712		6728		322		314		-1457		91		983		9621		196		668
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		1514		2112		1966		2017		1853		2398		2634
Massachusetts		7036		8133		8006		7327		6486		6687		7956
New Hampshire		3806		3927		4179		3998		3282		4255		3882
Pennsylvania		na		na		1265		1641		1929		2428		2284
Rhode Island		na		na		1498		154		161		1698		1496
West Virginia		2258		2176		2392		3428		2857		2972		2266
Kentucky		2095		2325		3532		258		3624		3752		3001
New Mexico		1927		1976		1719		2168		2201		2091		1862
Missouri		1472		1515		1641		1719		1688		185		1991
Ohio		na		na		236		2897		3641		443		3015
Wisconsin		664		601		66		773		1294		1336		1377
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		502		9		959		931		721		952		1161
Massachusetts		4035		4258		4126		359		3004		3141		3815
New Hampshire		2514		2721		2671		2403		1919		2564		2128
Pennsylvania		na		na		1013		1277		1473		1876		1738
Rhode Island		na		na		803		812		898		949		639
West Virginia		1496		1381		1636		2384		2006		1966		1372
Kentucky		1772		1764		2741		1863		2796		2682		2247
New Mexico		902		858		595		787		865		717		74
Missouri		1002		997		118		1192		1131		124		1255
Ohio		na		na		1804		2198		2693		3254		2165
Wisconsin		286		244		267		293		575		586		625
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		5609		6697		5845		5976		6142		7078		6936
Massachusetts		na		na		na		na		na		na		na
New Hampshire		5678		5968		6872		5883		5394		6787		6135
Pennsylvania		na		na		8374		9102		9010		10100		9983
Rhode Island		na		na		3567		3829		3527		3880		3262
West Virginia		4628		3889		4229		5489		4642		4832		4034
Kentucky		6756		6687		7517		6234		7613		8444		7205
New Mexico		5291		6842		7036		7402		7345		7672		7123
Missouri		3213		3235		3137		3373		3383		3421		3565
Ohio		na		na		8696		8789		9859		11432		9300
Wisconsin		2724		2661		3031		3291		4255		4633		5064

all drug

all opioids

heroin

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

15 to 24

25 to 34

35 to 54

55 and up

all drug

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

opioid

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

heroin

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Male		-140		7355		827		901		1286		-927		742		-758		1157		1241		1306		-829		146		301		1082		1242		1306		-1249
Female		841		5151		103		733		1257		-1521		659		-922		533		1204		1494		-1014		-132		1299		229		1331		1617		-1214
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		4888		4820		8365		9057		9873		11142		10110
Female		3201		3470		5257		5312		5701		6418		5442
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		3611		3879		3585		40		4496		5083		4662
Female		159		1695		1538		162		1816		2087		1875
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		2295		2328		2399		2658		2988		3379		2957
Female		839		828		936		957		1085		126		1107

	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017		q1		q2		q3
All drug		3948		4061		6589		6894		7458		8430		7696		889150252325		1075831326045		167997701832
Heroin		1452		1472		1571		1681		1891		2173		191		302341597796		476222826087		215786123488
Opioid		2447		2636		2429		2636		2956		3382		3088		208009807928		283004552352		271305063812
	Q12016-Q12017		Q22016-Q22017		Q32016-Q32017
All drug		889150252325		1075831326045		167997701832
Heroin		302341597796		476222826087		215786123488
Opioid		208009807928		283004552352		271305063812

	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
Heroin		136		674		701		1251		1486		-1209
Opioid		77		-785		853		1212		1442		-868
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
Heroin		1452		1472		1571		1681		1891		2173		191
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Heroin		1452		1472		1571		1681		1891		2173		191
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Opioid		77		-785		853		1212		1442		-868
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Heroin		136		674		701		1251		1486		-1209

Q12016-Q12017		Q12016-Q12017		Q12016-Q12017
Q22016-Q22017		Q22016-Q22017		Q22016-Q22017
Q32016-Q32017		Q32016-Q32017		Q32016-Q32017

Chart1

All drug

Heroin

Opioid

889150252325

302341597796

208009807928

1075831326045

476222826087

283004552352

167997701832

215786123488

271305063812

table with overall

table with overall

All drug

Suspected all drug overdose rates by 10000 ED visits

Sheet1

All drug

table by sex

Opioid

Quarter year

Suspected opioid overdose rates by 10000 ED visits

table by age

Opioid

table by state

Heroin

Quarter year

Suspected opioid overdose rates by 10000 ED visits

Heroin

All drug

Heroin

Opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Summary

Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017

Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin

Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency department data dissemination efforts

ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Maine		1941		-1273		225		278		1523		-201		3951		-692		257		-813		2945		981		793		656		-299		-2255		3199		2197
Massachusetts		na		na		na		na		na		na		1561		-157		-848		-1148		311		1897		553		-31		-13		-1632		456		2146
New Hampshire		511		1514		-1438		-832		2583		-961		318		64		-433		-1791		2967		-876		825		-184		-1002		-2016		3363		-17
Pennsylvania		na		na		869		-102		1211		-116		na		na		2979		1751		2589		-594		na		na		2601		1534		2735		-735
Rhode Island		na		na		735		-790		1002		-1594		na		na		28		454		544		-1191		na		na		121		1057		566		-3262
West Virginia		-1596		875		2978		-1543		409		-1651		-367		995		4331		-1664		402		-2377		-769		1847		4571		-1584		-199		-3022
Kentucky		-102		1242		-1707		2211		1092		-1468		1095		5192		-2694		4045		352		-2002		-043		5541		-3206		5012		-408		-1624
New Mexico		2932		283		521		-078		445		-716		255		-1298		2611		151		-501		-1093		-487		-3061		3227		987		-1715		323
Missouri		068		-304		754		028		114		421		292		827		477		-177		954		767		-046		1839		096		-512		966		125
Ohio		na		na		107		1216		1596		-1865		na		na		2274		2567		2167		-3194		na		na		2182		2254		2086		-3348
Wisconsin		-229		1388		861		2928		888		931		-948		986		1712		6728		322		314		-1457		91		983		9621		196		668
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		1514		2112		1966		2017		1853		2398		2634
Massachusetts		7036		8133		8006		7327		6486		6687		7956
New Hampshire		3806		3927		4179		3998		3282		4255		3882
Pennsylvania		na		na		1265		1641		1929		2428		2284
Rhode Island		na		na		1498		154		161		1698		1496
West Virginia		2258		2176		2392		3428		2857		2972		2266
Kentucky		2095		2325		3532		258		3624		3752		3001
New Mexico		1927		1976		1719		2168		2201		2091		1862
Missouri		1472		1515		1641		1719		1688		185		1991
Ohio		na		na		236		2897		3641		443		3015
Wisconsin		664		601		66		773		1294		1336		1377
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		502		9		959		931		721		952		1161
Massachusetts		4035		4258		4126		359		3004		3141		3815
New Hampshire		2514		2721		2671		2403		1919		2564		2128
Pennsylvania		na		na		1013		1277		1473		1876		1738
Rhode Island		na		na		803		812		898		949		639
West Virginia		1496		1381		1636		2384		2006		1966		1372
Kentucky		1772		1764		2741		1863		2796		2682		2247
New Mexico		902		858		595		787		865		717		74
Missouri		1002		997		118		1192		1131		124		1255
Ohio		na		na		1804		2198		2693		3254		2165
Wisconsin		286		244		267		293		575		586		625
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		5609		6697		5845		5976		6142		7078		6936
Massachusetts		na		na		na		na		na		na		na
New Hampshire		5678		5968		6872		5883		5394		6787		6135
Pennsylvania		na		na		8374		9102		9010		10100		9983
Rhode Island		na		na		3567		3829		3527		3880		3262
West Virginia		4628		3889		4229		5489		4642		4832		4034
Kentucky		6756		6687		7517		6234		7613		8444		7205
New Mexico		5291		6842		7036		7402		7345		7672		7123
Missouri		3213		3235		3137		3373		3383		3421		3565
Ohio		na		na		8696		8789		9859		11432		9300
Wisconsin		2724		2661		3031		3291		4255		4633		5064

all drug

all opioids

heroin

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

15 to 24

25 to 34

35 to 54

55 and up

all drug

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

opioid

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

heroin

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Male		-140		7355		827		901		1286		-927		742		-758		1157		1241		1306		-829		146		301		1082		1242		1306		-1249
Female		841		5151		103		733		1257		-1521		659		-922		533		1204		1494		-1014		-132		1299		229		1331		1617		-1214
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		4888		4820		8365		9057		9873		11142		10110
Female		3201		3470		5257		5312		5701		6418		5442
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		3611		3879		3585		40		4496		5083		4662
Female		159		1695		1538		162		1816		2087		1875
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		2295		2328		2399		2658		2988		3379		2957
Female		839		828		936		957		1085		126		1107

	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017		q1		q2		q3
All drug		3948		4061		6589		6894		7458		8430		7696		889150252325		1075831326045		167997701832
Heroin		1452		1472		1571		1681		1891		2173		191		302341597796		476222826087		215786123488
Opioid		2447		2636		2429		2636		2956		3382		3088		208009807928		283004552352		271305063812
	Q12016-Q12017		Q22016-Q22017		Q32016-Q32017
All drug		889150252325		1075831326045		167997701832
Heroin		302341597796		476222826087		215786123488
Opioid		208009807928		283004552352		271305063812

	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
Heroin		136		674		701		1251		1486		-1209
Opioid		77		-785		853		1212		1442		-868
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
Heroin		1452		1472		1571		1681		1891		2173		191
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Heroin		1452		1472		1571		1681		1891		2173		191
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Opioid		77		-785		853		1212		1442		-868
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Heroin		136		674		701		1251		1486		-1209

Q12016-Q12017		Q12016-Q12017		Q12016-Q12017
Q22016-Q22017		Q22016-Q22017		Q22016-Q22017
Q32016-Q32017		Q32016-Q32017		Q32016-Q32017

table with overall

table with overall

All drug

Suspected all drug overdose rates by 10000 ED visits

Sheet1

All drug

table by sex

Opioid

Quarter year

Suspected opioid overdose rates by 10000 ED visits

table by age

Opioid

table by state

Heroin

Quarter year

Suspected opioid overdose rates by 10000 ED visits

Heroin

All drug

Heroin

Opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Summary

Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017

Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin

Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency department data dissemination efforts

ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Maine		1941		-1273		225		278		1523		-201		3951		-692		257		-813		2945		981		793		656		-299		-2255		3199		2197
Massachusetts		na		na		na		na		na		na		1561		-157		-848		-1148		311		1897		553		-31		-13		-1632		456		2146
New Hampshire		511		1514		-1438		-832		2583		-961		318		64		-433		-1791		2967		-876		825		-184		-1002		-2016		3363		-17
Pennsylvania		na		na		869		-102		1211		-116		na		na		2979		1751		2589		-594		na		na		2601		1534		2735		-735
Rhode Island		na		na		735		-790		1002		-1594		na		na		28		454		544		-1191		na		na		121		1057		566		-3262
West Virginia		-1596		875		2978		-1543		409		-1651		-367		995		4331		-1664		402		-2377		-769		1847		4571		-1584		-199		-3022
Kentucky		-102		1242		-1707		2211		1092		-1468		1095		5192		-2694		4045		352		-2002		-043		5541		-3206		5012		-408		-1624
New Mexico		2932		283		521		-078		445		-716		255		-1298		2611		151		-501		-1093		-487		-3061		3227		987		-1715		323
Missouri		068		-304		754		028		114		421		292		827		477		-177		954		767		-046		1839		096		-512		966		125
Ohio		na		na		107		1216		1596		-1865		na		na		2274		2567		2167		-3194		na		na		2182		2254		2086		-3348
Wisconsin		-229		1388		861		2928		888		931		-948		986		1712		6728		322		314		-1457		91		983		9621		196		668
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		1514		2112		1966		2017		1853		2398		2634
Massachusetts		7036		8133		8006		7327		6486		6687		7956
New Hampshire		3806		3927		4179		3998		3282		4255		3882
Pennsylvania		na		na		1265		1641		1929		2428		2284
Rhode Island		na		na		1498		154		161		1698		1496
West Virginia		2258		2176		2392		3428		2857		2972		2266
Kentucky		2095		2325		3532		258		3624		3752		3001
New Mexico		1927		1976		1719		2168		2201		2091		1862
Missouri		1472		1515		1641		1719		1688		185		1991
Ohio		na		na		236		2897		3641		443		3015
Wisconsin		664		601		66		773		1294		1336		1377
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		502		9		959		931		721		952		1161
Massachusetts		4035		4258		4126		359		3004		3141		3815
New Hampshire		2514		2721		2671		2403		1919		2564		2128
Pennsylvania		na		na		1013		1277		1473		1876		1738
Rhode Island		na		na		803		812		898		949		639
West Virginia		1496		1381		1636		2384		2006		1966		1372
Kentucky		1772		1764		2741		1863		2796		2682		2247
New Mexico		902		858		595		787		865		717		74
Missouri		1002		997		118		1192		1131		124		1255
Ohio		na		na		1804		2198		2693		3254		2165
Wisconsin		286		244		267		293		575		586		625
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		5609		6697		5845		5976		6142		7078		6936
Massachusetts		na		na		na		na		na		na		na
New Hampshire		5678		5968		6872		5883		5394		6787		6135
Pennsylvania		na		na		8374		9102		9010		10100		9983
Rhode Island		na		na		3567		3829		3527		3880		3262
West Virginia		4628		3889		4229		5489		4642		4832		4034
Kentucky		6756		6687		7517		6234		7613		8444		7205
New Mexico		5291		6842		7036		7402		7345		7672		7123
Missouri		3213		3235		3137		3373		3383		3421		3565
Ohio		na		na		8696		8789		9859		11432		9300
Wisconsin		2724		2661		3031		3291		4255		4633		5064

all drug

all opioids

heroin

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

15 to 24

25 to 34

35 to 54

55 and up

all drug

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

opioid

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

heroin

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Male		-140		7355		827		901		1286		-927		742		-758		1157		1241		1306		-829		146		301		1082		1242		1306		-1249
Female		841		5151		103		733		1257		-1521		659		-922		533		1204		1494		-1014		-132		1299		229		1331		1617		-1214
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		4888		4820		8365		9057		9873		11142		10110
Female		3201		3470		5257		5312		5701		6418		5442
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		3611		3879		3585		40		4496		5083		4662
Female		159		1695		1538		162		1816		2087		1875
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		2295		2328		2399		2658		2988		3379		2957
Female		839		828		936		957		1085		126		1107

	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017		q1		q2		q3
All drug		3948		4061		6589		6894		7458		8430		7696		889150252325		1075831326045		167997701832
Heroin		1452		1472		1571		1681		1891		2173		191		302341597796		476222826087		215786123488
Opioid		2447		2636		2429		2636		2956		3382		3088		208009807928		283004552352		271305063812
	Q12016-Q12017		Q22016-Q22017		Q32016-Q32017
All drug		889150252325		1075831326045		167997701832
Heroin		302341597796		476222826087		215786123488
Opioid		208009807928		283004552352		271305063812

	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
Heroin		136		674		701		1251		1486		-1209
Opioid		77		-785		853		1212		1442		-868
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
Heroin		1452		1472		1571		1681		1891		2173		191
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
All drug		3948		4061		6589		6894		7458		8430		7696
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Opioid		2447		2636		2429		2636		2956		3382		3088
	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017
Heroin		1452		1472		1571		1681		1891		2173		191
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
All drug		286		6225		462		819		1303		-871
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Opioid		77		-785		853		1212		1442		-868
	Δ fromQ1-Q2 2016		Δ fromQ2-Q3 2016		Δ fromQ3-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1-Q2 2017		Δ fromQ2-Q3 2017
Heroin		136		674		701		1251		1486		-1209

table with overall

All drug

Suspected all drug overdose rates by 10000 ED visits

Sheet1

All drug

table by sex

Opioid

Quarter year

Suspected opioid overdose rates by 10000 ED visits

table by age

Opioid

table by state

Heroin

Quarter year

Suspected opioid overdose rates by 10000 ED visits

Heroin

All drug

Heroin

Opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Summary

Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017

Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin

Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency department data dissemination efforts

ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Maine		1941		-1273		225		278		1523		-201		3951		-692		257		-813		2945		981		793		656		-299		-2255		3199		2197
Massachusetts		na		na		na		na		na		na		1561		-157		-848		-1148		311		1897		553		-31		-13		-1632		456		2146
New Hampshire		511		1514		-1438		-832		2583		-961		318		64		-433		-1791		2967		-876		825		-184		-1002		-2016		3363		-17
Pennsylvania		na		na		869		-102		1211		-116		na		na		2979		1751		2589		-594		na		na		2601		1534		2735		-735
Rhode Island		na		na		735		-790		1002		-1594		na		na		28		454		544		-1191		na		na		121		1057		566		-3262
West Virginia		-1596		875		2978		-1543		409		-1651		-367		995		4331		-1664		402		-2377		-769		1847		4571		-1584		-199		-3022
Kentucky		-102		1242		-1707		2211		1092		-1468		1095		5192		-2694		4045		352		-2002		-043		5541		-3206		5012		-408		-1624
New Mexico		2932		283		521		-078		445		-716		255		-1298		2611		151		-501		-1093		-487		-3061		3227		987		-1715		323
Missouri		068		-304		754		028		114		421		292		827		477		-177		954		767		-046		1839		096		-512		966		125
Ohio		na		na		107		1216		1596		-1865		na		na		2274		2567		2167		-3194		na		na		2182		2254		2086		-3348
Wisconsin		-229		1388		861		2928		888		931		-948		986		1712		6728		322		314		-1457		91		983		9621		196		668
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		1514		2112		1966		2017		1853		2398		2634
Massachusetts		7036		8133		8006		7327		6486		6687		7956
New Hampshire		3806		3927		4179		3998		3282		4255		3882
Pennsylvania		na		na		1265		1641		1929		2428		2284
Rhode Island		na		na		1498		154		161		1698		1496
West Virginia		2258		2176		2392		3428		2857		2972		2266
Kentucky		2095		2325		3532		258		3624		3752		3001
New Mexico		1927		1976		1719		2168		2201		2091		1862
Missouri		1472		1515		1641		1719		1688		185		1991
Ohio		na		na		236		2897		3641		443		3015
Wisconsin		664		601		66		773		1294		1336		1377
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		502		9		959		931		721		952		1161
Massachusetts		4035		4258		4126		359		3004		3141		3815
New Hampshire		2514		2721		2671		2403		1919		2564		2128
Pennsylvania		na		na		1013		1277		1473		1876		1738
Rhode Island		na		na		803		812		898		949		639
West Virginia		1496		1381		1636		2384		2006		1966		1372
Kentucky		1772		1764		2741		1863		2796		2682		2247
New Mexico		902		858		595		787		865		717		74
Missouri		1002		997		118		1192		1131		124		1255
Ohio		na		na		1804		2198		2693		3254		2165
Wisconsin		286		244		267		293		575		586		625
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		5609		6697		5845		5976		6142		7078		6936
Massachusetts		na		na		na		na		na		na		na
New Hampshire		5678		5968		6872		5883		5394		6787		6135
Pennsylvania		na		na		8374		9102		9010		10100		9983
Rhode Island		na		na		3567		3829		3527		3880		3262
West Virginia		4628		3889		4229		5489		4642		4832		4034
Kentucky		6756		6687		7517		6234		7613		8444		7205
New Mexico		5291		6842		7036		7402		7345		7672		7123
Missouri		3213		3235		3137		3373		3383		3421		3565
Ohio		na		na		8696		8789		9859		11432		9300
Wisconsin		2724		2661		3031		3291		4255		4633		5064

all drug

all opioids

heroin

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

15 to 24

25 to 34

35 to 54

55 and up

all drug

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

opioid

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

heroin

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Male		-140		7355		827		901		1286		-927		742		-758		1157		1241		1306		-829		146		301		1082		1242		1306		-1249
Female		841		5151		103		733		1257		-1521		659		-922		533		1204		1494		-1014		-132		1299		229		1331		1617		-1214
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		4888		4820		8365		9057		9873		11142		10110
Female		3201		3470		5257		5312		5701		6418		5442
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		3611		3879		3585		40		4496		5083		4662
Female		159		1695		1538		162		1816		2087		1875
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		2295		2328		2399		2658		2988		3379		2957
Female		839		828		936		957		1085		126		1107

	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017		q1		q2		q3
All drug		3948		4061		6589		6894		7458		8430		7696		889150252325		1075831326045		167997701832
Heroin		1452		1472		1571		1681		1891		2173		191		302341597796		476222826087		215786123488
Opioid		2447		2636		2429		2636		2956		3382		3088		208009807928		283004552352		271305063812
	Q12016-Q12017		Q22016-Q22017		Q32016-Q32017
All drug		889150252325		1075831326045		167997701832
Heroin		302341597796		476222826087		215786123488
Opioid		208009807928		283004552352		271305063812

Sheet1

All drug

table by sex

Opioid

Quarter year

Suspected opioid overdose rates by 10000 ED visits

table by age

Opioid

table by state

Heroin

Quarter year

Suspected opioid overdose rates by 10000 ED visits

Heroin

All drug

Heroin

Opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Summary

Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017

Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin

Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency department data dissemination efforts

ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Maine		1941		-1273		225		278		1523		-201		3951		-692		257		-813		2945		981		793		656		-299		-2255		3199		2197
Massachusetts		na		na		na		na		na		na		1561		-157		-848		-1148		311		1897		553		-31		-13		-1632		456		2146
New Hampshire		511		1514		-1438		-832		2583		-961		318		64		-433		-1791		2967		-876		825		-184		-1002		-2016		3363		-17
Pennsylvania		na		na		869		-102		1211		-116		na		na		2979		1751		2589		-594		na		na		2601		1534		2735		-735
Rhode Island		na		na		735		-790		1002		-1594		na		na		28		454		544		-1191		na		na		121		1057		566		-3262
West Virginia		-1596		875		2978		-1543		409		-1651		-367		995		4331		-1664		402		-2377		-769		1847		4571		-1584		-199		-3022
Kentucky		-102		1242		-1707		2211		1092		-1468		1095		5192		-2694		4045		352		-2002		-043		5541		-3206		5012		-408		-1624
New Mexico		2932		283		521		-078		445		-716		255		-1298		2611		151		-501		-1093		-487		-3061		3227		987		-1715		323
Missouri		068		-304		754		028		114		421		292		827		477		-177		954		767		-046		1839		096		-512		966		125
Ohio		na		na		107		1216		1596		-1865		na		na		2274		2567		2167		-3194		na		na		2182		2254		2086		-3348
Wisconsin		-229		1388		861		2928		888		931		-948		986		1712		6728		322		314		-1457		91		983		9621		196		668
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		1514		2112		1966		2017		1853		2398		2634
Massachusetts		7036		8133		8006		7327		6486		6687		7956
New Hampshire		3806		3927		4179		3998		3282		4255		3882
Pennsylvania		na		na		1265		1641		1929		2428		2284
Rhode Island		na		na		1498		154		161		1698		1496
West Virginia		2258		2176		2392		3428		2857		2972		2266
Kentucky		2095		2325		3532		258		3624		3752		3001
New Mexico		1927		1976		1719		2168		2201		2091		1862
Missouri		1472		1515		1641		1719		1688		185		1991
Ohio		na		na		236		2897		3641		443		3015
Wisconsin		664		601		66		773		1294		1336		1377
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		502		9		959		931		721		952		1161
Massachusetts		4035		4258		4126		359		3004		3141		3815
New Hampshire		2514		2721		2671		2403		1919		2564		2128
Pennsylvania		na		na		1013		1277		1473		1876		1738
Rhode Island		na		na		803		812		898		949		639
West Virginia		1496		1381		1636		2384		2006		1966		1372
Kentucky		1772		1764		2741		1863		2796		2682		2247
New Mexico		902		858		595		787		865		717		74
Missouri		1002		997		118		1192		1131		124		1255
Ohio		na		na		1804		2198		2693		3254		2165
Wisconsin		286		244		267		293		575		586		625
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		5609		6697		5845		5976		6142		7078		6936
Massachusetts		na		na		na		na		na		na		na
New Hampshire		5678		5968		6872		5883		5394		6787		6135
Pennsylvania		na		na		8374		9102		9010		10100		9983
Rhode Island		na		na		3567		3829		3527		3880		3262
West Virginia		4628		3889		4229		5489		4642		4832		4034
Kentucky		6756		6687		7517		6234		7613		8444		7205
New Mexico		5291		6842		7036		7402		7345		7672		7123
Missouri		3213		3235		3137		3373		3383		3421		3565
Ohio		na		na		8696		8789		9859		11432		9300
Wisconsin		2724		2661		3031		3291		4255		4633		5064

all drug

all opioids

heroin

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

15 to 24

25 to 34

35 to 54

55 and up

all drug

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

opioid

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

heroin

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Male		-140		7355		827		901		1286		-927		742		-758		1157		1241		1306		-829		146		301		1082		1242		1306		-1249
Female		841		5151		103		733		1257		-1521		659		-922		533		1204		1494		-1014		-132		1299		229		1331		1617		-1214
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		4888		4820		8365		9057		9873		11142		10110
Female		3201		3470		5257		5312		5701		6418		5442
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		3611		3879		3585		40		4496		5083		4662
Female		159		1695		1538		162		1816		2087		1875
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		2295		2328		2399		2658		2988		3379		2957
Female		839		828		936		957		1085		126		1107

	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017		q1		q2		q3
All drug		3948		4061		6589		6894		7458		8430		7696		889150252325		1075831326045		167997701832
Heroin		1452		1472		1571		1681		1891		2173		191		302341597796		476222826087		215786123488
Opioid		2447		2636		2429		2636		2956		3382		3088		208009807928		283004552352		271305063812
	Q12016-Q12017		Q22016-Q22017		Q32016-Q32017
All drug		889150252325		1075831326045		167997701832
Heroin		302341597796		476222826087		215786123488
Opioid		208009807928		283004552352		271305063812

table by sex

Opioid

Quarter year

Suspected opioid overdose rates by 10000 ED visits

table by age

Opioid

table by state

Heroin

Quarter year

Suspected opioid overdose rates by 10000 ED visits

Heroin

All drug

Heroin

Opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Summary

Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017

Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin

Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency department data dissemination efforts

ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Maine		1941		-1273		225		278		1523		-201		3951		-692		257		-813		2945		981		793		656		-299		-2255		3199		2197
Massachusetts		na		na		na		na		na		na		1561		-157		-848		-1148		311		1897		553		-31		-13		-1632		456		2146
New Hampshire		511		1514		-1438		-832		2583		-961		318		64		-433		-1791		2967		-876		825		-184		-1002		-2016		3363		-17
Pennsylvania		na		na		869		-102		1211		-116		na		na		2979		1751		2589		-594		na		na		2601		1534		2735		-735
Rhode Island		na		na		735		-790		1002		-1594		na		na		28		454		544		-1191		na		na		121		1057		566		-3262
West Virginia		-1596		875		2978		-1543		409		-1651		-367		995		4331		-1664		402		-2377		-769		1847		4571		-1584		-199		-3022
Kentucky		-102		1242		-1707		2211		1092		-1468		1095		5192		-2694		4045		352		-2002		-043		5541		-3206		5012		-408		-1624
New Mexico		2932		283		521		-078		445		-716		255		-1298		2611		151		-501		-1093		-487		-3061		3227		987		-1715		323
Missouri		068		-304		754		028		114		421		292		827		477		-177		954		767		-046		1839		096		-512		966		125
Ohio		na		na		107		1216		1596		-1865		na		na		2274		2567		2167		-3194		na		na		2182		2254		2086		-3348
Wisconsin		-229		1388		861		2928		888		931		-948		986		1712		6728		322		314		-1457		91		983		9621		196		668
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		1514		2112		1966		2017		1853		2398		2634
Massachusetts		7036		8133		8006		7327		6486		6687		7956
New Hampshire		3806		3927		4179		3998		3282		4255		3882
Pennsylvania		na		na		1265		1641		1929		2428		2284
Rhode Island		na		na		1498		154		161		1698		1496
West Virginia		2258		2176		2392		3428		2857		2972		2266
Kentucky		2095		2325		3532		258		3624		3752		3001
New Mexico		1927		1976		1719		2168		2201		2091		1862
Missouri		1472		1515		1641		1719		1688		185		1991
Ohio		na		na		236		2897		3641		443		3015
Wisconsin		664		601		66		773		1294		1336		1377
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		502		9		959		931		721		952		1161
Massachusetts		4035		4258		4126		359		3004		3141		3815
New Hampshire		2514		2721		2671		2403		1919		2564		2128
Pennsylvania		na		na		1013		1277		1473		1876		1738
Rhode Island		na		na		803		812		898		949		639
West Virginia		1496		1381		1636		2384		2006		1966		1372
Kentucky		1772		1764		2741		1863		2796		2682		2247
New Mexico		902		858		595		787		865		717		74
Missouri		1002		997		118		1192		1131		124		1255
Ohio		na		na		1804		2198		2693		3254		2165
Wisconsin		286		244		267		293		575		586		625
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		5609		6697		5845		5976		6142		7078		6936
Massachusetts		na		na		na		na		na		na		na
New Hampshire		5678		5968		6872		5883		5394		6787		6135
Pennsylvania		na		na		8374		9102		9010		10100		9983
Rhode Island		na		na		3567		3829		3527		3880		3262
West Virginia		4628		3889		4229		5489		4642		4832		4034
Kentucky		6756		6687		7517		6234		7613		8444		7205
New Mexico		5291		6842		7036		7402		7345		7672		7123
Missouri		3213		3235		3137		3373		3383		3421		3565
Ohio		na		na		8696		8789		9859		11432		9300
Wisconsin		2724		2661		3031		3291		4255		4633		5064

all drug

all opioids

heroin

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

15 to 24

25 to 34

35 to 54

55 and up

all drug

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

opioid

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

heroin

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Male		-140		7355		827		901		1286		-927		742		-758		1157		1241		1306		-829		146		301		1082		1242		1306		-1249
Female		841		5151		103		733		1257		-1521		659		-922		533		1204		1494		-1014		-132		1299		229		1331		1617		-1214
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		4888		4820		8365		9057		9873		11142		10110
Female		3201		3470		5257		5312		5701		6418		5442
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		3611		3879		3585		40		4496		5083		4662
Female		159		1695		1538		162		1816		2087		1875
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		2295		2328		2399		2658		2988		3379		2957
Female		839		828		936		957		1085		126		1107

	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017		q1		q2		q3
All drug		3948		4061		6589		6894		7458		8430		7696		889150252325		1075831326045		167997701832
Heroin		1452		1472		1571		1681		1891		2173		191		302341597796		476222826087		215786123488
Opioid		2447		2636		2429		2636		2956		3382		3088		208009807928		283004552352		271305063812
	Q12016-Q12017		Q22016-Q22017		Q32016-Q32017
All drug		889150252325		1075831326045		167997701832
Heroin		302341597796		476222826087		215786123488
Opioid		208009807928		283004552352		271305063812

table by age

Opioid

table by state

Heroin

Quarter year

Suspected opioid overdose rates by 10000 ED visits

Heroin

All drug

Heroin

Opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Summary

Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017

Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin

Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency department data dissemination efforts

ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Maine		1941		-1273		225		278		1523		-201		3951		-692		257		-813		2945		981		793		656		-299		-2255		3199		2197
Massachusetts		na		na		na		na		na		na		1561		-157		-848		-1148		311		1897		553		-31		-13		-1632		456		2146
New Hampshire		511		1514		-1438		-832		2583		-961		318		64		-433		-1791		2967		-876		825		-184		-1002		-2016		3363		-17
Pennsylvania		na		na		869		-102		1211		-116		na		na		2979		1751		2589		-594		na		na		2601		1534		2735		-735
Rhode Island		na		na		735		-790		1002		-1594		na		na		28		454		544		-1191		na		na		121		1057		566		-3262
West Virginia		-1596		875		2978		-1543		409		-1651		-367		995		4331		-1664		402		-2377		-769		1847		4571		-1584		-199		-3022
Kentucky		-102		1242		-1707		2211		1092		-1468		1095		5192		-2694		4045		352		-2002		-043		5541		-3206		5012		-408		-1624
New Mexico		2932		283		521		-078		445		-716		255		-1298		2611		151		-501		-1093		-487		-3061		3227		987		-1715		323
Missouri		068		-304		754		028		114		421		292		827		477		-177		954		767		-046		1839		096		-512		966		125
Ohio		na		na		107		1216		1596		-1865		na		na		2274		2567		2167		-3194		na		na		2182		2254		2086		-3348
Wisconsin		-229		1388		861		2928		888		931		-948		986		1712		6728		322		314		-1457		91		983		9621		196		668
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		1514		2112		1966		2017		1853		2398		2634
Massachusetts		7036		8133		8006		7327		6486		6687		7956
New Hampshire		3806		3927		4179		3998		3282		4255		3882
Pennsylvania		na		na		1265		1641		1929		2428		2284
Rhode Island		na		na		1498		154		161		1698		1496
West Virginia		2258		2176		2392		3428		2857		2972		2266
Kentucky		2095		2325		3532		258		3624		3752		3001
New Mexico		1927		1976		1719		2168		2201		2091		1862
Missouri		1472		1515		1641		1719		1688		185		1991
Ohio		na		na		236		2897		3641		443		3015
Wisconsin		664		601		66		773		1294		1336		1377
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		502		9		959		931		721		952		1161
Massachusetts		4035		4258		4126		359		3004		3141		3815
New Hampshire		2514		2721		2671		2403		1919		2564		2128
Pennsylvania		na		na		1013		1277		1473		1876		1738
Rhode Island		na		na		803		812		898		949		639
West Virginia		1496		1381		1636		2384		2006		1966		1372
Kentucky		1772		1764		2741		1863		2796		2682		2247
New Mexico		902		858		595		787		865		717		74
Missouri		1002		997		118		1192		1131		124		1255
Ohio		na		na		1804		2198		2693		3254		2165
Wisconsin		286		244		267		293		575		586		625
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		5609		6697		5845		5976		6142		7078		6936
Massachusetts		na		na		na		na		na		na		na
New Hampshire		5678		5968		6872		5883		5394		6787		6135
Pennsylvania		na		na		8374		9102		9010		10100		9983
Rhode Island		na		na		3567		3829		3527		3880		3262
West Virginia		4628		3889		4229		5489		4642		4832		4034
Kentucky		6756		6687		7517		6234		7613		8444		7205
New Mexico		5291		6842		7036		7402		7345		7672		7123
Missouri		3213		3235		3137		3373		3383		3421		3565
Ohio		na		na		8696		8789		9859		11432		9300
Wisconsin		2724		2661		3031		3291		4255		4633		5064

all drug

all opioids

heroin

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

15 to 24

25 to 34

35 to 54

55 and up

all drug

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

opioid

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

heroin

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Male		-140		7355		827		901		1286		-927		742		-758		1157		1241		1306		-829		146		301		1082		1242		1306		-1249
Female		841		5151		103		733		1257		-1521		659		-922		533		1204		1494		-1014		-132		1299		229		1331		1617		-1214
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		4888		4820		8365		9057		9873		11142		10110
Female		3201		3470		5257		5312		5701		6418		5442
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		3611		3879		3585		40		4496		5083		4662
Female		159		1695		1538		162		1816		2087		1875
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		2295		2328		2399		2658		2988		3379		2957
Female		839		828		936		957		1085		126		1107

	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017		q1		q2		q3
All drug		3948		4061		6589		6894		7458		8430		7696		889150252325		1075831326045		167997701832
Heroin		1452		1472		1571		1681		1891		2173		191		302341597796		476222826087		215786123488
Opioid		2447		2636		2429		2636		2956		3382		3088		208009807928		283004552352		271305063812
	Q12016-Q12017		Q22016-Q22017		Q32016-Q32017
All drug		889150252325		1075831326045		167997701832
Heroin		302341597796		476222826087		215786123488
Opioid		208009807928		283004552352		271305063812

table by state

Heroin

Quarter year

Suspected opioid overdose rates by 10000 ED visits

Heroin

All drug

Heroin

Opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Summary

Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017

Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin

Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency department data dissemination efforts

ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Maine		1941		-1273		225		278		1523		-201		3951		-692		257		-813		2945		981		793		656		-299		-2255		3199		2197
Massachusetts		na		na		na		na		na		na		1561		-157		-848		-1148		311		1897		553		-31		-13		-1632		456		2146
New Hampshire		511		1514		-1438		-832		2583		-961		318		64		-433		-1791		2967		-876		825		-184		-1002		-2016		3363		-17
Pennsylvania		na		na		869		-102		1211		-116		na		na		2979		1751		2589		-594		na		na		2601		1534		2735		-735
Rhode Island		na		na		735		-790		1002		-1594		na		na		28		454		544		-1191		na		na		121		1057		566		-3262
West Virginia		-1596		875		2978		-1543		409		-1651		-367		995		4331		-1664		402		-2377		-769		1847		4571		-1584		-199		-3022
Kentucky		-102		1242		-1707		2211		1092		-1468		1095		5192		-2694		4045		352		-2002		-043		5541		-3206		5012		-408		-1624
New Mexico		2932		283		521		-078		445		-716		255		-1298		2611		151		-501		-1093		-487		-3061		3227		987		-1715		323
Missouri		068		-304		754		028		114		421		292		827		477		-177		954		767		-046		1839		096		-512		966		125
Ohio		na		na		107		1216		1596		-1865		na		na		2274		2567		2167		-3194		na		na		2182		2254		2086		-3348
Wisconsin		-229		1388		861		2928		888		931		-948		986		1712		6728		322		314		-1457		91		983		9621		196		668
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		1514		2112		1966		2017		1853		2398		2634
Massachusetts		7036		8133		8006		7327		6486		6687		7956
New Hampshire		3806		3927		4179		3998		3282		4255		3882
Pennsylvania		na		na		1265		1641		1929		2428		2284
Rhode Island		na		na		1498		154		161		1698		1496
West Virginia		2258		2176		2392		3428		2857		2972		2266
Kentucky		2095		2325		3532		258		3624		3752		3001
New Mexico		1927		1976		1719		2168		2201		2091		1862
Missouri		1472		1515		1641		1719		1688		185		1991
Ohio		na		na		236		2897		3641		443		3015
Wisconsin		664		601		66		773		1294		1336		1377
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		502		9		959		931		721		952		1161
Massachusetts		4035		4258		4126		359		3004		3141		3815
New Hampshire		2514		2721		2671		2403		1919		2564		2128
Pennsylvania		na		na		1013		1277		1473		1876		1738
Rhode Island		na		na		803		812		898		949		639
West Virginia		1496		1381		1636		2384		2006		1966		1372
Kentucky		1772		1764		2741		1863		2796		2682		2247
New Mexico		902		858		595		787		865		717		74
Missouri		1002		997		118		1192		1131		124		1255
Ohio		na		na		1804		2198		2693		3254		2165
Wisconsin		286		244		267		293		575		586		625
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		5609		6697		5845		5976		6142		7078		6936
Massachusetts		na		na		na		na		na		na		na
New Hampshire		5678		5968		6872		5883		5394		6787		6135
Pennsylvania		na		na		8374		9102		9010		10100		9983
Rhode Island		na		na		3567		3829		3527		3880		3262
West Virginia		4628		3889		4229		5489		4642		4832		4034
Kentucky		6756		6687		7517		6234		7613		8444		7205
New Mexico		5291		6842		7036		7402		7345		7672		7123
Missouri		3213		3235		3137		3373		3383		3421		3565
Ohio		na		na		8696		8789		9859		11432		9300
Wisconsin		2724		2661		3031		3291		4255		4633		5064

all drug

all opioids

heroin

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

15 to 24

25 to 34

35 to 54

55 and up

all drug

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

opioid

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

heroin

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Male		-140		7355		827		901		1286		-927		742		-758		1157		1241		1306		-829		146		301		1082		1242		1306		-1249
Female		841		5151		103		733		1257		-1521		659		-922		533		1204		1494		-1014		-132		1299		229		1331		1617		-1214
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		4888		4820		8365		9057		9873		11142		10110
Female		3201		3470		5257		5312		5701		6418		5442
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		3611		3879		3585		40		4496		5083		4662
Female		159		1695		1538		162		1816		2087		1875
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		2295		2328		2399		2658		2988		3379		2957
Female		839		828		936		957		1085		126		1107

	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017		q1		q2		q3
All drug		3948		4061		6589		6894		7458		8430		7696		889150252325		1075831326045		167997701832
Heroin		1452		1472		1571		1681		1891		2173		191		302341597796		476222826087		215786123488
Opioid		2447		2636		2429		2636		2956		3382		3088		208009807928		283004552352		271305063812
	Q12016-Q12017		Q22016-Q22017		Q32016-Q32017
All drug		889150252325		1075831326045		167997701832
Heroin		302341597796		476222826087		215786123488
Opioid		208009807928		283004552352		271305063812

Heroin

All drug

Heroin

Opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Summary

Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017

Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin

Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency department data dissemination efforts

ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Maine		1941		-1273		225		278		1523		-201		3951		-692		257		-813		2945		981		793		656		-299		-2255		3199		2197
Massachusetts		na		na		na		na		na		na		1561		-157		-848		-1148		311		1897		553		-31		-13		-1632		456		2146
New Hampshire		511		1514		-1438		-832		2583		-961		318		64		-433		-1791		2967		-876		825		-184		-1002		-2016		3363		-17
Pennsylvania		na		na		869		-102		1211		-116		na		na		2979		1751		2589		-594		na		na		2601		1534		2735		-735
Rhode Island		na		na		735		-790		1002		-1594		na		na		28		454		544		-1191		na		na		121		1057		566		-3262
West Virginia		-1596		875		2978		-1543		409		-1651		-367		995		4331		-1664		402		-2377		-769		1847		4571		-1584		-199		-3022
Kentucky		-102		1242		-1707		2211		1092		-1468		1095		5192		-2694		4045		352		-2002		-043		5541		-3206		5012		-408		-1624
New Mexico		2932		283		521		-078		445		-716		255		-1298		2611		151		-501		-1093		-487		-3061		3227		987		-1715		323
Missouri		068		-304		754		028		114		421		292		827		477		-177		954		767		-046		1839		096		-512		966		125
Ohio		na		na		107		1216		1596		-1865		na		na		2274		2567		2167		-3194		na		na		2182		2254		2086		-3348
Wisconsin		-229		1388		861		2928		888		931		-948		986		1712		6728		322		314		-1457		91		983		9621		196		668
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		1514		2112		1966		2017		1853		2398		2634
Massachusetts		7036		8133		8006		7327		6486		6687		7956
New Hampshire		3806		3927		4179		3998		3282		4255		3882
Pennsylvania		na		na		1265		1641		1929		2428		2284
Rhode Island		na		na		1498		154		161		1698		1496
West Virginia		2258		2176		2392		3428		2857		2972		2266
Kentucky		2095		2325		3532		258		3624		3752		3001
New Mexico		1927		1976		1719		2168		2201		2091		1862
Missouri		1472		1515		1641		1719		1688		185		1991
Ohio		na		na		236		2897		3641		443		3015
Wisconsin		664		601		66		773		1294		1336		1377
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		502		9		959		931		721		952		1161
Massachusetts		4035		4258		4126		359		3004		3141		3815
New Hampshire		2514		2721		2671		2403		1919		2564		2128
Pennsylvania		na		na		1013		1277		1473		1876		1738
Rhode Island		na		na		803		812		898		949		639
West Virginia		1496		1381		1636		2384		2006		1966		1372
Kentucky		1772		1764		2741		1863		2796		2682		2247
New Mexico		902		858		595		787		865		717		74
Missouri		1002		997		118		1192		1131		124		1255
Ohio		na		na		1804		2198		2693		3254		2165
Wisconsin		286		244		267		293		575		586		625
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		5609		6697		5845		5976		6142		7078		6936
Massachusetts		na		na		na		na		na		na		na
New Hampshire		5678		5968		6872		5883		5394		6787		6135
Pennsylvania		na		na		8374		9102		9010		10100		9983
Rhode Island		na		na		3567		3829		3527		3880		3262
West Virginia		4628		3889		4229		5489		4642		4832		4034
Kentucky		6756		6687		7517		6234		7613		8444		7205
New Mexico		5291		6842		7036		7402		7345		7672		7123
Missouri		3213		3235		3137		3373		3383		3421		3565
Ohio		na		na		8696		8789		9859		11432		9300
Wisconsin		2724		2661		3031		3291		4255		4633		5064

all drug

all opioids

heroin

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

15 to 24

25 to 34

35 to 54

55 and up

all drug

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

opioid

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

heroin

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Male		-140		7355		827		901		1286		-927		742		-758		1157		1241		1306		-829		146		301		1082		1242		1306		-1249
Female		841		5151		103		733		1257		-1521		659		-922		533		1204		1494		-1014		-132		1299		229		1331		1617		-1214
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		4888		4820		8365		9057		9873		11142		10110
Female		3201		3470		5257		5312		5701		6418		5442
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		3611		3879		3585		40		4496		5083		4662
Female		159		1695		1538		162		1816		2087		1875
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		2295		2328		2399		2658		2988		3379		2957
Female		839		828		936		957		1085		126		1107

	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017		q1		q2		q3
All drug		3948		4061		6589		6894		7458		8430		7696		889150252325		1075831326045		167997701832
Heroin		1452		1472		1571		1681		1891		2173		191		302341597796		476222826087		215786123488
Opioid		2447		2636		2429		2636		2956		3382		3088		208009807928		283004552352		271305063812
	Q12016-Q12017		Q22016-Q22017		Q32016-Q32017
All drug		889150252325		1075831326045		167997701832
Heroin		302341597796		476222826087		215786123488
Opioid		208009807928		283004552352		271305063812

All drug

Heroin

Opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Summary

Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017

Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin

Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency department data dissemination efforts

ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Maine		1941		-1273		225		278		1523		-201		3951		-692		257		-813		2945		981		793		656		-299		-2255		3199		2197
Massachusetts		na		na		na		na		na		na		1561		-157		-848		-1148		311		1897		553		-31		-13		-1632		456		2146
New Hampshire		511		1514		-1438		-832		2583		-961		318		64		-433		-1791		2967		-876		825		-184		-1002		-2016		3363		-17
Pennsylvania		na		na		869		-102		1211		-116		na		na		2979		1751		2589		-594		na		na		2601		1534		2735		-735
Rhode Island		na		na		735		-790		1002		-1594		na		na		28		454		544		-1191		na		na		121		1057		566		-3262
West Virginia		-1596		875		2978		-1543		409		-1651		-367		995		4331		-1664		402		-2377		-769		1847		4571		-1584		-199		-3022
Kentucky		-102		1242		-1707		2211		1092		-1468		1095		5192		-2694		4045		352		-2002		-043		5541		-3206		5012		-408		-1624
New Mexico		2932		283		521		-078		445		-716		255		-1298		2611		151		-501		-1093		-487		-3061		3227		987		-1715		323
Missouri		068		-304		754		028		114		421		292		827		477		-177		954		767		-046		1839		096		-512		966		125
Ohio		na		na		107		1216		1596		-1865		na		na		2274		2567		2167		-3194		na		na		2182		2254		2086		-3348
Wisconsin		-229		1388		861		2928		888		931		-948		986		1712		6728		322		314		-1457		91		983		9621		196		668
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		1514		2112		1966		2017		1853		2398		2634
Massachusetts		7036		8133		8006		7327		6486		6687		7956
New Hampshire		3806		3927		4179		3998		3282		4255		3882
Pennsylvania		na		na		1265		1641		1929		2428		2284
Rhode Island		na		na		1498		154		161		1698		1496
West Virginia		2258		2176		2392		3428		2857		2972		2266
Kentucky		2095		2325		3532		258		3624		3752		3001
New Mexico		1927		1976		1719		2168		2201		2091		1862
Missouri		1472		1515		1641		1719		1688		185		1991
Ohio		na		na		236		2897		3641		443		3015
Wisconsin		664		601		66		773		1294		1336		1377
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		502		9		959		931		721		952		1161
Massachusetts		4035		4258		4126		359		3004		3141		3815
New Hampshire		2514		2721		2671		2403		1919		2564		2128
Pennsylvania		na		na		1013		1277		1473		1876		1738
Rhode Island		na		na		803		812		898		949		639
West Virginia		1496		1381		1636		2384		2006		1966		1372
Kentucky		1772		1764		2741		1863		2796		2682		2247
New Mexico		902		858		595		787		865		717		74
Missouri		1002		997		118		1192		1131		124		1255
Ohio		na		na		1804		2198		2693		3254		2165
Wisconsin		286		244		267		293		575		586		625
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		5609		6697		5845		5976		6142		7078		6936
Massachusetts		na		na		na		na		na		na		na
New Hampshire		5678		5968		6872		5883		5394		6787		6135
Pennsylvania		na		na		8374		9102		9010		10100		9983
Rhode Island		na		na		3567		3829		3527		3880		3262
West Virginia		4628		3889		4229		5489		4642		4832		4034
Kentucky		6756		6687		7517		6234		7613		8444		7205
New Mexico		5291		6842		7036		7402		7345		7672		7123
Missouri		3213		3235		3137		3373		3383		3421		3565
Ohio		na		na		8696		8789		9859		11432		9300
Wisconsin		2724		2661		3031		3291		4255		4633		5064

all drug

all opioids

heroin

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

15 to 24

25 to 34

35 to 54

55 and up

all drug

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

opioid

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

heroin

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Male		-140		7355		827		901		1286		-927		742		-758		1157		1241		1306		-829		146		301		1082		1242		1306		-1249
Female		841		5151		103		733		1257		-1521		659		-922		533		1204		1494		-1014		-132		1299		229		1331		1617		-1214
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		4888		4820		8365		9057		9873		11142		10110
Female		3201		3470		5257		5312		5701		6418		5442
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		3611		3879		3585		40		4496		5083		4662
Female		159		1695		1538		162		1816		2087		1875
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		2295		2328		2399		2658		2988		3379		2957
Female		839		828		936		957		1085		126		1107

	Q1 2016		Q2 2016		Q3 2016		Q4 2016		Q1 2017		Q2 2017		Q3 2017		q1		q2		q3
All drug		3948		4061		6589		6894		7458		8430		7696		889150252325		1075831326045		167997701832
Heroin		1452		1472		1571		1681		1891		2173		191		302341597796		476222826087		215786123488
Opioid		2447		2636		2429		2636		2956		3382		3088		208009807928		283004552352		271305063812
	Q12016-Q12017		Q22016-Q22017		Q32016-Q32017
All drug		889150252325		1075831326045		167997701832
Heroin		302341597796		476222826087		215786123488
Opioid		208009807928		283004552352		271305063812

All drug

Heroin

Opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Summary

Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017

Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin

Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency department data dissemination efforts

ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Maine		1941		-1273		225		278		1523		-201		3951		-692		257		-813		2945		981		793		656		-299		-2255		3199		2197
Massachusetts		na		na		na		na		na		na		1561		-157		-848		-1148		311		1897		553		-31		-13		-1632		456		2146
New Hampshire		511		1514		-1438		-832		2583		-961		318		64		-433		-1791		2967		-876		825		-184		-1002		-2016		3363		-17
Pennsylvania		na		na		869		-102		1211		-116		na		na		2979		1751		2589		-594		na		na		2601		1534		2735		-735
Rhode Island		na		na		735		-790		1002		-1594		na		na		28		454		544		-1191		na		na		121		1057		566		-3262
West Virginia		-1596		875		2978		-1543		409		-1651		-367		995		4331		-1664		402		-2377		-769		1847		4571		-1584		-199		-3022
Kentucky		-102		1242		-1707		2211		1092		-1468		1095		5192		-2694		4045		352		-2002		-043		5541		-3206		5012		-408		-1624
New Mexico		2932		283		521		-078		445		-716		255		-1298		2611		151		-501		-1093		-487		-3061		3227		987		-1715		323
Missouri		068		-304		754		028		114		421		292		827		477		-177		954		767		-046		1839		096		-512		966		125
Ohio		na		na		107		1216		1596		-1865		na		na		2274		2567		2167		-3194		na		na		2182		2254		2086		-3348
Wisconsin		-229		1388		861		2928		888		931		-948		986		1712		6728		322		314		-1457		91		983		9621		196		668
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		1514		2112		1966		2017		1853		2398		2634
Massachusetts		7036		8133		8006		7327		6486		6687		7956
New Hampshire		3806		3927		4179		3998		3282		4255		3882
Pennsylvania		na		na		1265		1641		1929		2428		2284
Rhode Island		na		na		1498		154		161		1698		1496
West Virginia		2258		2176		2392		3428		2857		2972		2266
Kentucky		2095		2325		3532		258		3624		3752		3001
New Mexico		1927		1976		1719		2168		2201		2091		1862
Missouri		1472		1515		1641		1719		1688		185		1991
Ohio		na		na		236		2897		3641		443		3015
Wisconsin		664		601		66		773		1294		1336		1377
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		502		9		959		931		721		952		1161
Massachusetts		4035		4258		4126		359		3004		3141		3815
New Hampshire		2514		2721		2671		2403		1919		2564		2128
Pennsylvania		na		na		1013		1277		1473		1876		1738
Rhode Island		na		na		803		812		898		949		639
West Virginia		1496		1381		1636		2384		2006		1966		1372
Kentucky		1772		1764		2741		1863		2796		2682		2247
New Mexico		902		858		595		787		865		717		74
Missouri		1002		997		118		1192		1131		124		1255
Ohio		na		na		1804		2198		2693		3254		2165
Wisconsin		286		244		267		293		575		586		625
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		5609		6697		5845		5976		6142		7078		6936
Massachusetts		na		na		na		na		na		na		na
New Hampshire		5678		5968		6872		5883		5394		6787		6135
Pennsylvania		na		na		8374		9102		9010		10100		9983
Rhode Island		na		na		3567		3829		3527		3880		3262
West Virginia		4628		3889		4229		5489		4642		4832		4034
Kentucky		6756		6687		7517		6234		7613		8444		7205
New Mexico		5291		6842		7036		7402		7345		7672		7123
Missouri		3213		3235		3137		3373		3383		3421		3565
Ohio		na		na		8696		8789		9859		11432		9300
Wisconsin		2724		2661		3031		3291		4255		4633		5064

all drug

all opioids

heroin

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

15 to 24

25 to 34

35 to 54

55 and up

all drug

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

opioid

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

heroin

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Male		-140		7355		827		901		1286		-927		742		-758		1157		1241		1306		-829		146		301		1082		1242		1306		-1249
Female		841		5151		103		733		1257		-1521		659		-922		533		1204		1494		-1014		-132		1299		229		1331		1617		-1214
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		4888		4820		8365		9057		9873		11142		10110
Female		3201		3470		5257		5312		5701		6418		5442
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		3611		3879		3585		40		4496		5083		4662
Female		159		1695		1538		162		1816		2087		1875
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		2295		2328		2399		2658		2988		3379		2957
Female		839		828		936		957		1085		126		1107

Rx Summit wwwNationalRxDrugAbuseSummitorg

Summary

Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017

Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin

Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency department data dissemination efforts

ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Maine		1941		-1273		225		278		1523		-201		3951		-692		257		-813		2945		981		793		656		-299		-2255		3199		2197
Massachusetts		na		na		na		na		na		na		1561		-157		-848		-1148		311		1897		553		-31		-13		-1632		456		2146
New Hampshire		511		1514		-1438		-832		2583		-961		318		64		-433		-1791		2967		-876		825		-184		-1002		-2016		3363		-17
Pennsylvania		na		na		869		-102		1211		-116		na		na		2979		1751		2589		-594		na		na		2601		1534		2735		-735
Rhode Island		na		na		735		-790		1002		-1594		na		na		28		454		544		-1191		na		na		121		1057		566		-3262
West Virginia		-1596		875		2978		-1543		409		-1651		-367		995		4331		-1664		402		-2377		-769		1847		4571		-1584		-199		-3022
Kentucky		-102		1242		-1707		2211		1092		-1468		1095		5192		-2694		4045		352		-2002		-043		5541		-3206		5012		-408		-1624
New Mexico		2932		283		521		-078		445		-716		255		-1298		2611		151		-501		-1093		-487		-3061		3227		987		-1715		323
Missouri		068		-304		754		028		114		421		292		827		477		-177		954		767		-046		1839		096		-512		966		125
Ohio		na		na		107		1216		1596		-1865		na		na		2274		2567		2167		-3194		na		na		2182		2254		2086		-3348
Wisconsin		-229		1388		861		2928		888		931		-948		986		1712		6728		322		314		-1457		91		983		9621		196		668
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		1514		2112		1966		2017		1853		2398		2634
Massachusetts		7036		8133		8006		7327		6486		6687		7956
New Hampshire		3806		3927		4179		3998		3282		4255		3882
Pennsylvania		na		na		1265		1641		1929		2428		2284
Rhode Island		na		na		1498		154		161		1698		1496
West Virginia		2258		2176		2392		3428		2857		2972		2266
Kentucky		2095		2325		3532		258		3624		3752		3001
New Mexico		1927		1976		1719		2168		2201		2091		1862
Missouri		1472		1515		1641		1719		1688		185		1991
Ohio		na		na		236		2897		3641		443		3015
Wisconsin		664		601		66		773		1294		1336		1377
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		502		9		959		931		721		952		1161
Massachusetts		4035		4258		4126		359		3004		3141		3815
New Hampshire		2514		2721		2671		2403		1919		2564		2128
Pennsylvania		na		na		1013		1277		1473		1876		1738
Rhode Island		na		na		803		812		898		949		639
West Virginia		1496		1381		1636		2384		2006		1966		1372
Kentucky		1772		1764		2741		1863		2796		2682		2247
New Mexico		902		858		595		787		865		717		74
Missouri		1002		997		118		1192		1131		124		1255
Ohio		na		na		1804		2198		2693		3254		2165
Wisconsin		286		244		267		293		575		586		625
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		5609		6697		5845		5976		6142		7078		6936
Massachusetts		na		na		na		na		na		na		na
New Hampshire		5678		5968		6872		5883		5394		6787		6135
Pennsylvania		na		na		8374		9102		9010		10100		9983
Rhode Island		na		na		3567		3829		3527		3880		3262
West Virginia		4628		3889		4229		5489		4642		4832		4034
Kentucky		6756		6687		7517		6234		7613		8444		7205
New Mexico		5291		6842		7036		7402		7345		7672		7123
Missouri		3213		3235		3137		3373		3383		3421		3565
Ohio		na		na		8696		8789		9859		11432		9300
Wisconsin		2724		2661		3031		3291		4255		4633		5064

all drug

all opioids

heroin

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

15 to 24

25 to 34

35 to 54

55 and up

all drug

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

opioid

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

heroin

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Male		-140		7355		827		901		1286		-927		742		-758		1157		1241		1306		-829		146		301		1082		1242		1306		-1249
Female		841		5151		103		733		1257		-1521		659		-922		533		1204		1494		-1014		-132		1299		229		1331		1617		-1214
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		4888		4820		8365		9057		9873		11142		10110
Female		3201		3470		5257		5312		5701		6418		5442
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		3611		3879		3585		40		4496		5083		4662
Female		159		1695		1538		162		1816		2087		1875
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Male		2295		2328		2399		2658		2988		3379		2957
Female		839		828		936		957		1085		126		1107

Rx Summit wwwNationalRxDrugAbuseSummitorg

Summary

Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017

Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin

Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency department data dissemination efforts

ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Maine		1941		-1273		225		278		1523		-201		3951		-692		257		-813		2945		981		793		656		-299		-2255		3199		2197
Massachusetts		na		na		na		na		na		na		1561		-157		-848		-1148		311		1897		553		-31		-13		-1632		456		2146
New Hampshire		511		1514		-1438		-832		2583		-961		318		64		-433		-1791		2967		-876		825		-184		-1002		-2016		3363		-17
Pennsylvania		na		na		869		-102		1211		-116		na		na		2979		1751		2589		-594		na		na		2601		1534		2735		-735
Rhode Island		na		na		735		-790		1002		-1594		na		na		28		454		544		-1191		na		na		121		1057		566		-3262
West Virginia		-1596		875		2978		-1543		409		-1651		-367		995		4331		-1664		402		-2377		-769		1847		4571		-1584		-199		-3022
Kentucky		-102		1242		-1707		2211		1092		-1468		1095		5192		-2694		4045		352		-2002		-043		5541		-3206		5012		-408		-1624
New Mexico		2932		283		521		-078		445		-716		255		-1298		2611		151		-501		-1093		-487		-3061		3227		987		-1715		323
Missouri		068		-304		754		028		114		421		292		827		477		-177		954		767		-046		1839		096		-512		966		125
Ohio		na		na		107		1216		1596		-1865		na		na		2274		2567		2167		-3194		na		na		2182		2254		2086		-3348
Wisconsin		-229		1388		861		2928		888		931		-948		986		1712		6728		322		314		-1457		91		983		9621		196		668
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		1514		2112		1966		2017		1853		2398		2634
Massachusetts		7036		8133		8006		7327		6486		6687		7956
New Hampshire		3806		3927		4179		3998		3282		4255		3882
Pennsylvania		na		na		1265		1641		1929		2428		2284
Rhode Island		na		na		1498		154		161		1698		1496
West Virginia		2258		2176		2392		3428		2857		2972		2266
Kentucky		2095		2325		3532		258		3624		3752		3001
New Mexico		1927		1976		1719		2168		2201		2091		1862
Missouri		1472		1515		1641		1719		1688		185		1991
Ohio		na		na		236		2897		3641		443		3015
Wisconsin		664		601		66		773		1294		1336		1377
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		502		9		959		931		721		952		1161
Massachusetts		4035		4258		4126		359		3004		3141		3815
New Hampshire		2514		2721		2671		2403		1919		2564		2128
Pennsylvania		na		na		1013		1277		1473		1876		1738
Rhode Island		na		na		803		812		898		949		639
West Virginia		1496		1381		1636		2384		2006		1966		1372
Kentucky		1772		1764		2741		1863		2796		2682		2247
New Mexico		902		858		595		787		865		717		74
Missouri		1002		997		118		1192		1131		124		1255
Ohio		na		na		1804		2198		2693		3254		2165
Wisconsin		286		244		267		293		575		586		625
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		5609		6697		5845		5976		6142		7078		6936
Massachusetts		na		na		na		na		na		na		na
New Hampshire		5678		5968		6872		5883		5394		6787		6135
Pennsylvania		na		na		8374		9102		9010		10100		9983
Rhode Island		na		na		3567		3829		3527		3880		3262
West Virginia		4628		3889		4229		5489		4642		4832		4034
Kentucky		6756		6687		7517		6234		7613		8444		7205
New Mexico		5291		6842		7036		7402		7345		7672		7123
Missouri		3213		3235		3137		3373		3383		3421		3565
Ohio		na		na		8696		8789		9859		11432		9300
Wisconsin		2724		2661		3031		3291		4255		4633		5064

all drug

all opioids

heroin

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

Δ fromQ1 2016-Q2 2016

Δ fromQ2 2016-Q3 2016

Δ fromQ3 2016-Q4 2016

Δ fromQ4 2016-Q1 2017

Δ fromQ1 2017-Q2 2017

Δ fromQ2 2017-Q3 2017

15 to 24

25 to 34

35 to 54

55 and up

all drug

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

opioid

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

heroin

Q1 2016 rate

Q2 2016 rate

Q3 2016 rate

Q4 2016 rate

Q1 2017 rate

Q2 2017 rate

Q3 2017 rate

15 to 24

25 to 34

35 to 54

55 and up

Rx Summit wwwNationalRxDrugAbuseSummitorg

Summary

Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017

Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin

Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency department data dissemination efforts

ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml

	all drug							all opioids							heroin
	Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017		Δ fromQ1 2016-Q2 2016		Δ fromQ2 2016-Q3 2016		Δ fromQ3 2016-Q4 2016		Δ fromQ4 2016-Q1 2017		Δ fromQ1 2017-Q2 2017		Δ fromQ2 2017-Q3 2017
Maine		1941		-1273		225		278		1523		-201		3951		-692		257		-813		2945		981		793		656		-299		-2255		3199		2197
Massachusetts		na		na		na		na		na		na		1561		-157		-848		-1148		311		1897		553		-31		-13		-1632		456		2146
New Hampshire		511		1514		-1438		-832		2583		-961		318		64		-433		-1791		2967		-876		825		-184		-1002		-2016		3363		-17
Pennsylvania		na		na		869		-102		1211		-116		na		na		2979		1751		2589		-594		na		na		2601		1534		2735		-735
Rhode Island		na		na		735		-790		1002		-1594		na		na		28		454		544		-1191		na		na		121		1057		566		-3262
West Virginia		-1596		875		2978		-1543		409		-1651		-367		995		4331		-1664		402		-2377		-769		1847		4571		-1584		-199		-3022
Kentucky		-102		1242		-1707		2211		1092		-1468		1095		5192		-2694		4045		352		-2002		-043		5541		-3206		5012		-408		-1624
New Mexico		2932		283		521		-078		445		-716		255		-1298		2611		151		-501		-1093		-487		-3061		3227		987		-1715		323
Missouri		068		-304		754		028		114		421		292		827		477		-177		954		767		-046		1839		096		-512		966		125
Ohio		na		na		107		1216		1596		-1865		na		na		2274		2567		2167		-3194		na		na		2182		2254		2086		-3348
Wisconsin		-229		1388		861		2928		888		931		-948		986		1712		6728		322		314		-1457		91		983		9621		196		668
	opioid
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		1514		2112		1966		2017		1853		2398		2634
Massachusetts		7036		8133		8006		7327		6486		6687		7956
New Hampshire		3806		3927		4179		3998		3282		4255		3882
Pennsylvania		na		na		1265		1641		1929		2428		2284
Rhode Island		na		na		1498		154		161		1698		1496
West Virginia		2258		2176		2392		3428		2857		2972		2266
Kentucky		2095		2325		3532		258		3624		3752		3001
New Mexico		1927		1976		1719		2168		2201		2091		1862
Missouri		1472		1515		1641		1719		1688		185		1991
Ohio		na		na		236		2897		3641		443		3015
Wisconsin		664		601		66		773		1294		1336		1377
	heroin
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		502		9		959		931		721		952		1161
Massachusetts		4035		4258		4126		359		3004		3141		3815
New Hampshire		2514		2721		2671		2403		1919		2564		2128
Pennsylvania		na		na		1013		1277		1473		1876		1738
Rhode Island		na		na		803		812		898		949		639
West Virginia		1496		1381		1636		2384		2006		1966		1372
Kentucky		1772		1764		2741		1863		2796		2682		2247
New Mexico		902		858		595		787		865		717		74
Missouri		1002		997		118		1192		1131		124		1255
Ohio		na		na		1804		2198		2693		3254		2165
Wisconsin		286		244		267		293		575		586		625
	all drug
	Q1 2016 rate		Q2 2016 rate		Q3 2016 rate		Q4 2016 rate		Q1 2017 rate		Q2 2017 rate		Q3 2017 rate
Maine		5609		6697		5845		5976		6142		7078		6936
Massachusetts		na		na		na		na		na		na		na
New Hampshire		5678		5968		6872		5883		5394		6787		6135
Pennsylvania		na		na		8374		9102		9010		10100		9983
Rhode Island		na		na		3567		3829		3527		3880		3262
West Virginia		4628		3889		4229		5489		4642		4832		4034
Kentucky		6756		6687		7517		6234		7613		8444		7205
New Mexico		5291		6842		7036		7402		7345		7672		7123
Missouri		3213		3235		3137		3373		3383		3421		3565
Ohio		na		na		8696		8789		9859		11432		9300
Wisconsin		2724		2661		3031		3291		4255		4633		5064

Rx Summit wwwNationalRxDrugAbuseSummitorg

Summary

Stable increases for all drug and heroin from Q1 2016 to Q3 2017- Opioid had stable increases from Q3 2016 to Q2 2017

Moderate decreases from Q2 to Q3 2017- 9 for all drug 9 for opioid and 12 for heroin

Annual percentage changes were above 15 increases- Q1 to Q1 89 all drug 30 heroin amp 21 opioid- Q2 to Q2 108 all drug 48 heroin amp 28 opioid- Q3 to Q3 17 all drug 22 heroin amp 27 opioid

Rx Summit wwwNationalRxDrugAbuseSummitorg

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency department data dissemination efforts

ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml

Rx Summit wwwNationalRxDrugAbuseSummitorg

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency department data dissemination efforts

ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml

Rx Summit wwwNationalRxDrugAbuseSummitorg

Emergency department data dissemination efforts

ldquoOpioid Overdoses Treated in Emergency Departmentsrdquo -httpswwwcdcgovvitalsignsopioid-overdosesindexhtml

Rx Summit wwwNationalRxDrugAbuseSummitorg

Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose

Reporting System

Presenter Julie OrsquoDonnell PhD MPHEpidemiologist

Centers for Disease Control and Prevention

Co-authors Christine Mattson Puja Seth Alana Vivolo-Kantor R Matthew Gladden

Rx Summit wwwNationalRxDrugAbuseSummitorg

Disclosure Statement

Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services

Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control

Rx Summit wwwNationalRxDrugAbuseSummitorg

Rx Summit wwwNationalRxDrugAbuseSummitorg

Increase in deaths outpaces increase in use

Rx Summit wwwNationalRxDrugAbuseSummitorg

Fatal opioid

overdose

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Fatal opioid overdose surveillance

Track specific substances contributing to overdose deaths

Detect newly-emerging substances involved in overdose

Determine risk factors circumstances associated with fatal overdose

Assess common drug combinations Provide more timely data on overdose deaths

Rx Summit wwwNationalRxDrugAbuseSummitorg

State Unintentional Drug Overdose Reporting System (SUDORS)

Death certificates

Medical examiner

coroner reportsToxicology

reports

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS data submitted bi-annually

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

1 Data entry started

2 Data entry finished

1 Data entry started

2 Data entry finished

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS leverages National Violent Death Reporting System (NVDRS) platform

- Basic descriptors- Compare across demographics

- Recent release from institution- Overdose location - Survival time

- Mental health diagnoses- Substance abuse treatment history

- Substances present- Substances contributing to death

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Toxicology information

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS data as good as sources allow

Death Certificates

- Drug specificity- Time lag in

cause of death codes

Medical Examiner Coroner Reports

- Scene evidence availability

- Death scene investigation

Toxicology Reports

- Testing availability

- Emerging substances

Rx Summit wwwNationalRxDrugAbuseSummitorg

Despite limitations SUDORS data have many strengths

Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months

Flexibility to include substances contributing to death outside of death certificate textcode fields

Overdose-specific circumstance data collected within 8 months

Rx Summit wwwNationalRxDrugAbuseSummitorg

Preliminary results

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Total deaths (20162017)10699

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths by state and reporting period

Preliminary results

Chart1

2nd-half 2016

1st-half 2017

State

Number of deaths

524

646

156

144

1108

883

193

205

166

155

2063

2389

210

214

145

120

394

442

418

394

Sheet1

Sheet1

IMF

Rx fent

Sheet2

Sheet2

2016

2017

Sheet3

Sheet3

2nd-half 2016

1st-half 2017

State

Number of deaths

Regional

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

	2016 and 2017 data combined (KY currently doesnt have any 2017 data in there)
	of all opioid deaths with these categories as cause of death (not mutually exclusive)															of each drug category with circumstances
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI				Prescription		Heroin		Fentanyl
	Prescription		097		3133		2163		2166		1519		4860		1954		6525		2447		3861		4014		3375			Recent release		789		1151		993
	Heroin		4854		3700		3737		4224		886		5701		3581		2435		5032		2317		3860		6117			Prior OD		1023		1234		1331
	Fentanyl			7467		7716		6264		8759		1215		7708		1820		7415		7027		6615		3598			Current treatment		980		836		755
															Recent opioid use relapse		755		1620		1296
															History of heroin abuse		1946		4259		3926
															History of Rx opioid abuse		1434		361		393
															History of Rx opioid AND heroin abuse		541		656		603

opioid deaths overall
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
	2nd-half 2016		524		156		1108		427		193		166		2063		210		1388		145		394		418			7192
	1st-half 2017		646		144		883		127		205		155		2389		214		1452		120		442		394			7171
															14363
																		14522

			KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
		2016		000		2821		163		070		1244		663		2648		095		490		205		2030		407
		2017			2986		136		000		1485		024		4641		235		1894		885		2902		1804

	KY-2016		KY-2017		ME-2016		ME-2017		MA-2016		MA-2017		MO-2016		MO-2017		NH-2016		NH-2017		NM-2016		NM-2017		OH-2016		OH-2017		OK-2016		OK-2017		PA-2016		PA-2017		RI-2016		RI-2017		WV-2016		WV-2017		WI-2016		WI-2017
IMF		171			82		60		708		596		236		84		132		146		13		11		996		1291		8		11		695		1002		79		48		164		205		106		96
Rx fent		5			1		1		3		1		5		2		1		0		6		0		5		2		11		11		5		2		3		1		2		0		7		3

KY		KY
ME		ME
MA		MA
NH		NH
NM		NM
OH		OH
OK		OK
RI		RI
WV		WV
WI		WI

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

Rx Summit wwwNationalRxDrugAbuseSummitorg

Disclosure Statement

Julie OrsquoDonnell PhD has disclosed no relevant real or apparent personal or professional financial relationships with proprietary entities that produce health care goods and services

Disclaimer The findings and conclusions are those of the presenter and do not necessarily represent the official position of the Centers for Disease Control

Rx Summit wwwNationalRxDrugAbuseSummitorg

Rx Summit wwwNationalRxDrugAbuseSummitorg

Increase in deaths outpaces increase in use

Rx Summit wwwNationalRxDrugAbuseSummitorg

Fatal opioid

overdose

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Fatal opioid overdose surveillance

Track specific substances contributing to overdose deaths

Detect newly-emerging substances involved in overdose

Determine risk factors circumstances associated with fatal overdose

Assess common drug combinations Provide more timely data on overdose deaths

Rx Summit wwwNationalRxDrugAbuseSummitorg

State Unintentional Drug Overdose Reporting System (SUDORS)

Death certificates

Medical examiner

coroner reportsToxicology

reports

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS data submitted bi-annually

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

1 Data entry started

2 Data entry finished

1 Data entry started

2 Data entry finished

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS leverages National Violent Death Reporting System (NVDRS) platform

- Basic descriptors- Compare across demographics

- Recent release from institution- Overdose location - Survival time

- Mental health diagnoses- Substance abuse treatment history

- Substances present- Substances contributing to death

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Toxicology information

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS data as good as sources allow

Death Certificates

- Drug specificity- Time lag in

cause of death codes

Medical Examiner Coroner Reports

- Scene evidence availability

- Death scene investigation

Toxicology Reports

- Testing availability

- Emerging substances

Rx Summit wwwNationalRxDrugAbuseSummitorg

Despite limitations SUDORS data have many strengths

Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months

Flexibility to include substances contributing to death outside of death certificate textcode fields

Overdose-specific circumstance data collected within 8 months

Rx Summit wwwNationalRxDrugAbuseSummitorg

Preliminary results

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Total deaths (20162017)10699

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths by state and reporting period

Preliminary results

Chart1

2nd-half 2016

1st-half 2017

State

Number of deaths

524

646

156

144

1108

883

193

205

166

155

2063

2389

210

214

145

120

394

442

418

394

Sheet1

Sheet1

IMF

Rx fent

Sheet2

Sheet2

2016

2017

Sheet3

Sheet3

2nd-half 2016

1st-half 2017

State

Number of deaths

Regional

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

	2016 and 2017 data combined (KY currently doesnt have any 2017 data in there)
	of all opioid deaths with these categories as cause of death (not mutually exclusive)															of each drug category with circumstances
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI				Prescription		Heroin		Fentanyl
	Prescription		097		3133		2163		2166		1519		4860		1954		6525		2447		3861		4014		3375			Recent release		789		1151		993
	Heroin		4854		3700		3737		4224		886		5701		3581		2435		5032		2317		3860		6117			Prior OD		1023		1234		1331
	Fentanyl			7467		7716		6264		8759		1215		7708		1820		7415		7027		6615		3598			Current treatment		980		836		755
															Recent opioid use relapse		755		1620		1296
															History of heroin abuse		1946		4259		3926
															History of Rx opioid abuse		1434		361		393
															History of Rx opioid AND heroin abuse		541		656		603

opioid deaths overall
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
	2nd-half 2016		524		156		1108		427		193		166		2063		210		1388		145		394		418			7192
	1st-half 2017		646		144		883		127		205		155		2389		214		1452		120		442		394			7171
															14363
																		14522

			KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
		2016		000		2821		163		070		1244		663		2648		095		490		205		2030		407
		2017			2986		136		000		1485		024		4641		235		1894		885		2902		1804

	KY-2016		KY-2017		ME-2016		ME-2017		MA-2016		MA-2017		MO-2016		MO-2017		NH-2016		NH-2017		NM-2016		NM-2017		OH-2016		OH-2017		OK-2016		OK-2017		PA-2016		PA-2017		RI-2016		RI-2017		WV-2016		WV-2017		WI-2016		WI-2017
IMF		171			82		60		708		596		236		84		132		146		13		11		996		1291		8		11		695		1002		79		48		164		205		106		96
Rx fent		5			1		1		3		1		5		2		1		0		6		0		5		2		11		11		5		2		3		1		2		0		7		3

KY		KY
ME		ME
MA		MA
NH		NH
NM		NM
OH		OH
OK		OK
RI		RI
WV		WV
WI		WI

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

Rx Summit wwwNationalRxDrugAbuseSummitorg

Rx Summit wwwNationalRxDrugAbuseSummitorg

Increase in deaths outpaces increase in use

Rx Summit wwwNationalRxDrugAbuseSummitorg

Fatal opioid

overdose

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Fatal opioid overdose surveillance

Track specific substances contributing to overdose deaths

Detect newly-emerging substances involved in overdose

Determine risk factors circumstances associated with fatal overdose

Assess common drug combinations Provide more timely data on overdose deaths

Rx Summit wwwNationalRxDrugAbuseSummitorg

State Unintentional Drug Overdose Reporting System (SUDORS)

Death certificates

Medical examiner

coroner reportsToxicology

reports

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS data submitted bi-annually

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

1 Data entry started

2 Data entry finished

1 Data entry started

2 Data entry finished

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS leverages National Violent Death Reporting System (NVDRS) platform

- Basic descriptors- Compare across demographics

- Recent release from institution- Overdose location - Survival time

- Mental health diagnoses- Substance abuse treatment history

- Substances present- Substances contributing to death

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Toxicology information

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS data as good as sources allow

Death Certificates

- Drug specificity- Time lag in

cause of death codes

Medical Examiner Coroner Reports

- Scene evidence availability

- Death scene investigation

Toxicology Reports

- Testing availability

- Emerging substances

Rx Summit wwwNationalRxDrugAbuseSummitorg

Despite limitations SUDORS data have many strengths

Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months

Flexibility to include substances contributing to death outside of death certificate textcode fields

Overdose-specific circumstance data collected within 8 months

Rx Summit wwwNationalRxDrugAbuseSummitorg

Preliminary results

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Total deaths (20162017)10699

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths by state and reporting period

Preliminary results

Chart1

2nd-half 2016

1st-half 2017

State

Number of deaths

524

646

156

144

1108

883

193

205

166

155

2063

2389

210

214

145

120

394

442

418

394

Sheet1

Sheet1

IMF

Rx fent

Sheet2

Sheet2

2016

2017

Sheet3

Sheet3

2nd-half 2016

1st-half 2017

State

Number of deaths

Regional

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

	2016 and 2017 data combined (KY currently doesnt have any 2017 data in there)
	of all opioid deaths with these categories as cause of death (not mutually exclusive)															of each drug category with circumstances
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI				Prescription		Heroin		Fentanyl
	Prescription		097		3133		2163		2166		1519		4860		1954		6525		2447		3861		4014		3375			Recent release		789		1151		993
	Heroin		4854		3700		3737		4224		886		5701		3581		2435		5032		2317		3860		6117			Prior OD		1023		1234		1331
	Fentanyl			7467		7716		6264		8759		1215		7708		1820		7415		7027		6615		3598			Current treatment		980		836		755
															Recent opioid use relapse		755		1620		1296
															History of heroin abuse		1946		4259		3926
															History of Rx opioid abuse		1434		361		393
															History of Rx opioid AND heroin abuse		541		656		603

opioid deaths overall
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
	2nd-half 2016		524		156		1108		427		193		166		2063		210		1388		145		394		418			7192
	1st-half 2017		646		144		883		127		205		155		2389		214		1452		120		442		394			7171
															14363
																		14522

			KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
		2016		000		2821		163		070		1244		663		2648		095		490		205		2030		407
		2017			2986		136		000		1485		024		4641		235		1894		885		2902		1804

	KY-2016		KY-2017		ME-2016		ME-2017		MA-2016		MA-2017		MO-2016		MO-2017		NH-2016		NH-2017		NM-2016		NM-2017		OH-2016		OH-2017		OK-2016		OK-2017		PA-2016		PA-2017		RI-2016		RI-2017		WV-2016		WV-2017		WI-2016		WI-2017
IMF		171			82		60		708		596		236		84		132		146		13		11		996		1291		8		11		695		1002		79		48		164		205		106		96
Rx fent		5			1		1		3		1		5		2		1		0		6		0		5		2		11		11		5		2		3		1		2		0		7		3

KY		KY
ME		ME
MA		MA
NH		NH
NM		NM
OH		OH
OK		OK
RI		RI
WV		WV
WI		WI

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

Rx Summit wwwNationalRxDrugAbuseSummitorg

Increase in deaths outpaces increase in use

Rx Summit wwwNationalRxDrugAbuseSummitorg

Fatal opioid

overdose

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Fatal opioid overdose surveillance

Track specific substances contributing to overdose deaths

Detect newly-emerging substances involved in overdose

Determine risk factors circumstances associated with fatal overdose

Assess common drug combinations Provide more timely data on overdose deaths

Rx Summit wwwNationalRxDrugAbuseSummitorg

State Unintentional Drug Overdose Reporting System (SUDORS)

Death certificates

Medical examiner

coroner reportsToxicology

reports

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS data submitted bi-annually

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

1 Data entry started

2 Data entry finished

1 Data entry started

2 Data entry finished

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS leverages National Violent Death Reporting System (NVDRS) platform

- Basic descriptors- Compare across demographics

- Recent release from institution- Overdose location - Survival time

- Mental health diagnoses- Substance abuse treatment history

- Substances present- Substances contributing to death

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Toxicology information

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS data as good as sources allow

Death Certificates

- Drug specificity- Time lag in

cause of death codes

Medical Examiner Coroner Reports

- Scene evidence availability

- Death scene investigation

Toxicology Reports

- Testing availability

- Emerging substances

Rx Summit wwwNationalRxDrugAbuseSummitorg

Despite limitations SUDORS data have many strengths

Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months

Flexibility to include substances contributing to death outside of death certificate textcode fields

Overdose-specific circumstance data collected within 8 months

Rx Summit wwwNationalRxDrugAbuseSummitorg

Preliminary results

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Total deaths (20162017)10699

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths by state and reporting period

Preliminary results

Chart1

2nd-half 2016

1st-half 2017

State

Number of deaths

524

646

156

144

1108

883

193

205

166

155

2063

2389

210

214

145

120

394

442

418

394

Sheet1

Sheet1

IMF

Rx fent

Sheet2

Sheet2

2016

2017

Sheet3

Sheet3

2nd-half 2016

1st-half 2017

State

Number of deaths

Regional

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

	2016 and 2017 data combined (KY currently doesnt have any 2017 data in there)
	of all opioid deaths with these categories as cause of death (not mutually exclusive)															of each drug category with circumstances
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI				Prescription		Heroin		Fentanyl
	Prescription		097		3133		2163		2166		1519		4860		1954		6525		2447		3861		4014		3375			Recent release		789		1151		993
	Heroin		4854		3700		3737		4224		886		5701		3581		2435		5032		2317		3860		6117			Prior OD		1023		1234		1331
	Fentanyl			7467		7716		6264		8759		1215		7708		1820		7415		7027		6615		3598			Current treatment		980		836		755
															Recent opioid use relapse		755		1620		1296
															History of heroin abuse		1946		4259		3926
															History of Rx opioid abuse		1434		361		393
															History of Rx opioid AND heroin abuse		541		656		603

opioid deaths overall
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
	2nd-half 2016		524		156		1108		427		193		166		2063		210		1388		145		394		418			7192
	1st-half 2017		646		144		883		127		205		155		2389		214		1452		120		442		394			7171
															14363
																		14522

			KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
		2016		000		2821		163		070		1244		663		2648		095		490		205		2030		407
		2017			2986		136		000		1485		024		4641		235		1894		885		2902		1804

	KY-2016		KY-2017		ME-2016		ME-2017		MA-2016		MA-2017		MO-2016		MO-2017		NH-2016		NH-2017		NM-2016		NM-2017		OH-2016		OH-2017		OK-2016		OK-2017		PA-2016		PA-2017		RI-2016		RI-2017		WV-2016		WV-2017		WI-2016		WI-2017
IMF		171			82		60		708		596		236		84		132		146		13		11		996		1291		8		11		695		1002		79		48		164		205		106		96
Rx fent		5			1		1		3		1		5		2		1		0		6		0		5		2		11		11		5		2		3		1		2		0		7		3

KY		KY
ME		ME
MA		MA
NH		NH
NM		NM
OH		OH
OK		OK
RI		RI
WV		WV
WI		WI

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

Rx Summit wwwNationalRxDrugAbuseSummitorg

Fatal opioid

overdose

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Fatal opioid overdose surveillance

Track specific substances contributing to overdose deaths

Detect newly-emerging substances involved in overdose

Determine risk factors circumstances associated with fatal overdose

Assess common drug combinations Provide more timely data on overdose deaths

Rx Summit wwwNationalRxDrugAbuseSummitorg

State Unintentional Drug Overdose Reporting System (SUDORS)

Death certificates

Medical examiner

coroner reportsToxicology

reports

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS data submitted bi-annually

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

1 Data entry started

2 Data entry finished

1 Data entry started

2 Data entry finished

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS leverages National Violent Death Reporting System (NVDRS) platform

- Basic descriptors- Compare across demographics

- Recent release from institution- Overdose location - Survival time

- Mental health diagnoses- Substance abuse treatment history

- Substances present- Substances contributing to death

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Toxicology information

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS data as good as sources allow

Death Certificates

- Drug specificity- Time lag in

cause of death codes

Medical Examiner Coroner Reports

- Scene evidence availability

- Death scene investigation

Toxicology Reports

- Testing availability

- Emerging substances

Rx Summit wwwNationalRxDrugAbuseSummitorg

Despite limitations SUDORS data have many strengths

Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months

Flexibility to include substances contributing to death outside of death certificate textcode fields

Overdose-specific circumstance data collected within 8 months

Rx Summit wwwNationalRxDrugAbuseSummitorg

Preliminary results

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Total deaths (20162017)10699

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths by state and reporting period

Preliminary results

Chart1

2nd-half 2016

1st-half 2017

State

Number of deaths

524

646

156

144

1108

883

193

205

166

155

2063

2389

210

214

145

120

394

442

418

394

Sheet1

Sheet1

IMF

Rx fent

Sheet2

Sheet2

2016

2017

Sheet3

Sheet3

2nd-half 2016

1st-half 2017

State

Number of deaths

Regional

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

	2016 and 2017 data combined (KY currently doesnt have any 2017 data in there)
	of all opioid deaths with these categories as cause of death (not mutually exclusive)															of each drug category with circumstances
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI				Prescription		Heroin		Fentanyl
	Prescription		097		3133		2163		2166		1519		4860		1954		6525		2447		3861		4014		3375			Recent release		789		1151		993
	Heroin		4854		3700		3737		4224		886		5701		3581		2435		5032		2317		3860		6117			Prior OD		1023		1234		1331
	Fentanyl			7467		7716		6264		8759		1215		7708		1820		7415		7027		6615		3598			Current treatment		980		836		755
															Recent opioid use relapse		755		1620		1296
															History of heroin abuse		1946		4259		3926
															History of Rx opioid abuse		1434		361		393
															History of Rx opioid AND heroin abuse		541		656		603

opioid deaths overall
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
	2nd-half 2016		524		156		1108		427		193		166		2063		210		1388		145		394		418			7192
	1st-half 2017		646		144		883		127		205		155		2389		214		1452		120		442		394			7171
															14363
																		14522

			KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
		2016		000		2821		163		070		1244		663		2648		095		490		205		2030		407
		2017			2986		136		000		1485		024		4641		235		1894		885		2902		1804

	KY-2016		KY-2017		ME-2016		ME-2017		MA-2016		MA-2017		MO-2016		MO-2017		NH-2016		NH-2017		NM-2016		NM-2017		OH-2016		OH-2017		OK-2016		OK-2017		PA-2016		PA-2017		RI-2016		RI-2017		WV-2016		WV-2017		WI-2016		WI-2017
IMF		171			82		60		708		596		236		84		132		146		13		11		996		1291		8		11		695		1002		79		48		164		205		106		96
Rx fent		5			1		1		3		1		5		2		1		0		6		0		5		2		11		11		5		2		3		1		2		0		7		3

KY		KY
ME		ME
MA		MA
NH		NH
NM		NM
OH		OH
OK		OK
RI		RI
WV		WV
WI		WI

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

Rx Summit wwwNationalRxDrugAbuseSummitorg

Fatal opioid overdose surveillance

Track specific substances contributing to overdose deaths

Detect newly-emerging substances involved in overdose

Determine risk factors circumstances associated with fatal overdose

Assess common drug combinations Provide more timely data on overdose deaths

Rx Summit wwwNationalRxDrugAbuseSummitorg

State Unintentional Drug Overdose Reporting System (SUDORS)

Death certificates

Medical examiner

coroner reportsToxicology

reports

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS data submitted bi-annually

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

1 Data entry started

2 Data entry finished

1 Data entry started

2 Data entry finished

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS leverages National Violent Death Reporting System (NVDRS) platform

- Basic descriptors- Compare across demographics

- Recent release from institution- Overdose location - Survival time

- Mental health diagnoses- Substance abuse treatment history

- Substances present- Substances contributing to death

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Toxicology information

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS data as good as sources allow

Death Certificates

- Drug specificity- Time lag in

cause of death codes

Medical Examiner Coroner Reports

- Scene evidence availability

- Death scene investigation

Toxicology Reports

- Testing availability

- Emerging substances

Rx Summit wwwNationalRxDrugAbuseSummitorg

Despite limitations SUDORS data have many strengths

Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months

Flexibility to include substances contributing to death outside of death certificate textcode fields

Overdose-specific circumstance data collected within 8 months

Rx Summit wwwNationalRxDrugAbuseSummitorg

Preliminary results

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Total deaths (20162017)10699

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths by state and reporting period

Preliminary results

Chart1

2nd-half 2016

1st-half 2017

State

Number of deaths

524

646

156

144

1108

883

193

205

166

155

2063

2389

210

214

145

120

394

442

418

394

Sheet1

Sheet1

IMF

Rx fent

Sheet2

Sheet2

2016

2017

Sheet3

Sheet3

2nd-half 2016

1st-half 2017

State

Number of deaths

Regional

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

	2016 and 2017 data combined (KY currently doesnt have any 2017 data in there)
	of all opioid deaths with these categories as cause of death (not mutually exclusive)															of each drug category with circumstances
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI				Prescription		Heroin		Fentanyl
	Prescription		097		3133		2163		2166		1519		4860		1954		6525		2447		3861		4014		3375			Recent release		789		1151		993
	Heroin		4854		3700		3737		4224		886		5701		3581		2435		5032		2317		3860		6117			Prior OD		1023		1234		1331
	Fentanyl			7467		7716		6264		8759		1215		7708		1820		7415		7027		6615		3598			Current treatment		980		836		755
															Recent opioid use relapse		755		1620		1296
															History of heroin abuse		1946		4259		3926
															History of Rx opioid abuse		1434		361		393
															History of Rx opioid AND heroin abuse		541		656		603

opioid deaths overall
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
	2nd-half 2016		524		156		1108		427		193		166		2063		210		1388		145		394		418			7192
	1st-half 2017		646		144		883		127		205		155		2389		214		1452		120		442		394			7171
															14363
																		14522

			KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
		2016		000		2821		163		070		1244		663		2648		095		490		205		2030		407
		2017			2986		136		000		1485		024		4641		235		1894		885		2902		1804

	KY-2016		KY-2017		ME-2016		ME-2017		MA-2016		MA-2017		MO-2016		MO-2017		NH-2016		NH-2017		NM-2016		NM-2017		OH-2016		OH-2017		OK-2016		OK-2017		PA-2016		PA-2017		RI-2016		RI-2017		WV-2016		WV-2017		WI-2016		WI-2017
IMF		171			82		60		708		596		236		84		132		146		13		11		996		1291		8		11		695		1002		79		48		164		205		106		96
Rx fent		5			1		1		3		1		5		2		1		0		6		0		5		2		11		11		5		2		3		1		2		0		7		3

KY		KY
ME		ME
MA		MA
NH		NH
NM		NM
OH		OH
OK		OK
RI		RI
WV		WV
WI		WI

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

Rx Summit wwwNationalRxDrugAbuseSummitorg

State Unintentional Drug Overdose Reporting System (SUDORS)

Death certificates

Medical examiner

coroner reportsToxicology

reports

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS data submitted bi-annually

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

1 Data entry started

2 Data entry finished

1 Data entry started

2 Data entry finished

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS leverages National Violent Death Reporting System (NVDRS) platform

- Basic descriptors- Compare across demographics

- Recent release from institution- Overdose location - Survival time

- Mental health diagnoses- Substance abuse treatment history

- Substances present- Substances contributing to death

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Toxicology information

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS data as good as sources allow

Death Certificates

- Drug specificity- Time lag in

cause of death codes

Medical Examiner Coroner Reports

- Scene evidence availability

- Death scene investigation

Toxicology Reports

- Testing availability

- Emerging substances

Rx Summit wwwNationalRxDrugAbuseSummitorg

Despite limitations SUDORS data have many strengths

Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months

Flexibility to include substances contributing to death outside of death certificate textcode fields

Overdose-specific circumstance data collected within 8 months

Rx Summit wwwNationalRxDrugAbuseSummitorg

Preliminary results

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Total deaths (20162017)10699

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths by state and reporting period

Preliminary results

Chart1

2nd-half 2016

1st-half 2017

State

Number of deaths

524

646

156

144

1108

883

193

205

166

155

2063

2389

210

214

145

120

394

442

418

394

Sheet1

Sheet1

IMF

Rx fent

Sheet2

Sheet2

2016

2017

Sheet3

Sheet3

2nd-half 2016

1st-half 2017

State

Number of deaths

Regional

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

	2016 and 2017 data combined (KY currently doesnt have any 2017 data in there)
	of all opioid deaths with these categories as cause of death (not mutually exclusive)															of each drug category with circumstances
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI				Prescription		Heroin		Fentanyl
	Prescription		097		3133		2163		2166		1519		4860		1954		6525		2447		3861		4014		3375			Recent release		789		1151		993
	Heroin		4854		3700		3737		4224		886		5701		3581		2435		5032		2317		3860		6117			Prior OD		1023		1234		1331
	Fentanyl			7467		7716		6264		8759		1215		7708		1820		7415		7027		6615		3598			Current treatment		980		836		755
															Recent opioid use relapse		755		1620		1296
															History of heroin abuse		1946		4259		3926
															History of Rx opioid abuse		1434		361		393
															History of Rx opioid AND heroin abuse		541		656		603

opioid deaths overall
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
	2nd-half 2016		524		156		1108		427		193		166		2063		210		1388		145		394		418			7192
	1st-half 2017		646		144		883		127		205		155		2389		214		1452		120		442		394			7171
															14363
																		14522

			KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
		2016		000		2821		163		070		1244		663		2648		095		490		205		2030		407
		2017			2986		136		000		1485		024		4641		235		1894		885		2902		1804

	KY-2016		KY-2017		ME-2016		ME-2017		MA-2016		MA-2017		MO-2016		MO-2017		NH-2016		NH-2017		NM-2016		NM-2017		OH-2016		OH-2017		OK-2016		OK-2017		PA-2016		PA-2017		RI-2016		RI-2017		WV-2016		WV-2017		WI-2016		WI-2017
IMF		171			82		60		708		596		236		84		132		146		13		11		996		1291		8		11		695		1002		79		48		164		205		106		96
Rx fent		5			1		1		3		1		5		2		1		0		6		0		5		2		11		11		5		2		3		1		2		0		7		3

KY		KY
ME		ME
MA		MA
NH		NH
NM		NM
OH		OH
OK		OK
RI		RI
WV		WV
WI		WI

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS data submitted bi-annually

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

1 Data entry started

2 Data entry finished

1 Data entry started

2 Data entry finished

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS leverages National Violent Death Reporting System (NVDRS) platform

- Basic descriptors- Compare across demographics

- Recent release from institution- Overdose location - Survival time

- Mental health diagnoses- Substance abuse treatment history

- Substances present- Substances contributing to death

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Toxicology information

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS data as good as sources allow

Death Certificates

- Drug specificity- Time lag in

cause of death codes

Medical Examiner Coroner Reports

- Scene evidence availability

- Death scene investigation

Toxicology Reports

- Testing availability

- Emerging substances

Rx Summit wwwNationalRxDrugAbuseSummitorg

Despite limitations SUDORS data have many strengths

Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months

Flexibility to include substances contributing to death outside of death certificate textcode fields

Overdose-specific circumstance data collected within 8 months

Rx Summit wwwNationalRxDrugAbuseSummitorg

Preliminary results

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Total deaths (20162017)10699

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths by state and reporting period

Preliminary results

Chart1

2nd-half 2016

1st-half 2017

State

Number of deaths

524

646

156

144

1108

883

193

205

166

155

2063

2389

210

214

145

120

394

442

418

394

Sheet1

Sheet1

IMF

Rx fent

Sheet2

Sheet2

2016

2017

Sheet3

Sheet3

2nd-half 2016

1st-half 2017

State

Number of deaths

Regional

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

	2016 and 2017 data combined (KY currently doesnt have any 2017 data in there)
	of all opioid deaths with these categories as cause of death (not mutually exclusive)															of each drug category with circumstances
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI				Prescription		Heroin		Fentanyl
	Prescription		097		3133		2163		2166		1519		4860		1954		6525		2447		3861		4014		3375			Recent release		789		1151		993
	Heroin		4854		3700		3737		4224		886		5701		3581		2435		5032		2317		3860		6117			Prior OD		1023		1234		1331
	Fentanyl			7467		7716		6264		8759		1215		7708		1820		7415		7027		6615		3598			Current treatment		980		836		755
															Recent opioid use relapse		755		1620		1296
															History of heroin abuse		1946		4259		3926
															History of Rx opioid abuse		1434		361		393
															History of Rx opioid AND heroin abuse		541		656		603

opioid deaths overall
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
	2nd-half 2016		524		156		1108		427		193		166		2063		210		1388		145		394		418			7192
	1st-half 2017		646		144		883		127		205		155		2389		214		1452		120		442		394			7171
															14363
																		14522

			KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
		2016		000		2821		163		070		1244		663		2648		095		490		205		2030		407
		2017			2986		136		000		1485		024		4641		235		1894		885		2902		1804

	KY-2016		KY-2017		ME-2016		ME-2017		MA-2016		MA-2017		MO-2016		MO-2017		NH-2016		NH-2017		NM-2016		NM-2017		OH-2016		OH-2017		OK-2016		OK-2017		PA-2016		PA-2017		RI-2016		RI-2017		WV-2016		WV-2017		WI-2016		WI-2017
IMF		171			82		60		708		596		236		84		132		146		13		11		996		1291		8		11		695		1002		79		48		164		205		106		96
Rx fent		5			1		1		3		1		5		2		1		0		6		0		5		2		11		11		5		2		3		1		2		0		7		3

KY		KY
ME		ME
MA		MA
NH		NH
NM		NM
OH		OH
OK		OK
RI		RI
WV		WV
WI		WI

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS leverages National Violent Death Reporting System (NVDRS) platform

- Basic descriptors- Compare across demographics

- Recent release from institution- Overdose location - Survival time

- Mental health diagnoses- Substance abuse treatment history

- Substances present- Substances contributing to death

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Toxicology information

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS data as good as sources allow

Death Certificates

- Drug specificity- Time lag in

cause of death codes

Medical Examiner Coroner Reports

- Scene evidence availability

- Death scene investigation

Toxicology Reports

- Testing availability

- Emerging substances

Rx Summit wwwNationalRxDrugAbuseSummitorg

Despite limitations SUDORS data have many strengths

Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months

Flexibility to include substances contributing to death outside of death certificate textcode fields

Overdose-specific circumstance data collected within 8 months

Rx Summit wwwNationalRxDrugAbuseSummitorg

Preliminary results

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Total deaths (20162017)10699

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths by state and reporting period

Preliminary results

Chart1

2nd-half 2016

1st-half 2017

State

Number of deaths

524

646

156

144

1108

883

193

205

166

155

2063

2389

210

214

145

120

394

442

418

394

Sheet1

Sheet1

IMF

Rx fent

Sheet2

Sheet2

2016

2017

Sheet3

Sheet3

2nd-half 2016

1st-half 2017

State

Number of deaths

Regional

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

	2016 and 2017 data combined (KY currently doesnt have any 2017 data in there)
	of all opioid deaths with these categories as cause of death (not mutually exclusive)															of each drug category with circumstances
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI				Prescription		Heroin		Fentanyl
	Prescription		097		3133		2163		2166		1519		4860		1954		6525		2447		3861		4014		3375			Recent release		789		1151		993
	Heroin		4854		3700		3737		4224		886		5701		3581		2435		5032		2317		3860		6117			Prior OD		1023		1234		1331
	Fentanyl			7467		7716		6264		8759		1215		7708		1820		7415		7027		6615		3598			Current treatment		980		836		755
															Recent opioid use relapse		755		1620		1296
															History of heroin abuse		1946		4259		3926
															History of Rx opioid abuse		1434		361		393
															History of Rx opioid AND heroin abuse		541		656		603

opioid deaths overall
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
	2nd-half 2016		524		156		1108		427		193		166		2063		210		1388		145		394		418			7192
	1st-half 2017		646		144		883		127		205		155		2389		214		1452		120		442		394			7171
															14363
																		14522

			KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
		2016		000		2821		163		070		1244		663		2648		095		490		205		2030		407
		2017			2986		136		000		1485		024		4641		235		1894		885		2902		1804

	KY-2016		KY-2017		ME-2016		ME-2017		MA-2016		MA-2017		MO-2016		MO-2017		NH-2016		NH-2017		NM-2016		NM-2017		OH-2016		OH-2017		OK-2016		OK-2017		PA-2016		PA-2017		RI-2016		RI-2017		WV-2016		WV-2017		WI-2016		WI-2017
IMF		171			82		60		708		596		236		84		132		146		13		11		996		1291		8		11		695		1002		79		48		164		205		106		96
Rx fent		5			1		1		3		1		5		2		1		0		6		0		5		2		11		11		5		2		3		1		2		0		7		3

KY		KY
ME		ME
MA		MA
NH		NH
NM		NM
OH		OH
OK		OK
RI		RI
WV		WV
WI		WI

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Toxicology information

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS data as good as sources allow

Death Certificates

- Drug specificity- Time lag in

cause of death codes

Medical Examiner Coroner Reports

- Scene evidence availability

- Death scene investigation

Toxicology Reports

- Testing availability

- Emerging substances

Rx Summit wwwNationalRxDrugAbuseSummitorg

Despite limitations SUDORS data have many strengths

Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months

Flexibility to include substances contributing to death outside of death certificate textcode fields

Overdose-specific circumstance data collected within 8 months

Rx Summit wwwNationalRxDrugAbuseSummitorg

Preliminary results

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Total deaths (20162017)10699

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths by state and reporting period

Preliminary results

Chart1

2nd-half 2016

1st-half 2017

State

Number of deaths

524

646

156

144

1108

883

193

205

166

155

2063

2389

210

214

145

120

394

442

418

394

Sheet1

Sheet1

IMF

Rx fent

Sheet2

Sheet2

2016

2017

Sheet3

Sheet3

2nd-half 2016

1st-half 2017

State

Number of deaths

Regional

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

	2016 and 2017 data combined (KY currently doesnt have any 2017 data in there)
	of all opioid deaths with these categories as cause of death (not mutually exclusive)															of each drug category with circumstances
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI				Prescription		Heroin		Fentanyl
	Prescription		097		3133		2163		2166		1519		4860		1954		6525		2447		3861		4014		3375			Recent release		789		1151		993
	Heroin		4854		3700		3737		4224		886		5701		3581		2435		5032		2317		3860		6117			Prior OD		1023		1234		1331
	Fentanyl			7467		7716		6264		8759		1215		7708		1820		7415		7027		6615		3598			Current treatment		980		836		755
															Recent opioid use relapse		755		1620		1296
															History of heroin abuse		1946		4259		3926
															History of Rx opioid abuse		1434		361		393
															History of Rx opioid AND heroin abuse		541		656		603

opioid deaths overall
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
	2nd-half 2016		524		156		1108		427		193		166		2063		210		1388		145		394		418			7192
	1st-half 2017		646		144		883		127		205		155		2389		214		1452		120		442		394			7171
															14363
																		14522

			KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
		2016		000		2821		163		070		1244		663		2648		095		490		205		2030		407
		2017			2986		136		000		1485		024		4641		235		1894		885		2902		1804

	KY-2016		KY-2017		ME-2016		ME-2017		MA-2016		MA-2017		MO-2016		MO-2017		NH-2016		NH-2017		NM-2016		NM-2017		OH-2016		OH-2017		OK-2016		OK-2017		PA-2016		PA-2017		RI-2016		RI-2017		WV-2016		WV-2017		WI-2016		WI-2017
IMF		171			82		60		708		596		236		84		132		146		13		11		996		1291		8		11		695		1002		79		48		164		205		106		96
Rx fent		5			1		1		3		1		5		2		1		0		6		0		5		2		11		11		5		2		3		1		2		0		7		3

KY		KY
ME		ME
MA		MA
NH		NH
NM		NM
OH		OH
OK		OK
RI		RI
WV		WV
WI		WI

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Toxicology information

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS data as good as sources allow

Death Certificates

- Drug specificity- Time lag in

cause of death codes

Medical Examiner Coroner Reports

- Scene evidence availability

- Death scene investigation

Toxicology Reports

- Testing availability

- Emerging substances

Rx Summit wwwNationalRxDrugAbuseSummitorg

Despite limitations SUDORS data have many strengths

Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months

Flexibility to include substances contributing to death outside of death certificate textcode fields

Overdose-specific circumstance data collected within 8 months

Rx Summit wwwNationalRxDrugAbuseSummitorg

Preliminary results

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Total deaths (20162017)10699

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths by state and reporting period

Preliminary results

Chart1

2nd-half 2016

1st-half 2017

State

Number of deaths

524

646

156

144

1108

883

193

205

166

155

2063

2389

210

214

145

120

394

442

418

394

Sheet1

Sheet1

IMF

Rx fent

Sheet2

Sheet2

2016

2017

Sheet3

Sheet3

2nd-half 2016

1st-half 2017

State

Number of deaths

Regional

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

	2016 and 2017 data combined (KY currently doesnt have any 2017 data in there)
	of all opioid deaths with these categories as cause of death (not mutually exclusive)															of each drug category with circumstances
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI				Prescription		Heroin		Fentanyl
	Prescription		097		3133		2163		2166		1519		4860		1954		6525		2447		3861		4014		3375			Recent release		789		1151		993
	Heroin		4854		3700		3737		4224		886		5701		3581		2435		5032		2317		3860		6117			Prior OD		1023		1234		1331
	Fentanyl			7467		7716		6264		8759		1215		7708		1820		7415		7027		6615		3598			Current treatment		980		836		755
															Recent opioid use relapse		755		1620		1296
															History of heroin abuse		1946		4259		3926
															History of Rx opioid abuse		1434		361		393
															History of Rx opioid AND heroin abuse		541		656		603

opioid deaths overall
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
	2nd-half 2016		524		156		1108		427		193		166		2063		210		1388		145		394		418			7192
	1st-half 2017		646		144		883		127		205		155		2389		214		1452		120		442		394			7171
															14363
																		14522

			KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
		2016		000		2821		163		070		1244		663		2648		095		490		205		2030		407
		2017			2986		136		000		1485		024		4641		235		1894		885		2902		1804

	KY-2016		KY-2017		ME-2016		ME-2017		MA-2016		MA-2017		MO-2016		MO-2017		NH-2016		NH-2017		NM-2016		NM-2017		OH-2016		OH-2017		OK-2016		OK-2017		PA-2016		PA-2017		RI-2016		RI-2017		WV-2016		WV-2017		WI-2016		WI-2017
IMF		171			82		60		708		596		236		84		132		146		13		11		996		1291		8		11		695		1002		79		48		164		205		106		96
Rx fent		5			1		1		3		1		5		2		1		0		6		0		5		2		11		11		5		2		3		1		2		0		7		3

KY		KY
ME		ME
MA		MA
NH		NH
NM		NM
OH		OH
OK		OK
RI		RI
WV		WV
WI		WI

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Toxicology information

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS data as good as sources allow

Death Certificates

- Drug specificity- Time lag in

cause of death codes

Medical Examiner Coroner Reports

- Scene evidence availability

- Death scene investigation

Toxicology Reports

- Testing availability

- Emerging substances

Rx Summit wwwNationalRxDrugAbuseSummitorg

Despite limitations SUDORS data have many strengths

Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months

Flexibility to include substances contributing to death outside of death certificate textcode fields

Overdose-specific circumstance data collected within 8 months

Rx Summit wwwNationalRxDrugAbuseSummitorg

Preliminary results

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Total deaths (20162017)10699

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths by state and reporting period

Preliminary results

Chart1

2nd-half 2016

1st-half 2017

State

Number of deaths

524

646

156

144

1108

883

193

205

166

155

2063

2389

210

214

145

120

394

442

418

394

Sheet1

Sheet1

IMF

Rx fent

Sheet2

Sheet2

2016

2017

Sheet3

Sheet3

2nd-half 2016

1st-half 2017

State

Number of deaths

Regional

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

	2016 and 2017 data combined (KY currently doesnt have any 2017 data in there)
	of all opioid deaths with these categories as cause of death (not mutually exclusive)															of each drug category with circumstances
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI				Prescription		Heroin		Fentanyl
	Prescription		097		3133		2163		2166		1519		4860		1954		6525		2447		3861		4014		3375			Recent release		789		1151		993
	Heroin		4854		3700		3737		4224		886		5701		3581		2435		5032		2317		3860		6117			Prior OD		1023		1234		1331
	Fentanyl			7467		7716		6264		8759		1215		7708		1820		7415		7027		6615		3598			Current treatment		980		836		755
															Recent opioid use relapse		755		1620		1296
															History of heroin abuse		1946		4259		3926
															History of Rx opioid abuse		1434		361		393
															History of Rx opioid AND heroin abuse		541		656		603

opioid deaths overall
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
	2nd-half 2016		524		156		1108		427		193		166		2063		210		1388		145		394		418			7192
	1st-half 2017		646		144		883		127		205		155		2389		214		1452		120		442		394			7171
															14363
																		14522

			KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
		2016		000		2821		163		070		1244		663		2648		095		490		205		2030		407
		2017			2986		136		000		1485		024		4641		235		1894		885		2902		1804

	KY-2016		KY-2017		ME-2016		ME-2017		MA-2016		MA-2017		MO-2016		MO-2017		NH-2016		NH-2017		NM-2016		NM-2017		OH-2016		OH-2017		OK-2016		OK-2017		PA-2016		PA-2017		RI-2016		RI-2017		WV-2016		WV-2017		WI-2016		WI-2017
IMF		171			82		60		708		596		236		84		132		146		13		11		996		1291		8		11		695		1002		79		48		164		205		106		96
Rx fent		5			1		1		3		1		5		2		1		0		6		0		5		2		11		11		5		2		3		1		2		0		7		3

KY		KY
ME		ME
MA		MA
NH		NH
NM		NM
OH		OH
OK		OK
RI		RI
WV		WV
WI		WI

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Toxicology information

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS data as good as sources allow

Death Certificates

- Drug specificity- Time lag in

cause of death codes

Medical Examiner Coroner Reports

- Scene evidence availability

- Death scene investigation

Toxicology Reports

- Testing availability

- Emerging substances

Rx Summit wwwNationalRxDrugAbuseSummitorg

Despite limitations SUDORS data have many strengths

Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months

Flexibility to include substances contributing to death outside of death certificate textcode fields

Overdose-specific circumstance data collected within 8 months

Rx Summit wwwNationalRxDrugAbuseSummitorg

Preliminary results

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Total deaths (20162017)10699

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths by state and reporting period

Preliminary results

Chart1

2nd-half 2016

1st-half 2017

State

Number of deaths

524

646

156

144

1108

883

193

205

166

155

2063

2389

210

214

145

120

394

442

418

394

Sheet1

Sheet1

IMF

Rx fent

Sheet2

Sheet2

2016

2017

Sheet3

Sheet3

2nd-half 2016

1st-half 2017

State

Number of deaths

Regional

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

	2016 and 2017 data combined (KY currently doesnt have any 2017 data in there)
	of all opioid deaths with these categories as cause of death (not mutually exclusive)															of each drug category with circumstances
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI				Prescription		Heroin		Fentanyl
	Prescription		097		3133		2163		2166		1519		4860		1954		6525		2447		3861		4014		3375			Recent release		789		1151		993
	Heroin		4854		3700		3737		4224		886		5701		3581		2435		5032		2317		3860		6117			Prior OD		1023		1234		1331
	Fentanyl			7467		7716		6264		8759		1215		7708		1820		7415		7027		6615		3598			Current treatment		980		836		755
															Recent opioid use relapse		755		1620		1296
															History of heroin abuse		1946		4259		3926
															History of Rx opioid abuse		1434		361		393
															History of Rx opioid AND heroin abuse		541		656		603

opioid deaths overall
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
	2nd-half 2016		524		156		1108		427		193		166		2063		210		1388		145		394		418			7192
	1st-half 2017		646		144		883		127		205		155		2389		214		1452		120		442		394			7171
															14363
																		14522

			KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
		2016		000		2821		163		070		1244		663		2648		095		490		205		2030		407
		2017			2986		136		000		1485		024		4641		235		1894		885		2902		1804

	KY-2016		KY-2017		ME-2016		ME-2017		MA-2016		MA-2017		MO-2016		MO-2017		NH-2016		NH-2017		NM-2016		NM-2017		OH-2016		OH-2017		OK-2016		OK-2017		PA-2016		PA-2017		RI-2016		RI-2017		WV-2016		WV-2017		WI-2016		WI-2017
IMF		171			82		60		708		596		236		84		132		146		13		11		996		1291		8		11		695		1002		79		48		164		205		106		96
Rx fent		5			1		1		3		1		5		2		1		0		6		0		5		2		11		11		5		2		3		1		2		0		7		3

KY		KY
ME		ME
MA		MA
NH		NH
NM		NM
OH		OH
OK		OK
RI		RI
WV		WV
WI		WI

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Toxicology information

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS data as good as sources allow

Death Certificates

- Drug specificity- Time lag in

cause of death codes

Medical Examiner Coroner Reports

- Scene evidence availability

- Death scene investigation

Toxicology Reports

- Testing availability

- Emerging substances

Rx Summit wwwNationalRxDrugAbuseSummitorg

Despite limitations SUDORS data have many strengths

Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months

Flexibility to include substances contributing to death outside of death certificate textcode fields

Overdose-specific circumstance data collected within 8 months

Rx Summit wwwNationalRxDrugAbuseSummitorg

Preliminary results

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Total deaths (20162017)10699

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths by state and reporting period

Preliminary results

Chart1

2nd-half 2016

1st-half 2017

State

Number of deaths

524

646

156

144

1108

883

193

205

166

155

2063

2389

210

214

145

120

394

442

418

394

Sheet1

Sheet1

IMF

Rx fent

Sheet2

Sheet2

2016

2017

Sheet3

Sheet3

2nd-half 2016

1st-half 2017

State

Number of deaths

Regional

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

	2016 and 2017 data combined (KY currently doesnt have any 2017 data in there)
	of all opioid deaths with these categories as cause of death (not mutually exclusive)															of each drug category with circumstances
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI				Prescription		Heroin		Fentanyl
	Prescription		097		3133		2163		2166		1519		4860		1954		6525		2447		3861		4014		3375			Recent release		789		1151		993
	Heroin		4854		3700		3737		4224		886		5701		3581		2435		5032		2317		3860		6117			Prior OD		1023		1234		1331
	Fentanyl			7467		7716		6264		8759		1215		7708		1820		7415		7027		6615		3598			Current treatment		980		836		755
															Recent opioid use relapse		755		1620		1296
															History of heroin abuse		1946		4259		3926
															History of Rx opioid abuse		1434		361		393
															History of Rx opioid AND heroin abuse		541		656		603

opioid deaths overall
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
	2nd-half 2016		524		156		1108		427		193		166		2063		210		1388		145		394		418			7192
	1st-half 2017		646		144		883		127		205		155		2389		214		1452		120		442		394			7171
															14363
																		14522

			KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
		2016		000		2821		163		070		1244		663		2648		095		490		205		2030		407
		2017			2986		136		000		1485		024		4641		235		1894		885		2902		1804

	KY-2016		KY-2017		ME-2016		ME-2017		MA-2016		MA-2017		MO-2016		MO-2017		NH-2016		NH-2017		NM-2016		NM-2017		OH-2016		OH-2017		OK-2016		OK-2017		PA-2016		PA-2017		RI-2016		RI-2017		WV-2016		WV-2017		WI-2016		WI-2017
IMF		171			82		60		708		596		236		84		132		146		13		11		996		1291		8		11		695		1002		79		48		164		205		106		96
Rx fent		5			1		1		3		1		5		2		1		0		6		0		5		2		11		11		5		2		3		1		2		0		7		3

KY		KY
ME		ME
MA		MA
NH		NH
NM		NM
OH		OH
OK		OK
RI		RI
WV		WV
WI		WI

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Toxicology information

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS data as good as sources allow

Death Certificates

- Drug specificity- Time lag in

cause of death codes

Medical Examiner Coroner Reports

- Scene evidence availability

- Death scene investigation

Toxicology Reports

- Testing availability

- Emerging substances

Rx Summit wwwNationalRxDrugAbuseSummitorg

Despite limitations SUDORS data have many strengths

Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months

Flexibility to include substances contributing to death outside of death certificate textcode fields

Overdose-specific circumstance data collected within 8 months

Rx Summit wwwNationalRxDrugAbuseSummitorg

Preliminary results

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Total deaths (20162017)10699

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths by state and reporting period

Preliminary results

Chart1

2nd-half 2016

1st-half 2017

State

Number of deaths

524

646

156

144

1108

883

193

205

166

155

2063

2389

210

214

145

120

394

442

418

394

Sheet1

Sheet1

IMF

Rx fent

Sheet2

Sheet2

2016

2017

Sheet3

Sheet3

2nd-half 2016

1st-half 2017

State

Number of deaths

Regional

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

	2016 and 2017 data combined (KY currently doesnt have any 2017 data in there)
	of all opioid deaths with these categories as cause of death (not mutually exclusive)															of each drug category with circumstances
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI				Prescription		Heroin		Fentanyl
	Prescription		097		3133		2163		2166		1519		4860		1954		6525		2447		3861		4014		3375			Recent release		789		1151		993
	Heroin		4854		3700		3737		4224		886		5701		3581		2435		5032		2317		3860		6117			Prior OD		1023		1234		1331
	Fentanyl			7467		7716		6264		8759		1215		7708		1820		7415		7027		6615		3598			Current treatment		980		836		755
															Recent opioid use relapse		755		1620		1296
															History of heroin abuse		1946		4259		3926
															History of Rx opioid abuse		1434		361		393
															History of Rx opioid AND heroin abuse		541		656		603

opioid deaths overall
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
	2nd-half 2016		524		156		1108		427		193		166		2063		210		1388		145		394		418			7192
	1st-half 2017		646		144		883		127		205		155		2389		214		1452		120		442		394			7171
															14363
																		14522

			KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
		2016		000		2821		163		070		1244		663		2648		095		490		205		2030		407
		2017			2986		136		000		1485		024		4641		235		1894		885		2902		1804

	KY-2016		KY-2017		ME-2016		ME-2017		MA-2016		MA-2017		MO-2016		MO-2017		NH-2016		NH-2017		NM-2016		NM-2017		OH-2016		OH-2017		OK-2016		OK-2017		PA-2016		PA-2017		RI-2016		RI-2017		WV-2016		WV-2017		WI-2016		WI-2017
IMF		171			82		60		708		596		236		84		132		146		13		11		996		1291		8		11		695		1002		79		48		164		205		106		96
Rx fent		5			1		1		3		1		5		2		1		0		6		0		5		2		11		11		5		2		3		1		2		0		7		3

KY		KY
ME		ME
MA		MA
NH		NH
NM		NM
OH		OH
OK		OK
RI		RI
WV		WV
WI		WI

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Toxicology information

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS data as good as sources allow

Death Certificates

- Drug specificity- Time lag in

cause of death codes

Medical Examiner Coroner Reports

- Scene evidence availability

- Death scene investigation

Toxicology Reports

- Testing availability

- Emerging substances

Rx Summit wwwNationalRxDrugAbuseSummitorg

Despite limitations SUDORS data have many strengths

Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months

Flexibility to include substances contributing to death outside of death certificate textcode fields

Overdose-specific circumstance data collected within 8 months

Rx Summit wwwNationalRxDrugAbuseSummitorg

Preliminary results

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Total deaths (20162017)10699

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths by state and reporting period

Preliminary results

Chart1

2nd-half 2016

1st-half 2017

State

Number of deaths

524

646

156

144

1108

883

193

205

166

155

2063

2389

210

214

145

120

394

442

418

394

Sheet1

Sheet1

IMF

Rx fent

Sheet2

Sheet2

2016

2017

Sheet3

Sheet3

2nd-half 2016

1st-half 2017

State

Number of deaths

Regional

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

	2016 and 2017 data combined (KY currently doesnt have any 2017 data in there)
	of all opioid deaths with these categories as cause of death (not mutually exclusive)															of each drug category with circumstances
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI				Prescription		Heroin		Fentanyl
	Prescription		097		3133		2163		2166		1519		4860		1954		6525		2447		3861		4014		3375			Recent release		789		1151		993
	Heroin		4854		3700		3737		4224		886		5701		3581		2435		5032		2317		3860		6117			Prior OD		1023		1234		1331
	Fentanyl			7467		7716		6264		8759		1215		7708		1820		7415		7027		6615		3598			Current treatment		980		836		755
															Recent opioid use relapse		755		1620		1296
															History of heroin abuse		1946		4259		3926
															History of Rx opioid abuse		1434		361		393
															History of Rx opioid AND heroin abuse		541		656		603

opioid deaths overall
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
	2nd-half 2016		524		156		1108		427		193		166		2063		210		1388		145		394		418			7192
	1st-half 2017		646		144		883		127		205		155		2389		214		1452		120		442		394			7171
															14363
																		14522

			KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
		2016		000		2821		163		070		1244		663		2648		095		490		205		2030		407
		2017			2986		136		000		1485		024		4641		235		1894		885		2902		1804

	KY-2016		KY-2017		ME-2016		ME-2017		MA-2016		MA-2017		MO-2016		MO-2017		NH-2016		NH-2017		NM-2016		NM-2017		OH-2016		OH-2017		OK-2016		OK-2017		PA-2016		PA-2017		RI-2016		RI-2017		WV-2016		WV-2017		WI-2016		WI-2017
IMF		171			82		60		708		596		236		84		132		146		13		11		996		1291		8		11		695		1002		79		48		164		205		106		96
Rx fent		5			1		1		3		1		5		2		1		0		6		0		5		2		11		11		5		2		3		1		2		0		7		3

KY		KY
ME		ME
MA		MA
NH		NH
NM		NM
OH		OH
OK		OK
RI		RI
WV		WV
WI		WI

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

Rx Summit wwwNationalRxDrugAbuseSummitorg

Overdose-specific fields

Rx Summit wwwNationalRxDrugAbuseSummitorg

Toxicology information

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS data as good as sources allow

Death Certificates

- Drug specificity- Time lag in

cause of death codes

Medical Examiner Coroner Reports

- Scene evidence availability

- Death scene investigation

Toxicology Reports

- Testing availability

- Emerging substances

Rx Summit wwwNationalRxDrugAbuseSummitorg

Despite limitations SUDORS data have many strengths

Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months

Flexibility to include substances contributing to death outside of death certificate textcode fields

Overdose-specific circumstance data collected within 8 months

Rx Summit wwwNationalRxDrugAbuseSummitorg

Preliminary results

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Total deaths (20162017)10699

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths by state and reporting period

Preliminary results

Chart1

2nd-half 2016

1st-half 2017

State

Number of deaths

524

646

156

144

1108

883

193

205

166

155

2063

2389

210

214

145

120

394

442

418

394

Sheet1

Sheet1

IMF

Rx fent

Sheet2

Sheet2

2016

2017

Sheet3

Sheet3

2nd-half 2016

1st-half 2017

State

Number of deaths

Regional

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

	2016 and 2017 data combined (KY currently doesnt have any 2017 data in there)
	of all opioid deaths with these categories as cause of death (not mutually exclusive)															of each drug category with circumstances
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI				Prescription		Heroin		Fentanyl
	Prescription		097		3133		2163		2166		1519		4860		1954		6525		2447		3861		4014		3375			Recent release		789		1151		993
	Heroin		4854		3700		3737		4224		886		5701		3581		2435		5032		2317		3860		6117			Prior OD		1023		1234		1331
	Fentanyl			7467		7716		6264		8759		1215		7708		1820		7415		7027		6615		3598			Current treatment		980		836		755
															Recent opioid use relapse		755		1620		1296
															History of heroin abuse		1946		4259		3926
															History of Rx opioid abuse		1434		361		393
															History of Rx opioid AND heroin abuse		541		656		603

opioid deaths overall
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
	2nd-half 2016		524		156		1108		427		193		166		2063		210		1388		145		394		418			7192
	1st-half 2017		646		144		883		127		205		155		2389		214		1452		120		442		394			7171
															14363
																		14522

			KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
		2016		000		2821		163		070		1244		663		2648		095		490		205		2030		407
		2017			2986		136		000		1485		024		4641		235		1894		885		2902		1804

	KY-2016		KY-2017		ME-2016		ME-2017		MA-2016		MA-2017		MO-2016		MO-2017		NH-2016		NH-2017		NM-2016		NM-2017		OH-2016		OH-2017		OK-2016		OK-2017		PA-2016		PA-2017		RI-2016		RI-2017		WV-2016		WV-2017		WI-2016		WI-2017
IMF		171			82		60		708		596		236		84		132		146		13		11		996		1291		8		11		695		1002		79		48		164		205		106		96
Rx fent		5			1		1		3		1		5		2		1		0		6		0		5		2		11		11		5		2		3		1		2		0		7		3

KY		KY
ME		ME
MA		MA
NH		NH
NM		NM
OH		OH
OK		OK
RI		RI
WV		WV
WI		WI

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

Rx Summit wwwNationalRxDrugAbuseSummitorg

Toxicology information

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS data as good as sources allow

Death Certificates

- Drug specificity- Time lag in

cause of death codes

Medical Examiner Coroner Reports

- Scene evidence availability

- Death scene investigation

Toxicology Reports

- Testing availability

- Emerging substances

Rx Summit wwwNationalRxDrugAbuseSummitorg

Despite limitations SUDORS data have many strengths

Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months

Flexibility to include substances contributing to death outside of death certificate textcode fields

Overdose-specific circumstance data collected within 8 months

Rx Summit wwwNationalRxDrugAbuseSummitorg

Preliminary results

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Total deaths (20162017)10699

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths by state and reporting period

Preliminary results

Chart1

2nd-half 2016

1st-half 2017

State

Number of deaths

524

646

156

144

1108

883

193

205

166

155

2063

2389

210

214

145

120

394

442

418

394

Sheet1

Sheet1

IMF

Rx fent

Sheet2

Sheet2

2016

2017

Sheet3

Sheet3

2nd-half 2016

1st-half 2017

State

Number of deaths

Regional

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

	2016 and 2017 data combined (KY currently doesnt have any 2017 data in there)
	of all opioid deaths with these categories as cause of death (not mutually exclusive)															of each drug category with circumstances
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI				Prescription		Heroin		Fentanyl
	Prescription		097		3133		2163		2166		1519		4860		1954		6525		2447		3861		4014		3375			Recent release		789		1151		993
	Heroin		4854		3700		3737		4224		886		5701		3581		2435		5032		2317		3860		6117			Prior OD		1023		1234		1331
	Fentanyl			7467		7716		6264		8759		1215		7708		1820		7415		7027		6615		3598			Current treatment		980		836		755
															Recent opioid use relapse		755		1620		1296
															History of heroin abuse		1946		4259		3926
															History of Rx opioid abuse		1434		361		393
															History of Rx opioid AND heroin abuse		541		656		603

opioid deaths overall
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
	2nd-half 2016		524		156		1108		427		193		166		2063		210		1388		145		394		418			7192
	1st-half 2017		646		144		883		127		205		155		2389		214		1452		120		442		394			7171
															14363
																		14522

			KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
		2016		000		2821		163		070		1244		663		2648		095		490		205		2030		407
		2017			2986		136		000		1485		024		4641		235		1894		885		2902		1804

	KY-2016		KY-2017		ME-2016		ME-2017		MA-2016		MA-2017		MO-2016		MO-2017		NH-2016		NH-2017		NM-2016		NM-2017		OH-2016		OH-2017		OK-2016		OK-2017		PA-2016		PA-2017		RI-2016		RI-2017		WV-2016		WV-2017		WI-2016		WI-2017
IMF		171			82		60		708		596		236		84		132		146		13		11		996		1291		8		11		695		1002		79		48		164		205		106		96
Rx fent		5			1		1		3		1		5		2		1		0		6		0		5		2		11		11		5		2		3		1		2		0		7		3

KY		KY
ME		ME
MA		MA
NH		NH
NM		NM
OH		OH
OK		OK
RI		RI
WV		WV
WI		WI

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS data as good as sources allow

Death Certificates

- Drug specificity- Time lag in

cause of death codes

Medical Examiner Coroner Reports

- Scene evidence availability

- Death scene investigation

Toxicology Reports

- Testing availability

- Emerging substances

Rx Summit wwwNationalRxDrugAbuseSummitorg

Despite limitations SUDORS data have many strengths

Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months

Flexibility to include substances contributing to death outside of death certificate textcode fields

Overdose-specific circumstance data collected within 8 months

Rx Summit wwwNationalRxDrugAbuseSummitorg

Preliminary results

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Total deaths (20162017)10699

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths by state and reporting period

Preliminary results

Chart1

2nd-half 2016

1st-half 2017

State

Number of deaths

524

646

156

144

1108

883

193

205

166

155

2063

2389

210

214

145

120

394

442

418

394

Sheet1

Sheet1

IMF

Rx fent

Sheet2

Sheet2

2016

2017

Sheet3

Sheet3

2nd-half 2016

1st-half 2017

State

Number of deaths

Regional

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

	2016 and 2017 data combined (KY currently doesnt have any 2017 data in there)
	of all opioid deaths with these categories as cause of death (not mutually exclusive)															of each drug category with circumstances
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI				Prescription		Heroin		Fentanyl
	Prescription		097		3133		2163		2166		1519		4860		1954		6525		2447		3861		4014		3375			Recent release		789		1151		993
	Heroin		4854		3700		3737		4224		886		5701		3581		2435		5032		2317		3860		6117			Prior OD		1023		1234		1331
	Fentanyl			7467		7716		6264		8759		1215		7708		1820		7415		7027		6615		3598			Current treatment		980		836		755
															Recent opioid use relapse		755		1620		1296
															History of heroin abuse		1946		4259		3926
															History of Rx opioid abuse		1434		361		393
															History of Rx opioid AND heroin abuse		541		656		603

opioid deaths overall
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
	2nd-half 2016		524		156		1108		427		193		166		2063		210		1388		145		394		418			7192
	1st-half 2017		646		144		883		127		205		155		2389		214		1452		120		442		394			7171
															14363
																		14522

			KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
		2016		000		2821		163		070		1244		663		2648		095		490		205		2030		407
		2017			2986		136		000		1485		024		4641		235		1894		885		2902		1804

	KY-2016		KY-2017		ME-2016		ME-2017		MA-2016		MA-2017		MO-2016		MO-2017		NH-2016		NH-2017		NM-2016		NM-2017		OH-2016		OH-2017		OK-2016		OK-2017		PA-2016		PA-2017		RI-2016		RI-2017		WV-2016		WV-2017		WI-2016		WI-2017
IMF		171			82		60		708		596		236		84		132		146		13		11		996		1291		8		11		695		1002		79		48		164		205		106		96
Rx fent		5			1		1		3		1		5		2		1		0		6		0		5		2		11		11		5		2		3		1		2		0		7		3

KY		KY
ME		ME
MA		MA
NH		NH
NM		NM
OH		OH
OK		OK
RI		RI
WV		WV
WI		WI

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

Rx Summit wwwNationalRxDrugAbuseSummitorg

Despite limitations SUDORS data have many strengths

Most states census of unintentional and undetermined intent opioid overdose deaths- Data on count of deaths within 6 months

Flexibility to include substances contributing to death outside of death certificate textcode fields

Overdose-specific circumstance data collected within 8 months

Rx Summit wwwNationalRxDrugAbuseSummitorg

Preliminary results

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Total deaths (20162017)10699

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths by state and reporting period

Preliminary results

Chart1

2nd-half 2016

1st-half 2017

State

Number of deaths

524

646

156

144

1108

883

193

205

166

155

2063

2389

210

214

145

120

394

442

418

394

Sheet1

Sheet1

IMF

Rx fent

Sheet2

Sheet2

2016

2017

Sheet3

Sheet3

2nd-half 2016

1st-half 2017

State

Number of deaths

Regional

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

	2016 and 2017 data combined (KY currently doesnt have any 2017 data in there)
	of all opioid deaths with these categories as cause of death (not mutually exclusive)															of each drug category with circumstances
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI				Prescription		Heroin		Fentanyl
	Prescription		097		3133		2163		2166		1519		4860		1954		6525		2447		3861		4014		3375			Recent release		789		1151		993
	Heroin		4854		3700		3737		4224		886		5701		3581		2435		5032		2317		3860		6117			Prior OD		1023		1234		1331
	Fentanyl			7467		7716		6264		8759		1215		7708		1820		7415		7027		6615		3598			Current treatment		980		836		755
															Recent opioid use relapse		755		1620		1296
															History of heroin abuse		1946		4259		3926
															History of Rx opioid abuse		1434		361		393
															History of Rx opioid AND heroin abuse		541		656		603

opioid deaths overall
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
	2nd-half 2016		524		156		1108		427		193		166		2063		210		1388		145		394		418			7192
	1st-half 2017		646		144		883		127		205		155		2389		214		1452		120		442		394			7171
															14363
																		14522

			KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
		2016		000		2821		163		070		1244		663		2648		095		490		205		2030		407
		2017			2986		136		000		1485		024		4641		235		1894		885		2902		1804

	KY-2016		KY-2017		ME-2016		ME-2017		MA-2016		MA-2017		MO-2016		MO-2017		NH-2016		NH-2017		NM-2016		NM-2017		OH-2016		OH-2017		OK-2016		OK-2017		PA-2016		PA-2017		RI-2016		RI-2017		WV-2016		WV-2017		WI-2016		WI-2017
IMF		171			82		60		708		596		236		84		132		146		13		11		996		1291		8		11		695		1002		79		48		164		205		106		96
Rx fent		5			1		1		3		1		5		2		1		0		6		0		5		2		11		11		5		2		3		1		2		0		7		3

KY		KY
ME		ME
MA		MA
NH		NH
NM		NM
OH		OH
OK		OK
RI		RI
WV		WV
WI		WI

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

Rx Summit wwwNationalRxDrugAbuseSummitorg

Preliminary results

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Total deaths (20162017)10699

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths by state and reporting period

Preliminary results

Chart1

2nd-half 2016

1st-half 2017

State

Number of deaths

524

646

156

144

1108

883

193

205

166

155

2063

2389

210

214

145

120

394

442

418

394

Sheet1

Sheet1

IMF

Rx fent

Sheet2

Sheet2

2016

2017

Sheet3

Sheet3

2nd-half 2016

1st-half 2017

State

Number of deaths

Regional

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

	2016 and 2017 data combined (KY currently doesnt have any 2017 data in there)
	of all opioid deaths with these categories as cause of death (not mutually exclusive)															of each drug category with circumstances
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI				Prescription		Heroin		Fentanyl
	Prescription		097		3133		2163		2166		1519		4860		1954		6525		2447		3861		4014		3375			Recent release		789		1151		993
	Heroin		4854		3700		3737		4224		886		5701		3581		2435		5032		2317		3860		6117			Prior OD		1023		1234		1331
	Fentanyl			7467		7716		6264		8759		1215		7708		1820		7415		7027		6615		3598			Current treatment		980		836		755
															Recent opioid use relapse		755		1620		1296
															History of heroin abuse		1946		4259		3926
															History of Rx opioid abuse		1434		361		393
															History of Rx opioid AND heroin abuse		541		656		603

opioid deaths overall
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
	2nd-half 2016		524		156		1108		427		193		166		2063		210		1388		145		394		418			7192
	1st-half 2017		646		144		883		127		205		155		2389		214		1452		120		442		394			7171
															14363
																		14522

			KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
		2016		000		2821		163		070		1244		663		2648		095		490		205		2030		407
		2017			2986		136		000		1485		024		4641		235		1894		885		2902		1804

	KY-2016		KY-2017		ME-2016		ME-2017		MA-2016		MA-2017		MO-2016		MO-2017		NH-2016		NH-2017		NM-2016		NM-2017		OH-2016		OH-2017		OK-2016		OK-2017		PA-2016		PA-2017		RI-2016		RI-2017		WV-2016		WV-2017		WI-2016		WI-2017
IMF		171			82		60		708		596		236		84		132		146		13		11		996		1291		8		11		695		1002		79		48		164		205		106		96
Rx fent		5			1		1		3		1		5		2		1		0		6		0		5		2		11		11		5		2		3		1		2		0		7		3

KY		KY
ME		ME
MA		MA
NH		NH
NM		NM
OH		OH
OK		OK
RI		RI
WV		WV
WI		WI

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Total deaths (20162017)10699

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths by state and reporting period

Preliminary results

Chart1

2nd-half 2016

1st-half 2017

State

Number of deaths

524

646

156

144

1108

883

193

205

166

155

2063

2389

210

214

145

120

394

442

418

394

Sheet1

Sheet1

IMF

Rx fent

Sheet2

Sheet2

2016

2017

Sheet3

Sheet3

2nd-half 2016

1st-half 2017

State

Number of deaths

Regional

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

	2016 and 2017 data combined (KY currently doesnt have any 2017 data in there)
	of all opioid deaths with these categories as cause of death (not mutually exclusive)															of each drug category with circumstances
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI				Prescription		Heroin		Fentanyl
	Prescription		097		3133		2163		2166		1519		4860		1954		6525		2447		3861		4014		3375			Recent release		789		1151		993
	Heroin		4854		3700		3737		4224		886		5701		3581		2435		5032		2317		3860		6117			Prior OD		1023		1234		1331
	Fentanyl			7467		7716		6264		8759		1215		7708		1820		7415		7027		6615		3598			Current treatment		980		836		755
															Recent opioid use relapse		755		1620		1296
															History of heroin abuse		1946		4259		3926
															History of Rx opioid abuse		1434		361		393
															History of Rx opioid AND heroin abuse		541		656		603

opioid deaths overall
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
	2nd-half 2016		524		156		1108		427		193		166		2063		210		1388		145		394		418			7192
	1st-half 2017		646		144		883		127		205		155		2389		214		1452		120		442		394			7171
															14363
																		14522

			KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
		2016		000		2821		163		070		1244		663		2648		095		490		205		2030		407
		2017			2986		136		000		1485		024		4641		235		1894		885		2902		1804

	KY-2016		KY-2017		ME-2016		ME-2017		MA-2016		MA-2017		MO-2016		MO-2017		NH-2016		NH-2017		NM-2016		NM-2017		OH-2016		OH-2017		OK-2016		OK-2017		PA-2016		PA-2017		RI-2016		RI-2017		WV-2016		WV-2017		WI-2016		WI-2017
IMF		171			82		60		708		596		236		84		132		146		13		11		996		1291		8		11		695		1002		79		48		164		205		106		96
Rx fent		5			1		1		3		1		5		2		1		0		6		0		5		2		11		11		5		2		3		1		2		0		7		3

KY		KY
ME		ME
MA		MA
NH		NH
NM		NM
OH		OH
OK		OK
RI		RI
WV		WV
WI		WI

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Total deaths (20162017)10699

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths by state and reporting period

Preliminary results

Chart1

2nd-half 2016

1st-half 2017

State

Number of deaths

524

646

156

144

1108

883

193

205

166

155

2063

2389

210

214

145

120

394

442

418

394

Sheet1

Sheet1

IMF

Rx fent

Sheet2

Sheet2

2016

2017

Sheet3

Sheet3

2nd-half 2016

1st-half 2017

State

Number of deaths

Regional

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

	2016 and 2017 data combined (KY currently doesnt have any 2017 data in there)
	of all opioid deaths with these categories as cause of death (not mutually exclusive)															of each drug category with circumstances
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI				Prescription		Heroin		Fentanyl
	Prescription		097		3133		2163		2166		1519		4860		1954		6525		2447		3861		4014		3375			Recent release		789		1151		993
	Heroin		4854		3700		3737		4224		886		5701		3581		2435		5032		2317		3860		6117			Prior OD		1023		1234		1331
	Fentanyl			7467		7716		6264		8759		1215		7708		1820		7415		7027		6615		3598			Current treatment		980		836		755
															Recent opioid use relapse		755		1620		1296
															History of heroin abuse		1946		4259		3926
															History of Rx opioid abuse		1434		361		393
															History of Rx opioid AND heroin abuse		541		656		603

opioid deaths overall
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
	2nd-half 2016		524		156		1108		427		193		166		2063		210		1388		145		394		418			7192
	1st-half 2017		646		144		883		127		205		155		2389		214		1452		120		442		394			7171
															14363
																		14522

			KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
		2016		000		2821		163		070		1244		663		2648		095		490		205		2030		407
		2017			2986		136		000		1485		024		4641		235		1894		885		2902		1804

	KY-2016		KY-2017		ME-2016		ME-2017		MA-2016		MA-2017		MO-2016		MO-2017		NH-2016		NH-2017		NM-2016		NM-2017		OH-2016		OH-2017		OK-2016		OK-2017		PA-2016		PA-2017		RI-2016		RI-2017		WV-2016		WV-2017		WI-2016		WI-2017
IMF		171			82		60		708		596		236		84		132		146		13		11		996		1291		8		11		695		1002		79		48		164		205		106		96
Rx fent		5			1		1		3		1		5		2		1		0		6		0		5		2		11		11		5		2		3		1		2		0		7		3

KY		KY
ME		ME
MA		MA
NH		NH
NM		NM
OH		OH
OK		OK
RI		RI
WV		WV
WI		WI

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Total deaths (20162017)10699

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths by state and reporting period

Preliminary results

Chart1

2nd-half 2016

1st-half 2017

State

Number of deaths

524

646

156

144

1108

883

193

205

166

155

2063

2389

210

214

145

120

394

442

418

394

Sheet1

Sheet1

IMF

Rx fent

Sheet2

Sheet2

2016

2017

Sheet3

Sheet3

2nd-half 2016

1st-half 2017

State

Number of deaths

Regional

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

	2016 and 2017 data combined (KY currently doesnt have any 2017 data in there)
	of all opioid deaths with these categories as cause of death (not mutually exclusive)															of each drug category with circumstances
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI				Prescription		Heroin		Fentanyl
	Prescription		097		3133		2163		2166		1519		4860		1954		6525		2447		3861		4014		3375			Recent release		789		1151		993
	Heroin		4854		3700		3737		4224		886		5701		3581		2435		5032		2317		3860		6117			Prior OD		1023		1234		1331
	Fentanyl			7467		7716		6264		8759		1215		7708		1820		7415		7027		6615		3598			Current treatment		980		836		755
															Recent opioid use relapse		755		1620		1296
															History of heroin abuse		1946		4259		3926
															History of Rx opioid abuse		1434		361		393
															History of Rx opioid AND heroin abuse		541		656		603

opioid deaths overall
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
	2nd-half 2016		524		156		1108		427		193		166		2063		210		1388		145		394		418			7192
	1st-half 2017		646		144		883		127		205		155		2389		214		1452		120		442		394			7171
															14363
																		14522

			KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
		2016		000		2821		163		070		1244		663		2648		095		490		205		2030		407
		2017			2986		136		000		1485		024		4641		235		1894		885		2902		1804

	KY-2016		KY-2017		ME-2016		ME-2017		MA-2016		MA-2017		MO-2016		MO-2017		NH-2016		NH-2017		NM-2016		NM-2017		OH-2016		OH-2017		OK-2016		OK-2017		PA-2016		PA-2017		RI-2016		RI-2017		WV-2016		WV-2017		WI-2016		WI-2017
IMF		171			82		60		708		596		236		84		132		146		13		11		996		1291		8		11		695		1002		79		48		164		205		106		96
Rx fent		5			1		1		3		1		5		2		1		0		6		0		5		2		11		11		5		2		3		1		2		0		7		3

KY		KY
ME		ME
MA		MA
NH		NH
NM		NM
OH		OH
OK		OK
RI		RI
WV		WV
WI		WI

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017

Cohort 1 states (N=10)

Preliminary resultsMissouri Pennsylvania data not available

Total deaths (20162017)10699

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths by state and reporting period

Preliminary results

Chart1

2nd-half 2016

1st-half 2017

State

Number of deaths

524

646

156

144

1108

883

193

205

166

155

2063

2389

210

214

145

120

394

442

418

394

Sheet1

Sheet1

IMF

Rx fent

Sheet2

Sheet2

2016

2017

Sheet3

Sheet3

2nd-half 2016

1st-half 2017

State

Number of deaths

Regional

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

	2016 and 2017 data combined (KY currently doesnt have any 2017 data in there)
	of all opioid deaths with these categories as cause of death (not mutually exclusive)															of each drug category with circumstances
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI				Prescription		Heroin		Fentanyl
	Prescription		097		3133		2163		2166		1519		4860		1954		6525		2447		3861		4014		3375			Recent release		789		1151		993
	Heroin		4854		3700		3737		4224		886		5701		3581		2435		5032		2317		3860		6117			Prior OD		1023		1234		1331
	Fentanyl			7467		7716		6264		8759		1215		7708		1820		7415		7027		6615		3598			Current treatment		980		836		755
															Recent opioid use relapse		755		1620		1296
															History of heroin abuse		1946		4259		3926
															History of Rx opioid abuse		1434		361		393
															History of Rx opioid AND heroin abuse		541		656		603

opioid deaths overall
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
	2nd-half 2016		524		156		1108		427		193		166		2063		210		1388		145		394		418			7192
	1st-half 2017		646		144		883		127		205		155		2389		214		1452		120		442		394			7171
															14363
																		14522

			KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
		2016		000		2821		163		070		1244		663		2648		095		490		205		2030		407
		2017			2986		136		000		1485		024		4641		235		1894		885		2902		1804

	KY-2016		KY-2017		ME-2016		ME-2017		MA-2016		MA-2017		MO-2016		MO-2017		NH-2016		NH-2017		NM-2016		NM-2017		OH-2016		OH-2017		OK-2016		OK-2017		PA-2016		PA-2017		RI-2016		RI-2017		WV-2016		WV-2017		WI-2016		WI-2017
IMF		171			82		60		708		596		236		84		132		146		13		11		996		1291		8		11		695		1002		79		48		164		205		106		96
Rx fent		5			1		1		3		1		5		2		1		0		6		0		5		2		11		11		5		2		3		1		2		0		7		3

KY		KY
ME		ME
MA		MA
NH		NH
NM		NM
OH		OH
OK		OK
RI		RI
WV		WV
WI		WI

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

Chart1

Series 1

Time Period

Number of Deaths

5592

5377

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths by state and reporting period

Preliminary results

Chart1

2nd-half 2016

1st-half 2017

State

Number of deaths

524

646

156

144

1108

883

193

205

166

155

2063

2389

210

214

145

120

394

442

418

394

Sheet1

Sheet1

IMF

Rx fent

Sheet2

Sheet2

2016

2017

Sheet3

Sheet3

2nd-half 2016

1st-half 2017

State

Number of deaths

Regional

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

	2016 and 2017 data combined (KY currently doesnt have any 2017 data in there)
	of all opioid deaths with these categories as cause of death (not mutually exclusive)															of each drug category with circumstances
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI				Prescription		Heroin		Fentanyl
	Prescription		097		3133		2163		2166		1519		4860		1954		6525		2447		3861		4014		3375			Recent release		789		1151		993
	Heroin		4854		3700		3737		4224		886		5701		3581		2435		5032		2317		3860		6117			Prior OD		1023		1234		1331
	Fentanyl			7467		7716		6264		8759		1215		7708		1820		7415		7027		6615		3598			Current treatment		980		836		755
															Recent opioid use relapse		755		1620		1296
															History of heroin abuse		1946		4259		3926
															History of Rx opioid abuse		1434		361		393
															History of Rx opioid AND heroin abuse		541		656		603

opioid deaths overall
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
	2nd-half 2016		524		156		1108		427		193		166		2063		210		1388		145		394		418			7192
	1st-half 2017		646		144		883		127		205		155		2389		214		1452		120		442		394			7171
															14363
																		14522

			KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
		2016		000		2821		163		070		1244		663		2648		095		490		205		2030		407
		2017			2986		136		000		1485		024		4641		235		1894		885		2902		1804

	KY-2016		KY-2017		ME-2016		ME-2017		MA-2016		MA-2017		MO-2016		MO-2017		NH-2016		NH-2017		NM-2016		NM-2017		OH-2016		OH-2017		OK-2016		OK-2017		PA-2016		PA-2017		RI-2016		RI-2017		WV-2016		WV-2017		WI-2016		WI-2017
IMF		171			82		60		708		596		236		84		132		146		13		11		996		1291		8		11		695		1002		79		48		164		205		106		96
Rx fent		5			1		1		3		1		5		2		1		0		6		0		5		2		11		11		5		2		3		1		2		0		7		3

KY		KY
ME		ME
MA		MA
NH		NH
NM		NM
OH		OH
OK		OK
RI		RI
WV		WV
WI		WI

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

1st half 2017
2nd half 2016

Sheet1

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths by state and reporting period

Preliminary results

Chart1

2nd-half 2016

1st-half 2017

State

Number of deaths

524

646

156

144

1108

883

193

205

166

155

2063

2389

210

214

145

120

394

442

418

394

Sheet1

Sheet1

IMF

Rx fent

Sheet2

Sheet2

2016

2017

Sheet3

Sheet3

2nd-half 2016

1st-half 2017

State

Number of deaths

Regional

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

	2016 and 2017 data combined (KY currently doesnt have any 2017 data in there)
	of all opioid deaths with these categories as cause of death (not mutually exclusive)															of each drug category with circumstances
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI				Prescription		Heroin		Fentanyl
	Prescription		097		3133		2163		2166		1519		4860		1954		6525		2447		3861		4014		3375			Recent release		789		1151		993
	Heroin		4854		3700		3737		4224		886		5701		3581		2435		5032		2317		3860		6117			Prior OD		1023		1234		1331
	Fentanyl			7467		7716		6264		8759		1215		7708		1820		7415		7027		6615		3598			Current treatment		980		836		755
															Recent opioid use relapse		755		1620		1296
															History of heroin abuse		1946		4259		3926
															History of Rx opioid abuse		1434		361		393
															History of Rx opioid AND heroin abuse		541		656		603

opioid deaths overall
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
	2nd-half 2016		524		156		1108		427		193		166		2063		210		1388		145		394		418			7192
	1st-half 2017		646		144		883		127		205		155		2389		214		1452		120		442		394			7171
															14363
																		14522

			KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
		2016		000		2821		163		070		1244		663		2648		095		490		205		2030		407
		2017			2986		136		000		1485		024		4641		235		1894		885		2902		1804

	KY-2016		KY-2017		ME-2016		ME-2017		MA-2016		MA-2017		MO-2016		MO-2017		NH-2016		NH-2017		NM-2016		NM-2017		OH-2016		OH-2017		OK-2016		OK-2017		PA-2016		PA-2017		RI-2016		RI-2017		WV-2016		WV-2017		WI-2016		WI-2017
IMF		171			82		60		708		596		236		84		132		146		13		11		996		1291		8		11		695		1002		79		48		164		205		106		96
Rx fent		5			1		1		3		1		5		2		1		0		6		0		5		2		11		11		5		2		3		1		2		0		7		3

KY		KY
ME		ME
MA		MA
NH		NH
NM		NM
OH		OH
OK		OK
RI		RI
WV		WV
WI		WI

	Series 1		Series 2		Series 3
1st half 2017		5592		24		2
2nd half 2016		5377		44		2
Category 3		35		18		3
Category 4		45		28		5

Rx Summit wwwNationalRxDrugAbuseSummitorg

Number of opioid overdose deaths by state and reporting period

Preliminary results

Chart1

2nd-half 2016

1st-half 2017

State

Number of deaths

524

646

156

144

1108

883

193

205

166

155

2063

2389

210

214

145

120

394

442

418

394

Sheet1

Sheet1

IMF

Rx fent

Sheet2

Sheet2

2016

2017

Sheet3

Sheet3

2nd-half 2016

1st-half 2017

State

Number of deaths

Regional

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

	2016 and 2017 data combined (KY currently doesnt have any 2017 data in there)
	of all opioid deaths with these categories as cause of death (not mutually exclusive)															of each drug category with circumstances
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI				Prescription		Heroin		Fentanyl
	Prescription		097		3133		2163		2166		1519		4860		1954		6525		2447		3861		4014		3375			Recent release		789		1151		993
	Heroin		4854		3700		3737		4224		886		5701		3581		2435		5032		2317		3860		6117			Prior OD		1023		1234		1331
	Fentanyl			7467		7716		6264		8759		1215		7708		1820		7415		7027		6615		3598			Current treatment		980		836		755
															Recent opioid use relapse		755		1620		1296
															History of heroin abuse		1946		4259		3926
															History of Rx opioid abuse		1434		361		393
															History of Rx opioid AND heroin abuse		541		656		603

opioid deaths overall
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
	2nd-half 2016		524		156		1108		427		193		166		2063		210		1388		145		394		418			7192
	1st-half 2017		646		144		883		127		205		155		2389		214		1452		120		442		394			7171
															14363
																		14522

			KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
		2016		000		2821		163		070		1244		663		2648		095		490		205		2030		407
		2017			2986		136		000		1485		024		4641		235		1894		885		2902		1804

	KY-2016		KY-2017		ME-2016		ME-2017		MA-2016		MA-2017		MO-2016		MO-2017		NH-2016		NH-2017		NM-2016		NM-2017		OH-2016		OH-2017		OK-2016		OK-2017		PA-2016		PA-2017		RI-2016		RI-2017		WV-2016		WV-2017		WI-2016		WI-2017
IMF		171			82		60		708		596		236		84		132		146		13		11		996		1291		8		11		695		1002		79		48		164		205		106		96
Rx fent		5			1		1		3		1		5		2		1		0		6		0		5		2		11		11		5		2		3		1		2		0		7		3

KY		KY
ME		ME
MA		MA
NH		NH
NM		NM
OH		OH
OK		OK
RI		RI
WV		WV
WI		WI

Chart1

2nd-half 2016

1st-half 2017

State

Number of deaths

524

646

156

144

1108

883

193

205

166

155

2063

2389

210

214

145

120

394

442

418

394

Sheet1

Sheet1

IMF

Rx fent

Sheet2

Sheet2

2016

2017

Sheet3

Sheet3

2nd-half 2016

1st-half 2017

State

Number of deaths

Regional

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

	2016 and 2017 data combined (KY currently doesnt have any 2017 data in there)
	of all opioid deaths with these categories as cause of death (not mutually exclusive)															of each drug category with circumstances
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI				Prescription		Heroin		Fentanyl
	Prescription		097		3133		2163		2166		1519		4860		1954		6525		2447		3861		4014		3375			Recent release		789		1151		993
	Heroin		4854		3700		3737		4224		886		5701		3581		2435		5032		2317		3860		6117			Prior OD		1023		1234		1331
	Fentanyl			7467		7716		6264		8759		1215		7708		1820		7415		7027		6615		3598			Current treatment		980		836		755
															Recent opioid use relapse		755		1620		1296
															History of heroin abuse		1946		4259		3926
															History of Rx opioid abuse		1434		361		393
															History of Rx opioid AND heroin abuse		541		656		603

opioid deaths overall
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
	2nd-half 2016		524		156		1108		427		193		166		2063		210		1388		145		394		418			7192
	1st-half 2017		646		144		883		127		205		155		2389		214		1452		120		442		394			7171
															14363
																		14522

			KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
		2016		000		2821		163		070		1244		663		2648		095		490		205		2030		407
		2017			2986		136		000		1485		024		4641		235		1894		885		2902		1804

	KY-2016		KY-2017		ME-2016		ME-2017		MA-2016		MA-2017		MO-2016		MO-2017		NH-2016		NH-2017		NM-2016		NM-2017		OH-2016		OH-2017		OK-2016		OK-2017		PA-2016		PA-2017		RI-2016		RI-2017		WV-2016		WV-2017		WI-2016		WI-2017
IMF		171			82		60		708		596		236		84		132		146		13		11		996		1291		8		11		695		1002		79		48		164		205		106		96
Rx fent		5			1		1		3		1		5		2		1		0		6		0		5		2		11		11		5		2		3		1		2		0		7		3

KY		KY
ME		ME
MA		MA
NH		NH
NM		NM
OH		OH
OK		OK
RI		RI
WV		WV
WI		WI

Sheet1

Sheet1

IMF

Rx fent

Sheet2

Sheet2

2016

2017

Sheet3

Sheet3

2nd-half 2016

1st-half 2017

State

Number of deaths

Regional

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

	2016 and 2017 data combined (KY currently doesnt have any 2017 data in there)
	of all opioid deaths with these categories as cause of death (not mutually exclusive)															of each drug category with circumstances
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI				Prescription		Heroin		Fentanyl
	Prescription		097		3133		2163		2166		1519		4860		1954		6525		2447		3861		4014		3375			Recent release		789		1151		993
	Heroin		4854		3700		3737		4224		886		5701		3581		2435		5032		2317		3860		6117			Prior OD		1023		1234		1331
	Fentanyl			7467		7716		6264		8759		1215		7708		1820		7415		7027		6615		3598			Current treatment		980		836		755
															Recent opioid use relapse		755		1620		1296
															History of heroin abuse		1946		4259		3926
															History of Rx opioid abuse		1434		361		393
															History of Rx opioid AND heroin abuse		541		656		603

opioid deaths overall
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
	2nd-half 2016		524		156		1108		427		193		166		2063		210		1388		145		394		418			7192
	1st-half 2017		646		144		883		127		205		155		2389		214		1452		120		442		394			7171
															14363
																		14522

			KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
		2016		000		2821		163		070		1244		663		2648		095		490		205		2030		407
		2017			2986		136		000		1485		024		4641		235		1894		885		2902		1804

	KY-2016		KY-2017		ME-2016		ME-2017		MA-2016		MA-2017		MO-2016		MO-2017		NH-2016		NH-2017		NM-2016		NM-2017		OH-2016		OH-2017		OK-2016		OK-2017		PA-2016		PA-2017		RI-2016		RI-2017		WV-2016		WV-2017		WI-2016		WI-2017
IMF		171			82		60		708		596		236		84		132		146		13		11		996		1291		8		11		695		1002		79		48		164		205		106		96
Rx fent		5			1		1		3		1		5		2		1		0		6		0		5		2		11		11		5		2		3		1		2		0		7		3

Sheet1

IMF

Rx fent

Sheet2

Sheet2

2016

2017

Sheet3

Sheet3

2nd-half 2016

1st-half 2017

State

Number of deaths

Regional

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

	2016 and 2017 data combined (KY currently doesnt have any 2017 data in there)
	of all opioid deaths with these categories as cause of death (not mutually exclusive)															of each drug category with circumstances
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI				Prescription		Heroin		Fentanyl
	Prescription		097		3133		2163		2166		1519		4860		1954		6525		2447		3861		4014		3375			Recent release		789		1151		993
	Heroin		4854		3700		3737		4224		886		5701		3581		2435		5032		2317		3860		6117			Prior OD		1023		1234		1331
	Fentanyl			7467		7716		6264		8759		1215		7708		1820		7415		7027		6615		3598			Current treatment		980		836		755
															Recent opioid use relapse		755		1620		1296
															History of heroin abuse		1946		4259		3926
															History of Rx opioid abuse		1434		361		393
															History of Rx opioid AND heroin abuse		541		656		603

opioid deaths overall
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
	2nd-half 2016		524		156		1108		427		193		166		2063		210		1388		145		394		418			7192
	1st-half 2017		646		144		883		127		205		155		2389		214		1452		120		442		394			7171
															14363
																		14522

			KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
		2016		000		2821		163		070		1244		663		2648		095		490		205		2030		407
		2017			2986		136		000		1485		024		4641		235		1894		885		2902		1804

Sheet2

Sheet2

2016

2017

Sheet3

Sheet3

2nd-half 2016

1st-half 2017

State

Number of deaths

Regional

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

	2016 and 2017 data combined (KY currently doesnt have any 2017 data in there)
	of all opioid deaths with these categories as cause of death (not mutually exclusive)															of each drug category with circumstances
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI				Prescription		Heroin		Fentanyl
	Prescription		097		3133		2163		2166		1519		4860		1954		6525		2447		3861		4014		3375			Recent release		789		1151		993
	Heroin		4854		3700		3737		4224		886		5701		3581		2435		5032		2317		3860		6117			Prior OD		1023		1234		1331
	Fentanyl			7467		7716		6264		8759		1215		7708		1820		7415		7027		6615		3598			Current treatment		980		836		755
															Recent opioid use relapse		755		1620		1296
															History of heroin abuse		1946		4259		3926
															History of Rx opioid abuse		1434		361		393
															History of Rx opioid AND heroin abuse		541		656		603

opioid deaths overall
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
	2nd-half 2016		524		156		1108		427		193		166		2063		210		1388		145		394		418			7192
	1st-half 2017		646		144		883		127		205		155		2389		214		1452		120		442		394			7171
															14363
																		14522

			KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
		2016		000		2821		163		070		1244		663		2648		095		490		205		2030		407
		2017			2986		136		000		1485		024		4641		235		1894		885		2902		1804

Sheet2

2016

2017

Sheet3

Sheet3

2nd-half 2016

1st-half 2017

State

Number of deaths

Regional

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

	2016 and 2017 data combined (KY currently doesnt have any 2017 data in there)
	of all opioid deaths with these categories as cause of death (not mutually exclusive)															of each drug category with circumstances
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI				Prescription		Heroin		Fentanyl
	Prescription		097		3133		2163		2166		1519		4860		1954		6525		2447		3861		4014		3375			Recent release		789		1151		993
	Heroin		4854		3700		3737		4224		886		5701		3581		2435		5032		2317		3860		6117			Prior OD		1023		1234		1331
	Fentanyl			7467		7716		6264		8759		1215		7708		1820		7415		7027		6615		3598			Current treatment		980		836		755
															Recent opioid use relapse		755		1620		1296
															History of heroin abuse		1946		4259		3926
															History of Rx opioid abuse		1434		361		393
															History of Rx opioid AND heroin abuse		541		656		603

opioid deaths overall
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
	2nd-half 2016		524		156		1108		427		193		166		2063		210		1388		145		394		418			7192
	1st-half 2017		646		144		883		127		205		155		2389		214		1452		120		442		394			7171
															14363
																		14522

Sheet3

Sheet3

2nd-half 2016

1st-half 2017

State

Number of deaths

Regional

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

	2016 and 2017 data combined (KY currently doesnt have any 2017 data in there)
	of all opioid deaths with these categories as cause of death (not mutually exclusive)															of each drug category with circumstances
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI				Prescription		Heroin		Fentanyl
	Prescription		097		3133		2163		2166		1519		4860		1954		6525		2447		3861		4014		3375			Recent release		789		1151		993
	Heroin		4854		3700		3737		4224		886		5701		3581		2435		5032		2317		3860		6117			Prior OD		1023		1234		1331
	Fentanyl			7467		7716		6264		8759		1215		7708		1820		7415		7027		6615		3598			Current treatment		980		836		755
															Recent opioid use relapse		755		1620		1296
															History of heroin abuse		1946		4259		3926
															History of Rx opioid abuse		1434		361		393
															History of Rx opioid AND heroin abuse		541		656		603

opioid deaths overall
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI
	2nd-half 2016		524		156		1108		427		193		166		2063		210		1388		145		394		418			7192
	1st-half 2017		646		144		883		127		205		155		2389		214		1452		120		442		394			7171
															14363
																		14522

Sheet3

2nd-half 2016

1st-half 2017

State

Number of deaths

Regional

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

	2016 and 2017 data combined (KY currently doesnt have any 2017 data in there)
	of all opioid deaths with these categories as cause of death (not mutually exclusive)															of each drug category with circumstances
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI				Prescription		Heroin		Fentanyl
	Prescription		097		3133		2163		2166		1519		4860		1954		6525		2447		3861		4014		3375			Recent release		789		1151		993
	Heroin		4854		3700		3737		4224		886		5701		3581		2435		5032		2317		3860		6117			Prior OD		1023		1234		1331
	Fentanyl			7467		7716		6264		8759		1215		7708		1820		7415		7027		6615		3598			Current treatment		980		836		755
															Recent opioid use relapse		755		1620		1296
															History of heroin abuse		1946		4259		3926
															History of Rx opioid abuse		1434		361		393
															History of Rx opioid AND heroin abuse		541		656		603

Regional

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

	2016 and 2017 data combined (KY currently doesnt have any 2017 data in there)
	of all opioid deaths with these categories as cause of death (not mutually exclusive)															of each drug category with circumstances
		KY		ME		MA		MO		NH		NM		OH		OK		PA		RI		WV		WI				Prescription		Heroin		Fentanyl
	Prescription		097		3133		2163		2166		1519		4860		1954		6525		2447		3861		4014		3375			Recent release		789		1151		993
	Heroin		4854		3700		3737		4224		886		5701		3581		2435		5032		2317		3860		6117			Prior OD		1023		1234		1331
	Fentanyl			7467		7716		6264		8759		1215		7708		1820		7415		7027		6615		3598			Current treatment		980		836		755
															Recent opioid use relapse		755		1620		1296
															History of heroin abuse		1946		4259		3926
															History of Rx opioid abuse		1434		361		393
															History of Rx opioid AND heroin abuse		541		656		603

Regional

Prescription

Heroin

Fentanyl

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

Prescription

Heroin

Fentanyl

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

Rx Summit wwwNationalRxDrugAbuseSummitorg

Most common prescription opioids involved in opioid overdose deaths

Prescription opioids3285 (30) deaths

Oxycodone1331 (41)

Hydrocodone576 (18)

Methadone542 (17)

Morphine448 (14)

Buprenorphine374 (11)

Oxymorphone334 (10)

Preliminary results

Substances listed as cause of death count does not include fentanyl categories not mutually exclusive

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

Rx Summit wwwNationalRxDrugAbuseSummitorg

Redefining morphine as heroin using scene and toxicology evidence

MorphineOriginal 4569 (42)Recoded 557 (6)

HeroinConfirmed 3437 (31)

Probable 813 (7)Suspected 0

Heroin- Confirmed heroin-positive- Probable morphine-positive evidence of injectionheroin useillicit drug use and no

evidence of prescription morphine use- Suspected morphine-positive no scene evidence heroin listed as cause of death

Morphine recoded morphine-positive not confirmedprobablesuspected heroin

Unknown morphine-positive no scene evidence

Preliminary results

Unknown386 (4)

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

Rx Summit wwwNationalRxDrugAbuseSummitorg

SUDORS Data

Drug potency

Polysubstance use

Route of administration

Overdose response

Health conditions

comorbidities

Capturing fentanyl analogs

All substances

present

Scene evidence indicating route(s)

Bystanders present naloxone

administration

Pain treatment

comorbidities

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

Rx Summit wwwNationalRxDrugAbuseSummitorg

Acknowledgments

State health departments participating in CDCrsquos Enhanced State Opioid Overdose Surveillance (ESOOS) program

State and local jurisdictions participating in CDCrsquos National Syndromic Surveillance Program (NSSP)BioSense ESSENCE

CDC ESOOS staff- Puja Seth- Reshma Mahendra- Alana Vivolo-Kantor- Christine Mattson- Shelby Alexander- Sabeen Bhimani- Felicita David- Naomi David- Terry Davis- Matthew Gladden- John Halpin

- Brooke Hoots- Mbabazi Kariisa- Stephen Liu- Londell McGlone- Julie OrsquoDonnell- Anita Pullani- Rose Rudd- Lawrence Scholl- Jessica Simpson- Nana Wilson

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

Rx Summit wwwNationalRxDrugAbuseSummitorg

Faster Data The CDC-Funded Enhanced State Opioid Overdose

Surveillance ProgramPuja Seth PhD Lead Overdose Epidemiology and Surveillance Team

Centers for Disease Control and Prevention (CDC)

Alana Vivolo-Kantor PhD MPH Behavioral Scientist CDC

Julie ODonnell PhD MPH Epidemiologist CDC

Federal Track

Moderator Puja Seth

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69

THANK YOURxSummit

wwwNationalRxDrugAbuseSummitorg

• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Disclosures
• Disclosures
• Learning Objectives
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program (ESOOS)
• Disclosure Statement
• Goals
• Opioid Overdoses Treated in Emergency Departments
• Slide Number 9
• Slide Number 10
• Slide Number 11
• Slide Number 12
• Slide Number 13
• Slide Number 14
• CDCrsquos Pillars on Opioids
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Enhanced State Opioid Overdose Surveillance (ESOOS)
• Funded ESOOS states
• Slide Number 19
• Next Two Presentationshellip
• The utilization of emergency department syndromic surveillance and emergency medical services data to monitor nonfatal opioid overdoses
• Disclosure Statement
• Why Emergency Department and Emergency Medical Service Data for Surveillance
• Our Philosophy
• Our approach
• Emergency Department Data
• Case definitions for suspected overdose
• Emergency medical services data
• Challenges in EMS data
• Data submission process
• Sample quality control report
• Sample site report
• ED results All drug (11 sites)
• ED results Opioid (11 sites)
• ED results Heroin (11 sites)
• Annual percentage changes (11 sites)
• Summary
• Slide Number 38
• Emergency department data dissemination efforts
• Fatal Opioid Overdose SurveillanceThe State Unintentional Drug Overdose Reporting System
• Disclosure Statement
• Slide Number 42
• Increase in deaths outpaces increase in use
• Slide Number 44
• Fatal opioid overdose surveillance
• Slide Number 46
• SUDORS data submitted bi-annually
• SUDORS leverages National Violent Death Reporting System (NVDRS) platform
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Overdose-specific fields
• Toxicology information
• SUDORS data as good as sources allow
• Despite limitations SUDORS data have many strengths
• Preliminary results
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths increasing 2nd-half 2016 to 1st-half 2017
• Number of opioid overdose deaths by state and reporting period
• Most common prescription opioids involved in opioid overdose deaths
• Redefining morphine as heroin using scene and toxicology evidence
• Slide Number 66
• Acknowledgments
• Faster Data The CDC-Funded Enhanced State Opioid Overdose Surveillance Program
• Slide Number 69