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G3O5. Decrease those struggling with substance abuse

Reduce the number of ER visits related to overdoses

16,869.02020

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Story Behind the Curve

Data Background

The data presented above can be found on the Indiana Drug Overdose Dashboard and is from the Indiana hospitalizations and emergency department (ED) visit data are a subset of data compiled from the Uniform Billing 2004 form. The data are supplied by the Indiana Hospital Association under a contract with IDOH. Data are processed by the IDOH, Office of Data and Analytics, Data Analysis Team to provide a dataset that is analyzed by the Hospital Discharge Data Analyst in conjunction with the Division of Trauma and Injury Prevention.

The inpatient (hospitalizations) data contain Indiana residents discharged from a non-federal, acute care facility who were admitted to the hospital. The outpatient (ED visits) data - shown above - contain Indiana residents discharged from a non-federal, acute care facility who received emergency services without being admitted to the hospital. Each hospitalization and ED visit are assigned ICD-10-CM codes* for the principal reason and up to 59 secondary reasons for the hospital visit. Statistics in these dashboards are based on all 60 diagnoses, and the frequencies are based on the decedent’s county of residence, not the county where the event occurred. The dashboard’s morbidity data reflects definitions of drug poisoning (overdose) and contributing involved drugs based on guidance provided by the CDC (see Table 1). Rates based on counts less than 20 are considered unstable/unreliable (U) and should be interpreted with caution. Age-adjusted rate per 100,000 was calculated using the 2000 Standard Million Population, U.S. Bureau of Census. To avoid over-counting the number of drug-related events, counts from various drug categories should not be added to counts from other categories as multiple drugs can be listed on the billing codes for drug poisoning events, and events can be included in more than one of these tables for discharges from certain drugs and drug types. An individual can have more than one hospitalization or ED visit during the reporting time frame. Frequencies and rates are based on the number of discharges and not on the number of individuals seen.

This data can also be found on the Indiana Department of Health's Stats Explorer. However, morbidity rates reported in this dashboard vary from the data shared on the Stats Explorer website, as the dashboard portrays age-adjusted rates rather than crude population rates. Dashboard reviewers should be aware of this difference when comparing the website data elements.

Table 1. Non-fatal Drug Poisoning (Overdose) Definitions for Indiana Hospital Discharge Morbidity Data

Definition Diagnosis/ICD-10-CM Codes

All drug overdose emergency department visits/hospitalizations 

[T36.x-T50.x] (1A): Unintentional Poisoning by drug; initial encounter [T36.x-T50.x] (2A): Self-Harm Poisoning by drug; initial encounter [T36.x-T50.x] (4A): Undetermined Poisoning by drug; initial encounter

Emergency department visits/hospitalizations involving any opioid 

[T40.0, T40.1, T40.2, T40.3, T40.4, T40.60, T40.69] (1A): Unintentional Poisoning by drug; initial encounter [T40.0, T40.1, T40.2, T40.3, T40.4, T40.60, T40.69] (2A): Self-Harm Poisoning by drug; initial encounter [T40.0, T40.1, T40.2, T40.3, T40.4, T40.60, T40.69] (4A): Undetermined Poisoning by drug; initial encounter

Emergency department visits/hospitalizations involving opioid pain relievers

[T40.2, T40.3, T40.4] (1A): Unintentional Poisoning by drug; initial encounter [T40.2, T40.3, T40.4] (2A): Self-Harm Poisoning by drug; initial encounter [T40.2, T40.3, T40.4] (4A): Undetermined Poisoning by drug; initial encounter

Emergency department visits/hospitalizations involving heroin

[T40.1] (1A): Unintentional Poisoning by drug; initial encounter [T40.1] (2A): Self-Harm Poisoning by drug; initial encounter [T40.1] (4A): Undetermined Poisoning by drug; initial encounter

Emergency department visits/hospitalizations involving cocaine

[T40.5] (1A): Unintentional Poisoning by drug; initial encounter [T40.5] (2A): Self-Harm Poisoning by drug; initial encounter [T40.5] (4A): Undetermined Poisoning by drug; initial encounter

Emergency department visits/hospitalizations visits involving synthetic opioids

[T40.4] (1A): Unintentional Poisoning by drug; initial encounter [T40.4] (2A): Self-Harm Poisoning by drug; initial encounter [T40.4] (4A): Undetermined Poisoning by drug; initial encounter

Emergency department visits involving benzodiazepines

[T42.4] (1A): Unintentional Poisoning by drug; initial encounter [T42.4] (2A): Self-Harm Poisoning by drug; initial encounter [T42.4] (4A): Undetermined Poisoning by drug; initial encounter

Fast Facts

  • From 2019 to 2020, there was a 13.7% increase in the number of ER visits related to overdoses. Provisional data for 2021 shows a similar increase of 13.1% from 2020, for a total increased of 26.8% over the two years.
  • The top five counties in Indiana with the highest counts of ER visits related to overdoses in 2020 are: Marion County with 3,550, Lake County with 690, Allen County with 766, St. Joseph County with 690 and Delaware County with 475.
  • The demographics most affected in this counties were males, 24-35 year olds and the white population, with the exception of Allen County whose most affected age range was 15-24 year olds.
  • According to Soares et al. (2022), overdose visit counts increased by 10.5% in 2020 compared with the counts in 2018 and 2019, despite a 14% decline in all-cause ED visits. Additionally, opioid overdose rates increased by 28.5% from 0.25 per 100 ED visits in 2018 to 2019 to 0.32 per 100 ED visits in 2020.
  • A cross-sectional study by Holland et al. (2021) of almost 190 million ED visits found that visit rates for mental health conditions, suicide attempts, all drug and opioid overdoses, intimate partner violence, and child abuse and neglect were higher in mid-March through October 2020, during the COVID-19 pandemic, compared with the same period in 2019.

 

* The ICD-10-CM is a morbidity classification published by the United States for classifying diagnoses and reason for visits in all health care settings. The ICD-10-CM is based on the ICD-10, the statistical classification of disease published by the World Health Organization (WHO).

What Works

The Center for Disease Control and Prevention (CDC) has a mission of preventing overdoses and substance-use related harms that is guided by  Six Principles and Five Strategic Priorities.

Guiding Principles

  1. Promote Health Equity
    1. All individuals have the right to be as healthy as possible. CDC is committed to ensuring everyone has an equitable opportunity to prevent overdose and substance use-related harms and remains dedicated to addressing and ending health disparities related to the overdose crisis. CDC also promotes actions to advance health equity to ensure all communities can fight the overdose crisis together.
  2. Address Underlying Factors
    1. Many factors contribute to harms associated with substance use while other factors can be protective. CDC is committed to identifying these factors to better design and focus interventions to address the overdose crisis, while attending to health disparities and inequities
  3. Partner Broadly
    1. Addressing the overdose crisis requires partnering with multiple sectors and organizations within all of CDC’s strategic priorities. Partnerships provide opportunities to develop, coordinate, and implement targeted strategies to prevent harm. CDC is dedicated to broad and diverse partnerships as a foundation of preventing overdose and substance-use related harms.
  4. Take Evidence-Based Action
    1. To better address the overdose crisis, CDC promotes strategies that have been extensively researched by scientists. Evidence-based action ensures the delivery (or implementation) of effective methods for preventing and reducing overdose and substance use-related harms that are translated and adapted for diverse audiences and settings.
  5. Advance Science
    1. Continuing to build the evidence-base for what works to prevent overdose and substance-use related harms is critical to ending the overdose crisis. By advancing science through supporting public health surveillance, identifying risk and protective factors, developing and evaluating prevention strategies, and ensuring effective communication strategies that are adapted for diverse audiences, CDC is committed to building the evidence-base for what works to end the overdose crisis.
  6. Drive Innovation
    1. The overdose crisis will require new and innovative ideas to prevent overdose and substance use-related harms. CDC promotes the generation, implementation, evaluation, and widespread adoption of innovative ideas to address the overdose crisis in all areas of its work.

Strategic Priorities

  1. Monitor, Analyze, and Communicate Trends
    1. Timely, high-quality data help public health officials and other decision-makers understand the extent of the problem, focus resources where they are needed most, particularly among populations disproportionately affected by overdose, and evaluate the success of overdose and substance use-related harm prevention efforts. Recognizing the importance of data, CDC is helping jurisdictions track overdose-related morbidity and mortality as well as use data to inform prevention activities.
  2. Build State, Tribal, Local, and Territorial Capacity
    1. States, tribes, local communities, and territories play an important role in preventing overdoses and substance use-related harms. They provide public health leadership; drive innovation; partner and collaborate; leverage surveillance to detect trends; and promote education, prevention (i.e., primary, secondary, and tertiary), and treatment. CDC works with jurisdictions to build their capacity in these and other areas to respond to the overdose crisis.
  3. Support Providers, Health Systems, Payors, and Employers
    1. Providers and health systems are crucial in promoting safer opioid prescribing and more effective and equitable pain management among adults and youth as well as providing evidence-based treatment for substance use disorders, particularly among disproportionately affected populations. In addition, health systems can implement quality improvement measures to track their efforts, integrate these measures into their electronic health records, and support care coordination. Private and public insurers and pharmacy benefit managers can help address the overdose crisis by addressing gaps in coverage, removing barriers to treatment for substance use disorders and pain treatments, and conducting drug utilization reviews. Employers can play a critical role in preventing overdose by offering comprehensive benefits and supporting employees affected by substance use disorders.
  4. Partner with Public Safety and Community Organizations
    1. CDC continues to build multidisciplinary and diverse partnerships through public health and public safety collaborations at national, state, and local levels to strengthen efforts to reduce drug overdoses. These partnerships allow for effective and equitable implementation of programs and help advance promising strategies that address the overdose crisis, while helping to eliminate the longstanding impact of systemic inequities on overdose prevention. For example, public safety collaborations can reach individuals during critical times such as involvement with the criminal justice system. In addition, partnerships with community organizations can link individuals to substance use disorder treatment or reduce substance use-related harms. These opportunities can bridge knowledge, data, and service gaps that impact the success of community-wide overdose prevention actions.
  5. Raise Public Awareness and Reduce Stigma
    1. CDC prioritizes raising awareness about all aspects of substance use including the risks of substance use and preventing associated harms among persons who use drugs, their families, and communities. In addition, CDC promotes evidence-based treatment for substance use disorders and advances understanding that addiction is a chronic disease. CDC also works to reduce stigma because stigma prevents people from seeking help for substance use disorders. CDC reduces stigma by addressing misinformation, endorsing non-stigmatizing language, and promoting awareness of stigma’s impact including among populations disproportionately affected by substance use and overdose.

Source: CDC Drug Overdose 

 

 

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Indiana Drug Overdose Dashboard

Source last updated: February 24, 2022

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