Provisional data in the United States shows that the reported number of drug overdose deaths occurring in the United States decreased by 0.9% from the 12 months ending in September 2018 to the 12 months ending in September 2019, from 68,421 to 67,839.
QuickStats: Percentage of Emergency Department Visits for Pain at Which Opioids Were Given or Prescribed, by Geographic Region of the Hospital — United States, 2005–2017January 17, 2020
The percentage of emergency department visits for pain at which an opioid was given or prescribed increased from 37.4% in 2005 to 43.1% in 2010 and then decreased to 30.9% in 2017.
A similar pattern was observed in all four regions. Percentages for the Northeast were lower than for the nation as a whole for all years analyzed.
In 2017, the percentage was 21.1% in the Northeast, compared with 32.0% in the Midwest, 32.0% in the South, and 34.7% in the West.
Source: National Center for Health Statistics. National Hospital Ambulatory Medical Care Survey, 2005–2017. https://www.cdc.gov/nchs/ahcd/ahcd_questionnaires.htm.
Trends in Opioids Prescribed at Discharge From Emergency Departments Among Adults: United States, 2006–2017January 8, 2020
Questions for Lead Author Anna Rui, Health Statistician, of “Trends in Opioids Prescribed at Discharge From Emergency Departments Among Adults: United States, 2006–2017.”
Q: Why did you decide to look at opioid prescribing at emergency department discharges?
AR: There is a large body of research reporting increases in opioid prescription rates from 1999 to 2010 but less is known about how rates have changed from 2010 on, particularly in the emergency department setting, where many patients present with pain symptoms and are likely to receive opioids for treatment. In response to the opioid epidemic, hundreds of local, state, and federal programs were implemented in recent years with the goal of changing prescribing practices. A goal of this report was to evaluate recent trends in opioid prescribing, in order to monitor the effects of public health policy.
Q: How did the data vary by patient/hospital characteristics and in the type of opioids prescribed at discharge?
AR: Variation in the rate of change was found for age, patient residence, and primary expected source of payment. The rate of decrease in the percentage of visits with an opioid prescribed at discharge by younger patients aged 18-44 from both the beginning of the study period (2006-2007) and from the inflection point (2010-2011) to the end of the study period (2016-2017) was the highest across all age groups. Similarly, the percentage of visits by patients living in medium or small metropolitan counties decreased by the highest percentage across the study period among all urban and rural categories. Both Medicaid and self-pay/no charge/charity experienced the highest rate of decrease from 2010-2011 through 2016-2017 whereas the percentage of visits by patients with Medicare that included an opioid prescribed at discharge remained stable across the study period.
In terms of hospital characteristics, among the four regions, the largest decrease in opioids prescribed at discharge from 2006-2007 to 2016-2017 was observed in the Northeast region. Generally, a higher percentage of visits at proprietary (or for-profit) hospital EDs, compared with nonprofit and government hospital EDs, included an opioid prescribed at discharge. Despite the high percentage, the rate of decrease among visits made to proprietary hospital EDs from 2006-2007 through 2016-2017 was modest.
In terms of the type of opioids prescribed, the percentage of opioid mentions with acetaminophen-hydrocodone (e.g., Vicodin) prescribed remained stable through 2012-2013 and decreased starting from 2014-2015. Corresponding to this decrease, the percentage of opioid mentions with tramadol and acetaminophen-codeine, which are known as having a lesser risk of dependence, increased starting in 2014-2015 and continued through 2016-2017.
Q: Was there a specific finding in the data that surprised you?
AR: One finding that surprised me was the magnitude of decrease in the percentage of opioids prescribed from 2010-2011 through 2016-2017 for most of the pain-related diagnoses. For example, the percentage of visits for extremity and back pain decreased by 68.8% and 49.1%, respectively, between 2010-2011 and 2016-2017.
Q: How did you obtain this data for this report?
AR: Restricted data (available from the Research Data Center) collected from the National Hospital Ambulatory Medical Care Survey were used for this report. Masked public use data are available for download from the Ambulatory Health Care Data website (https://www.cdc.gov/nchs/ahcd/datasets_documentation_related.htm)
Q: What is the take home message for this report?
AR: I think the take home message of the report is recent trends show a decrease in the percentage of visits with opioids prescribed at discharge from 2010-2011 through 2016-2017, and this trend was observed for most of the patient and hospital characteristics examined, as well as for most of the pain-related diagnoses prompting the ED visit.
Regional Differences in the Drugs Most Frequently Involved in Drug Overdose Deaths: United States, 2017October 25, 2019
NCHS report describes regional differences in the specific drugs most frequently involved in drug overdose deaths in the United States in 2017. Data from the 2017 National Vital Statistics System–Mortality files were linked to electronic files containing literal text information from death certificates.
- Among drug overdose deaths in 2017 that mentioned at least 1 specific drug on the death certificate, the 10 drugs most frequently involved included fentanyl, heroin, cocaine, methamphetamine, alprazolam, oxycodone, morphine, methadone, hydrocodone, and diphenhydramine.
- Regionally, 6 drugs (alprazolam, cocaine, fentanyl, heroin, methadone, and oxycodone) were found among the 10 most frequently involved drugs in all 10 HHS regions, although the relative ranking varied by region.
- Age-adjusted rates of drug overdose deaths involving fentanyl or deaths involving cocaine were higher in the regions east of the Mississippi River, while age-adjusted rates for drug overdose deaths involving methamphetamine were higher in the West.
- The regional patterns observed did not change after adjustment for differences in the specificity of drug reporting.
Opioids Prescribed at Discharge or Given During Emergency Department Visits Among Adults in the United States, 2016May 31, 2019
Questions for Lead Author Anna Rui, Health Statistician, of “Opioids Prescribed at Discharge or Given During Emergency Department Visits Among Adults in the United States, 2016.”
Q: Why did you decide to focus on opioids prescribed at discharge or given during emergency department visits in the United States for this report?
Prescription opioid abuse and overdose continue to be critical public health issues. Opioid misuse, abuse, and overdose are affected by multiple factors including the number of people exposed. The Emergency Department (ED) is one setting where people could become exposed to opioids. In 2016, 27.5% of adult ED visits included opioids given in the ED, prescribed at ED discharge, or both (data not shown in report). The ED setting is where people frequently receive their first opioid treatment, after which patients with moderate to severe pain are often sent home with a prescription for an opioid, leaving them with the option of filling/not filling the prescription, or diverting filled prescriptions.
In the National Hospital Ambulatory Medical Care Survey (NHAMCS), information is collected on whether drugs are given during the ED visit, prescribed at discharge, or both. However, in our published reports, the focus is on estimates of drugs and visits with drugs rather than how they are administered. I wanted to assess visits with opioids prescribed at discharge separately to see how they compared with those given in the ED, in order to glean new information that has not previously been reported. This could hopefully provide additional insight into patient populations visiting the ED who are exposed to opioids.
Q: How do rates of visits with opioids only given in the ED compare with opioids only prescribed at discharge and visits with both given and prescribed opioids?
AR: Generally, the rate of ED visits with opioids given during the visit was higher than the rate of ED visits with opioids prescribed at discharge. Compared with the rate of ED visits with opioids prescribed at discharge, the rate where opioids were only given in the ED was higher among patients aged 45 and over and for both women and men. Adults aged 18-44 were more likely to receive a prescription for an opioid at discharge compared with adults 45 and over.
Q: How did the data vary by emergency department visits where opioids were given, prescribed or both by primary diagnosis?
AR: The type of opioid administration among ED visits where opioids were given, prescribed, or both varied for certain selected diagnoses. For visits with a primary diagnosis of injury or trauma with opioids given or prescribed, the percentage with opioids only prescribed at discharge (40.7%) was higher than both the percentage of visits with opioids only given at the ED visit (26.3%) and visits with opioids both given and prescribed at discharge (32.7). Conversely, at visits for chest pain and abdominal pain with opioids given and/or prescribed, a higher percentage of opioids were only given at the ED visit. There was no variation across the types of opioid administration for back pain and extremity pain.
Q: Was there a specific finding in your report that surprised you?
AR:I was surprised at the high percentages of visits with opioids prescribed at discharge compared with those only given in the ED for certain diagnoses. For example, among visits with a primary diagnosis of injury or trauma and where opioids were given or prescribed, a total of 73.4% included an opioid prescription at discharge. Among visits primarily for extremity pain and where opioids were given or prescribed, 67.9% included an opioid prescription at discharge. Finally, among visits primarily for back pain in which opioids were given or prescribed, 64.5% included an opioid prescription at discharge. However I should also note that these estimates are based only on visits where the patient got opioids during the visit or at discharge. For example, there are other ED visits made for injury where the patient did not get opioids at all, but we did not assess this in the report.
Q: Do you foresee the number of prescription opioids at emergency department visits increasing in the future?
AR: We do not make predictions about future data trends, but other research published by CDC for recent years showed stable or declining trends in the percentage of visits with opioids given in the ED, prescribed at discharge, or both.
Prescription opioid analgesics are used to treat pain from surgery, injury, and health conditions such as cancer. Opioid dependence and opioid-related deaths are growing public health problems. Opioid analgesic sales (in kilograms per 10,000) quadrupled from 1999 to 2010, and from 1999 to 2012, opioid-related deaths (per 100,000) more than tripled. During 1999–2002, 4.2% of persons aged 18 and over used a prescription opioid analgesic in the past 30 days.
A new NCHS report provides updated estimates and trends in prescription opioid analgesic use among adults aged 20 and over, overall and by selected subgroups.
Key Findings from the Report:
- From 1999–2002 to 2003–2006, the percentage of adults aged 20 and over who used a prescription opioid analgesic in the past 30 days increased from 5.0% to 6.9%. From 2003–2006 to 2011–2012, the percentage who used an opioid analgesic remained stable at 6.9%.
- From 1999–2002 to 2011–2012, the percentage of opioid analgesic users who used an opioid analgesic stronger than morphine increased from 17.0% to 37.0%.
- During 2007–2012, the use of opioid analgesics was higher among women (7.2%) than men (6.3%).
- During 2007–2012, the use of opioid analgesics was higher among non-Hispanic white adults (7.5%) compared with Hispanic adults (4.9%). There was no significant difference in use between non-Hispanic white adults and non-Hispanic black adults (6.5%).
A new NCHS Health E-Stat provides information on annual rates of all drug-poisoning deaths and drug-poisoning deaths involving opioid analgesics and heroin for 1999 through 2012 using data from the Centers for Disease Control and Prevention’s National Vital Statistics System.
In 2012, there were 41,502 deaths due to drug poisoning (often referred to as drug-overdose deaths) in the United States, of which 16,007 involved opioid analgesics and 5,925 involved heroin.
From 1999 through 2012, the age-adjusted drug-poisoning death rate nationwide more than doubled, from 6.1 per 100,000 population in 1999 to 13.1 in 2012. During the same period, the age-adjusted rates for drug-poisoning deaths involving opioid analgesics more than tripled, from 1.4 per 100,000 in 1999 to 5.1 in 2012. Opioid-analgesic death rates increased at a fast pace from 1999 through 2006, with an average increase of about 18% each year, and then at a slower pace from 2006 forward. The decline in opioid-analgesic death rates from 2011 through 2012, a decline of 5%, is the first decrease seen in more than a decade.
Also from 1999 through 2012, the age-adjusted rates for drug-poisoning deaths involving heroin nearly tripled, from 0.7 deaths per 100,000 in 1999 to 1.9 in 2012. The rates increased substantially beginning in 2006. Between 2011 and 2012, the rate of drug-poisoning deaths involving heroin increased 35%, from 1.4 per 100,000 to 1.9.
In 2012, 14 states had age-adjusted drug-poisoning death rates that were significantly higher than the overall U.S. rate. The states with the highest rates per 100,000 population were West Virginia (32.0), Kentucky (25.0), New Mexico (24.7), Utah (23.1), and Nevada (21.0).