Drug Overdose Deaths, Hospitalizations, and Emergency Department Visits in Kentucky,

Transcription

1 Drug Overdose Deaths, Hospitalizations, and Emergency Department Visits in Kentucky, 2-212

2 Kentucky Injury Preven on and Research Center Drug Overdose Deaths, Hospitaliza ons, and Emergency Department Visits in Kentucky, January, 214 Prepared by Svetla Slavova, PhD Terry L. Bunn, PhD Joshua W. Lambert, MS Released by Kentucky Injury Preven on and Research Center (KIPRC) 333 Waller Avenue, Suite 242 Lexington, Kentucky 454 For more informa on contact Svetla Slavova E mail: ssslav2@ .uky.edu

3 Table of Contents: Executive summary Drug overdose deaths, Drug overdose hospitalizations, Drug overdose emergency department visits, Medicaid recipient opiate overdose hospitalizations and emergency department visits Opioid related disease condition hospitalizations, Neonatal abstinence syndrome hospitalizations, Appendix A Conclusions About this report

4 Execu ve Summary 1. The total number of Kentucky resident drug overdose deaths leveled off from 211 to 212 (1,22 deaths in 211 and 1,31 deaths in 212). 2. The Kentucky resident age adjusted drug overdose mortality rate decreased from 24.2 in 211 to 23.9 in 212 (1.2% decrease). 3. Pharmaceu cal opioids remained the primary cause of Kentucky resident drug overdose deaths in 212; pharmaceu cal opioids accounted for 471 drug overdose deaths. 4. Heroin contributed to 129 Kentucky resident drug overdose deaths in 212, a 27% increase from the 42 heroin involved deaths recorded in Benzodiazepines contributed to 362 Kentucky resident overdose deaths in 212, decreasing 16% from Kentucky age adjusted drug overdose hospitaliza on rates decreased 2.4% from 211 to 212, from hospitaliza ons/1, popula on in 211 to in Intent to self harm was the primary reason for 212 Kentucky resident inpa ent hospitaliza ons, similar to years Benzodiazepines were the primary drugs involved in Kentucky resident inpa ent hospitaliza ons in 212 decreasing 11% to 1,686 hospitaliza ons in Pharmaceu cal opioids were the second leading drug type involved in drug overdose related hospitaliza ons in 212, decreasing 8% from 1,61 hospitaliza ons in 211 to 1,483 in Total charges for drug overdose hospitaliza ons rose 7% from $121.1 million in 211 to $129.3 million in The primary expected payer source for Kentucky resident drug overdose inpa ent hospitaliza ons was Medicare followed by Medicaid for 211 and 212; Medicare was billed $41.3 million and Medicaid was billed $34.1 million in Casey, Carroll, Nicholas, Powell, and Johnson coun es had the highest Kentucky resident drug overdose emergency department (ED) visit rates,

5 Execu ve Summary (cont d) 13. Kentucky resident drug overdose ED visit numbers and rates leveled off in 212 from 6,496 visits and an age adjusted rate of visits/1, popula on in 211 to 6,492 visits and an age adjusted rate of 153. in Kentucky resident drug overdose ED visit charges increased 5% from $14.6 million in 211 to $15.3 million in Self pays were the primary payer billed for drug overdose ED admissions in 212 at $5 million; Medicaid was billed $4.2 million and commercial insurance was billed $3.6 million. 16. Benzodiazepines were the primary drugs involved in Kentucky drug overdose ED visits in 212 with 856 visits; pharmaceu cal opioid involvement decreased 6% to 721 visits in Heroin involvement in drug overdose related ED visits increased 197% from 266 ED visits in 211 to 789 visits in Medicaid recipient total drug overdose ED charges totaled $74, in 212, a 27% increase from a total of $584, charged in Medicaid recipient total drug overdose inpa ent hospitaliza on charges totaled $11 million in 212, approximately the same as in Kentucky resident opioid related disease condi on hospitaliza on charges totaled $167 million in 212; Medicaid was billed for $55 million. 21. There were 824 Kentucky resident neonatal abs nence syndrome hospitaliza ons. Associated charges amounted to $4 million; Medicaid was charged $35 million. 22. Of the 9,713 pharmaceu cal opioid or heroin related hospitaliza ons in 212, viral hepa s was codiagnosed for 1,653 (17%) of them with associated charges of $37 million. 23. There were 1,192 hospitaliza ons involving opioid drug dependence and viral hepa s in 212, a 22% increase over the 976 hospitaliza ons in

6 Drug Overdose Deaths

7 12 1 Kentucky Resident Drug Overdose Deaths, ,22 1,31 Total Number Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky Vital Statistics electronic death certificate file. Data for are provisional and subject to change. 3 Kentucky Resident Age Adjusted Drug Overdose Mortality Rates, Mortality Rate (# Deaths /1, Population) Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky Vital Statistics electronic death certificate file. Data for are provisional and subject to change. 5

8 Kentucky Resident Drug Overdose Deaths by Gender, Total Number Male Female Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky Vital Statistics electronic death certificate file. Data for are provisional and subject to change. 35 Kentucky Resident Age Adjusted Drug Overdose Mortality Rates by Gender, Mortality Rate (# Deaths/1, Population) Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky Vital Statistics electronic death certificate file. Data for are provisional and subject to change Male Female 6

9 Kentucky Resident Drug Overdose Deaths by Intent, Total Number Unintentional Self Harm Undetermined Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky Vital Statistics electronic death certificate file. Data for are provisional and subject to change. Kentucky Resident Crude Drug Overdose Mortality Rates by Intent, Crude Mortality Rate (# Deaths/1, Population) Unintentional Self Harm Undetermined Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky Vital Statistics electronic death certificate file. Data for are provisional and subject to change. 7

10 Kentucky Resident Drug Overdose Deaths by Contributing Drugs Year Contributing Drug ICD 1 code Nonopioid analgesics T Antiepileptic, sedative hypnotic, anti Parkinsonism, antidepressant, and other psychotropic drugs, not elsewhere classified. T42, T Benzodiazepines T Narcotics and psychodysleptics not elsewhere classified T36 T38.9, T4(..9), T41, T44, T45(..4), T45(.6.9), T46 T Opiates/opioids T4(..4) Heroin T Pharmaceutical Opioids T4., T4(.2.4) Methadone T Cocaine T Other and unspecified narcotics T Drugs not elsewhere classified or T unspecified T5.9 Only

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12 Occurrences of Specific Drugs among the Contributing Causes for Kentucky Resident Drug Overdose Deaths, Hydromorphone Tramadol Fentanyl Clonazepam Cocaine 25 5 Diazepam Morphine Oxymorphone 66 9 Methadone Heroin Hydrocodone Oxycodone Alprazolam Total Number Produced by the Kentucky Injury Prevention and Research Center, November 213. Data source: Kentucky Vital Statistics electronic death certificate file. Data for are provisional and subject to change. 1

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14 Drug Overdose Hospitaliza ons

15 7, Kentucky Resident Drug Overdose Hospitalizations, ,422 6,296 Total Number 6, 5, 4, 3, 2, 3,372 4,24 4,312 4,531 4,626 4,524 4,963 5,244 5,32 5,626 5,749 1, Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for are provisional and subject to change. Age Adjusted Rate (# hospitalizations/ 1, population) Kentucky Resident Age Adjusted Drug Overdose Hospitalization Rates, Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for are provisional and subject to change

16 Kentucky Resident Drug Overdose Hospitalizations by Gender, , 3,734 3,677 Total Number 3,5 3, 2,5 2, 1,5 1,383 1,989 1,581 2,443 1,724 2,588 1,853 2,678 1,99 2,717 1,933 2,591 2,127 2,836 2,144 3,1 2,173 3,147 2,336 3,29 2,41 3,339 2,688 2,619 Male Female 1, Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for are provisional and subject to change. Hospitalization Rate (#hospitalizations/ 1, population) Kentucky Resident Age Adjusted Drug Overdose Hospitalization Rates by Gender, Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for are provisional and subject to change Male Female 14

17 Kentucky Resident Drug Overdose Hospitalizations by Intent, Total Number 3, 2,5 2, 1,5 1, 5 2,27 2,254 2,281 2,346 2,186 2,398 2, , , ,147 1,271 1,44 1,497 1, ,566 2,497 2,53 2,78 2, , , ,252 1,14 2,221 1, , 2,1 2,2 2,3 2,4 2,5 2,6 2,7 2,8 2,9 2,1 2,11 2,12 Unintentional Self Harm Undetermined No Ecode Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for are provisional and subject to change. Hospitalization Rate (# hospitalizations/1, population) Kentucky Resident Drug Overdose Hospitalization Rates by Intent, Unintentional Self/Harm Undetermined No Ecode Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for are provisional and subject to change. 15

18 Kentucky Resident Drug Overdose Related Hospitalizations Drug Type ICD 9 CM Codes Year DRUG 3,372 4,24 4,312 4,531 4,626 4,524 4,963 5,244 5,32 5,626 5,749 6,422 6,296 Nonopioid analgesics Aminophenol Opiates/opioids ,65 1,259 1,298 1,668 1,637 Heroin Pharmaceutical Opioids ,3 1,21 1,254 1,61 1,483 Methadone Cocaine Antidepressants 1,781 2,275 2,389 2,487 2,529 2,461 2,667 2,849 2,973 3,32 3,44 3,479 3,25 Benzodiazepines 793 1,12 1,181 1,181 1,245 1,196 1,386 1,511 1,561 1,661 1,645 1,885 1,686 Psychostimulants For ICD 9 CM codes see Appendix A Anticoagulants Other Unspecified 1,755 1,972 2,19 2,198 2,231 2,212 2,489 2,546 2,769 2,845 3,9 3,369 3,41 16

19 $14. $12. Total Charges for Drug Overdose Hospitalizations, $121.1 $129.3 $1. $87.8 $93. Dollars (in millions) $8. $6. $4. $2. $21.1 $26.2 $33.7 $43.8 $48.2 $5.6 $61.3 $69.3 $77.4 $ Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for are provisional and subject to change. 25, Drug Overdose Hospitalizations by Total Length of Stay, ,594 21,344 2, 17,82 17,832 19,4 18,664 15,839 Total Days of Hospital Stay 15, 1, 5, 1,385 12,367 13,768 15,61 14,635 14, Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for are provisional and subject to change. 17

20 2, Kentucky Resident Drug Overdose Hospitalizations by Expected Payer, ,8 1,6 1,4 Total Number 1,2 1, Commercial Medicaid Medicare Other Self Pay or Charity Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for are provisional and subject to change. $45 Kentucky Resident Total Drug Overdose Hospitalization Charges by Expected Payer, $4 $35 $3 Dollars (in millions) $25 $2 $15 $1 $5 $ Commercial Medicaid Medicare Other Self Pay or Charity Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for are provisional and subject to change. 18

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22 Drug Overdose Emergency Department Visits

23 7, 6, Kentucky Resident Drug Overdose Emergency Department Visits, ,414 5,917 5,778 6,496 6,492 5, Total Number 4, 3, 2, 1, Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for are provisional and subject to change. Age adjusted rate (# ED visits/ 1, population) Kentucky Resident Age Adjusted Drug Overdose Emergency Department Visit Rates, Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for are provisional and subject to change. 21

24 4, Kentucky Resident Drug Overdose Emergency Department Visits by Gender, ,5 3, 2,5 2,362 3,52 2,659 3,258 2,658 3,12 3,17 3,479 3,24 3,468 Total Number 2, 1,5 Male Female 1, Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for are provisional and subject to change. Age adjusted rate (# ED visits/1, population) Kentucky Resident Age Adjusted Drug Overdose Emergency Department Visit Rates by Gender, Male Female Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for are provisional and subject to change. 22

25 4, 3,5 Kentucky Resident Drug Overdose Emergency Department Visits by Intent, ,157 3,354 Total Number 3, 2,5 2, 1,5 1, 5 2,289 1, ,68 1, ,629 1, ,646 1, ,547 1, Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for are provisional and subject to change. Unintentional Self Harm Undetermined No Ecode Crude rate (# ED visits/1, population) Kentucky Resident Crude Drug Overdose Emergency Department Visit Rates by Intent, Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for are provisional and subject to change. Unintentional Self Harm Undetermined No Ecode 23

26 $18 Kentucky Resident Total Drug Overdose Emergency Department Visit Charges, $16 $14 $14.6 $15.3 $12 $11.4 $12. Dollars (in millions) $1 $8 $6 $4 $9.4 $2 $ Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for are provisional and subject to change. $6 Kentucky Resident Total Drug Overdose Emergency Department Visit Charges by Expected Payer, Dollars (in millions) $5 $4 $3 $2 $1 $2.9 $2.8 $1.5 $.3 $1.9 $2.9 $3.4 $1.7 $.2 $3.3 $3.1 $3.2 $1.8 $.3 $3.6 $3.8 $3.7 $2.5 $.3 $4.3 $3.6 $4.2 $2.3 $.3 $5. $ Commercial Medicaid Medicare Other Self Pay or Charity Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for are provisional and subject to change. 24

27 Kentucky Resident Drug Overdose Related ED Visits Year DRUG Involved 5,414 5,917 5,778 6,496 6,492 Nonopioid analgesics, Antipyretics, and Antirheumatics Aminophenol derivatives Opiates/opioids ,26 1,488 Heroin Pharmaceutical Opioids Methadone Cocaine Antidepressants, barbiturates and other antiepileptics, 2,33 2,179 2,75 2,32 2,2 sedative hypnotics, and psychotropic drugs not elsewhere classified Benzodiazepines Psychostimulants with abuse potential including methamphetamine, MDMA (Ecstasy) For ICD 9 CM codes see Appendix A Anticoagulants Other specified and unspecified drugs 3,195 3,5 3,455 3,864 3,651 Total Number 1, Kentucky Resident Drug Overdose Emergency Department Visits by Drugs Involved, Benzodiazepine Pharmaceutical Opioids Heroin Cocaine Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for are provisional and subject to change. 25

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29 Medicaid Recipient Opiate Overdose Hospitaliza ons and Emergency Department Visits 27

30 35 Medicaid Recipient Opiate Overdose Hospitalizations by Gender, Total Number Male Female Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for are provisional and subject to change. 25 Medicaid Recipient Opiate Overdose Hospitalizations by Intent, Total Number , 2,1 2,2 2,3 2,4 2,5 2,6 2,7 2,8 2,9 2,1 2,11 2,12 Unintentional Self Harm Undetermined No Ecode Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for are provisional and subject to change. 28

31 Medicaid Recipient Total Opiate Overdose Inpatient Hospitalization Charges, $12 $11.4 $11.1 $1 $8 Dollars (in millions) $6 $5.6 $6.7 Total Charges Operating Room Charges Other Charges Oncology Charges Pharmacy Charges Radiology Charges Room & Board Charges $4 $4.1 Labor & Delivery Charges Anesthesia Charges Ancillary Charges $2 $ Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for are provisional and subject to change. 29

32 16 Medicaid Recipient Opiate Overdose Emergency Department Visits by Gender, Total Number Male Female Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for are provisional and subject to change. 16 Medicaid Recipient Opiate Overdose Emergency Department Visits by Intent, Total Number Unintentional Self Harm Undetermined No Ecode Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for are provisional and subject to change. 3

33 $9 $8 Medicaid Recipient Opiate Overdose Total Emergency Department Charges, $74 $7 $6 $584 Dollars (in thousands) $5 $4 $3 $2 $36 $45 $472 $1 $ Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for are provisional and subject to change. 31

34 Opioid Related Disease Condi on Hospitaliza ons

35 9, 8, 7, 6, Kentucky Resident Opioid Related Disease Condition Hospitalizations, ,464 5,725 6,4 6,99 7,389 7,891 8,465 Total Number 5, 4, 3, 2, 2,29 3,142 3,357 3,86 4,385 4,677 1, Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for are provisional and subject to change. Note: 6.7% of all opioid related disease condi on hospitaliza ons listed also an ICD 9 CM code for drug overdose Kentucky Resident Opioid Related Disease Condition Hospitalizations by Condition Type, Total Number 7, 6, 5, 4, 3, 2, 1, 361 1, , , , , ,795 1,124 4,356 1,158 4,578 1,193 5,22 1,358 5,572 1,661 5,757 1,771 6,147 2,5 6, Nondependent opioid abuse Opioid type drug dependence Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for are provisional and subject to change. Note:.3% of all opioid related disease condi on hospitaliza ons listed both condi on types 33

36 Kentucky Resident Opioid Related Disease Condition Hospitalizations by Gender, , 4,61 Total Number 4,5 4, 3,5 3, 2,5 2, 1,5 1, 1, ,718 1,424 1,793 1,564 2,13 1,847 2,241 2,144 2,355 2,322 2,77 2,694 2,89 2,835 3,231 3,168 3,43 3,479 3,711 3,678 3,83 4,88 3,855 Male Female Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for are provisional and subject to change. Dollars (in millions) $18. $16. $14. $12. $1. $8. $6. $4. $2. $. Kentucky Resident Opioid Related Disease Condition Hospitalization Charges, $13.9 $21.6 $27.7 $34.7 $41.6 $48.6 $62.1 $66.1 $84.5 $14. $122.1 $144.1 $ Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for are provisional and subject to change. 34

37 $1.2 $1.4 $2.9 $2. $2.7 $6.3 $8.7 $5.5 $7.8 $5.2 $6. $3.5 $6.8 $1.8 $7.5 $3.8 $2.2 $5.2 $8.3 $8.3 $3.3 $2.3 $4.2 $6.7 $5.2 $1.2 $1. $2.5 $5. $4.1 Kentucky Resident Opioid Related Disease Condition Hospitalization Charges by Expected Payer, $8.8 $1. $8.2 $9.8 $5.6 $13.8 $15. $13.2 $12.7 $6.9 $12.8 $1.3 $14.4 $17.7 $2.8 $2.5 $17. $17.3 $15. $19.4 $22.8 $21.7 $23.7 $22.7 $27. $31.3 $3.3 $. $1. $2. $3. $4. $5. $6. $7. $37.3 $36.9 Dollars (in millions) $39.6 $41.4 $41.4 $45.9 $49.3 $55.4 Self Pay or Charity Other Medicare Medicaid Commercial Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for are provisional and subject to change. 35

38 Kentucky Resident Hospitalizations Involving Opioid Drug Overdose or an Opioid Related Disease Condition AND Viral Hepatitis, , Year Opioid type drug dependence & Viral hepatitis Nondependent opioid abuse & Viral hepatitis Drug overdoses due to the effect of opiates and related narcotics &Viral hepatitis , 1,2 Total Number Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for are provisional and subject to change. 36

39 Neonatal Abs nence Syndrome Hospitaliza ons

40 9 8 7 Kentucky Resident Neonatal Abstinence Syndrome Hospitalizations, Total Number Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for are provisional and subject to change. $45. $4. $35. Kentucky Resident Neonatal Abstinence Syndrome Hospitalization Charges, $36. $4.2 Dollars (in millions) $3. $25. $2. $15. $1. $5. $. $25. $23.8 $15. $7.5 $5.2 $4. $1.5 $.2 $1.3 $2.4 $ Produced by the Kentucky Injury Prevention and Research Center, January 214. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for are provisional and subject to change. 38

41 Kentucky Resident Neonatal Abstinence Syndrome Hospitalizations by Expected Payer, Self Pay or Commercial Medicaid Other Charity Year <5 < <5 < <5 < < < < Note: Counts less than 5 were suppressed by state data management policy. Year Kentucky Resident Neonatal Abstinence Syndrome Hospitalization Charges by Expected Payer, Commercial Medicaid Self Pay or Charity Other Total 2 $75,463 $155,642 $4,318 $1,74 $235, $989,491 $464,827 $11,18 $2,927 $1,465, $181,443 $932,251 $24,374 $113,947 $1,138,68 23 $685,212 $1,597,333 $9,166 $145,842 $2,291,71 24 $262,538 $2,731,983 $5,125 $189,625 $3,44, $471,64 $3,21,153 $46,89 $276,77 $3,718, $161,693 $4,82,755 $138,686 $134,258 $5,13, $697,463 $6,1,22 $414,598 $355,295 $7,113, $2,7,471 $11,53,166 $685,389 $96,154 $14,889,26 29 $3,142,217 $19,266,47 $1,198,435 $227,639 $23,67,58 21 $2,156,244 $21,52,317 $1,231,29 $58,43 $24,439, $6,36,864 $28,13,564 $1,267,251 $232,167 $35,758, $3,287,661 $34,876,3 $1,66,756 $476,472 $39,77,716 39

42 APPENDIX A ICD 9 CM codes for acute poisonings due to the effects of drugs (drug overdoses) Type of Poison ICD 9 CM codes DRUG E85 E585, E95(..5), E962., E98(..5), Nonopioid analgesics, Antipyretics, and E85(.3.8), 965(.1.8) Antirheumatics 4 Aminophenol derivatives E85.4, Opiates/opioids E85(..2), 965. Heroin E85., Pharmaceutical Opioids E85(.1.2), 965(.,.2.9) Methadone E85.1,965.2 Cocaine E854.3, E855.2, 968.5, Antidepressants, barbiturates and other antiepileptics, sedative hypnotics, and psychotropic drugs not elsewhere classified E851 E853, E854(..2,.8), E855., E95(.1.3), E98(.1.3), 966, 967, 969, 97(.,.1,.89) Benzodiazepines E853.2, Psychostimulants with abuse potential including methamphetamine, MDMA (Ecstasy) E854.2, Anticoagulants Other specified and unspecified drugs E85(.9), E855(.1,.3.9), E856 E858, E95(.,.4,.5), E962., E98(.,.4,.5), , 964(.,.1,.3.9), 965.9, 968(..4,.6.9), 97(.9), , For more informa on, please refer to: Consensus Recommenda ons for Na onal and State Poisoning Surveillance, Safe States, April

43 Conclusions The combina on of mul ple preven on approaches such as mandatory enrollment and use of the Kentucky All Schedule Prescrip on Electronic Repor ng system by prescribers and dispensers, physician ownership of pain clinics, prescriber guidelines for pain treatment, and increased law enforcement resulted in substan al decreases in Kentucky resident prescrip on drug overdose deaths, inpa ent hospitaliza ons, and ED admissions from 211 to 212. With that said, pharmaceu cal opioids remained the primary drugs involved in drug overdose deaths; benzodiazepines were the primary drugs involved in drug overdose related inpa ent hospitaliza ons and ED visits. Pharmaceu cal opioid involvement decreased 12% for drug overdose deaths, 8% for inpa ent hospitaliza ons, and 6% for ED visits from Correspondingly, benzodiazepine involvement decreased 16% for drug overdose deaths, 11% for inpa ent hospitaliza ons, and 9% for ED visits from Raising awareness of the dangers of mixing benzodiazepines with opioids should be an emphasis of physician con nuing educa on for relaying to opioid pa ents during medical consulta ons. While the contribu on of prescrip on opioids and benzodiazepines to drug overdoses decreased from 211 to 212, there was a precipitous increase in heroin involvement in drug overdose deaths, inpa ent hospitaliza ons, and ED visits over the same me period. Heroin involvement increased 27% for drug overdose deaths, 174% for inpa ent hospitaliza ons, and 197% for ED visits. Opioid related hospitaliza ons and ED visits are costly in more than only financial erms. Disease condi ons already present or those caused by opiate addic on such as viral hepa s also exert an enormous societal as well as financial toll on the commonwealth s popula on. Increased law enforcement, adjudica on, legisla on, and heroin abuse treatment should be a major priority for Kentucky to reduce heroin related deaths, and hospitaliza ons. Total inpa ent hospitaliza on charges for drug overdoses rose 7% in 212 to $129.3 million. Likewise, drug overdose ED charges rose 5% to $15.3 million in 212. The primary expected payers for drug overdose related inpa ent hospitaliza ons were Medicare ($41.3 million) and Medicaid ($34.1 million). Self pays were the largest expected payer for drug overdose ED visits ($5 million) followed by Medicaid ($4.2 million). Medicaid recipient opiate overdose ED charges increased 27% in 212 to $74,. Inpa ent hospitaliza ons of Medicaid recipients for opiate overdoses leveled off in 212 at $11 million. Elevated Medicaid charges illustrate the need for naloxone (an opiate an dote) reimbursement by Medicaid so that Medicaid recipients are not charged for its purchase. Intranasal administra on of naloxone during an opiate overdose has been credited with saving countless lives. A mul pronged strategy to reduce substance abuse in the Commonwealth of Kentucky involves the basic elements of the public health model that includes comprehensive surveillance and tracking of drug overdoses, iden fica on of the risk factors that result in drug overdoses, development of interven ons to prevent drug overdoses, and the widespread adop on of substance abuse preven on interven ons. In addi on, increased con nuing educa on of physicians on drug abuse and treatment, increased law enforcement, increased adjudica on, and increased substance abuse treatment facili es are necessary to decrease the extraordinary toll of substance abuse on Kentucky ci zens who are addicted. 41

44 About This Report This report presents drug overdose morbidity and mortality data for Kentucky residents, using mul ple data sources: Kentucky Death Cer ficate Files, Kentucky Office of Vital Sta s cs, (data captured as of October 21, 213). The files are provisional and subject to change. Kentucky Inpa ent Hospitaliza on (IH) Discharge Files, Cabinet for Health and Family Services, Office of Health Policy, (data for are provisional and subject to change). Kentucky Emergency Department (ED) Discharge Files, Cabinet for Health and Family Services, Office of Health Policy, (data for are provisional and subject to change). Drug overdose mortality and morbidity case selec on was based on opera onal defini ons of acute drug poisoning (also called drug overdose ) by the Injury Surveillance Workgroup on Poisoning (ISW7) in their Consensus Recommenda ons for Na onal and State Poisoning Surveillance, The Safe States Alliance, Atlanta, GA, April Drug Overdose Deaths: Each death cer ficate contains one underlying cause of death and mul ple contribu ng causes of death. The underlying cause of death is defined as the reason that ini ated the chain of events leading directly to death. The underlying and contribu ng causes of death are coded according to the Interna onal Classifica on of Diseases, 1 th revision (ICD 1) [ ons/icd1/]. Defini on: Drug overdose deaths were iden fied as deaths with an underlying cause of death in the following range: X4 X44(accidental/uninten onal drug poisoning), X6 X64(suicide by drug poisoning), X85 (homicide by drug poisoning), and Y1 Y14 (drug poisoning with undetermined intent). The types of drugs contribu ng to drug overdose deaths were iden fied using ICD 1 codes T36 T5.9 listed in any of the mul ple causes of death fields. Contribu ng drugs were reported in standardized categories, following the ISW7 Poisoning Matrix for ICD 1 Coded Mortality Data. 1 Drug Overdose Hospitaliza ons and ED Visits : IH and ED data were coded according to the Interna onal Classifica on of Disease, 9 th revision, Clinical Modifica on (ICD 9 CM, The ICD 9 CM system describes an injury using diagnosis codes and E codes. The Kentucky IH and ED data systems include up to 25 diagnosis code fields per case. The first diagnosis code is called the principal diagnosis code. The principal diagnosis for a hospitalized pa ent is the main reason for the pa ent s hospital stay and is based on the clinical findings during the pa ent s stay. For ED data, the primary diagnosis code is the diagnosis established to be the main reason for the visit to the emergency department. Other condi ons/diagnoses that exist at the me of the IH/ED visit and affect the diagnosis, treatment, or length of stay in the health facility, are also coded in the remaining 24 diagnosis code fields in the IH/ED datasets and are called secondary diagnoses. Injury diagnoses should be supplemented (when circumstances of the injury are known) with addi onal codes called E codes. E codes are separated into three groups: external cause of injury codes, place of injury codes, and ac vity codes. 42

45 The external cause of injury code describes the external cause (in this case, poisoning) and the intent of injury. Based on the external cause of injury code, a drug poisoning can be classified by intent as accidental (uninten onal, E85 E858), inten onal (self harm, E95. E95.5; or assault, E962.), or undetermined (E98. E98.5 when based on insufficient documenta on in the medical chart to determine whether the drug overdose was accidental or inten onal). Some injury records in the IH or ED datasets, however, are not supplemented with E codes at all. We treat such records as a separate category and refer to them as missing intent or no E code. IH and ED electronic records may contain up to three designated E code fields. On average, more than 9 percent of the Kentucky HD and ED cases with poisoning diagnoses are supplemented with valid external cause of injury codes. Defini on: A hospitaliza on or emergency department visit was considered a drug overdose if 1) any of the ICD 9 CM codes in the range were listed in any diagnosis (principal or secondary) fields; or 2) any of the ICD 9 CM codes in the range E85 E858, E95. E95.5, E962., or E98. E98.5 were listed in the E code fields. This Injury Surveillance Workgroup on Poisoning 1 defini on is a broader defini on than the defini on used in the 212 report 2 on drug overdose morbidity and mortality in Kentucky. Therefore, if comparing the morbidity sec ons in the current and in the 212 report, one will no ce about a 3% increase in the reported cases of drug overdose hospitaliza ons or ED visits. The 212 report was based on defini ons derived from the external cause of injury matrix and didn t capture encounters of care where the principal diagnosis was not a drug overdose but the secondary diagnosis was drug overdose. A study on drug overdose ED visits in the U.S. suggested that mild or moderate drug overdoses were likely to have the drug poisoning as their primary diagnosis but severe drug poisoning cases were likely to have a cri cal illness as the primary diagnosis. 3 Severe drug overdoses can result in acute respiratory, heart, or renal failure that may be listed as principal diagnoses with a drug overdose listed as the secondary diagnosis. As the state enacts policies and plans for adequate substance abuse treatment resources, the most comprehensive defini on to track and enumerate total drug overdose hospitaliza ons and ED visits was used to provide a more accurate picture of the magnitude of substance abuse and misuse, the specific drugs involved, and the specific popula ons at higher risk for drug overdoses. Only records for KY residents treated in Kentucky acute care hospitals or Kentucky emergency departments are included in this report. Data for Kentucky residents treated in neighboring states were not available and not included in this report. Therefore, the presented counts and rates likely underes mate the full extent of drug overdoses in Kentucky. Reported frequencies reflect the number of visits/ hospitaliza ons since follow up visits and readmissions for one and the same drug overdose could not be iden fied. Age adjusted morbidity and mortality rates were based on 2 U.S. standard popula on data. For each of the three data sets, the number of cases classified as assault was low (48 ED visits from , 35 hospitaliza ons from and seven fatali es from 2 212) and were not included in the figures or discussed in this report. A sec on on mental disorder hospitaliza ons involving opiates/opioids was included in the report in order to describe disease condi ons induced by opium, heroin, and/or opioid analgesics. The case selec on followed the ISW7 1 framework and included hospitaliza ons related to opioid type dependence, drug dependence on combina ons of opioid type drugs with any other, or nondependent opioid abuse, iden fied by any of the following ICD 9 CM codes in any of the diagnosis fields: 34 (..2,.7.72), 35 (.5.52). 43

46 In the hospital discharge dataset, drug overdoses due to the effect of opiates and related narco cs were iden fied as records with any of the ICD 9 CM code 965(..9) in any of the diagnosis fields. Viral hepa s cases we iden fied by ICD 9 CM code 7 in any of the diagnosis fields. Neonatal Abs nence Syndrome (NAS) is a drug withdrawal syndrome in a newborn that is caused by the mother s drug abuse during pregnancy. Hospitaliza ons involving drug withdrawal syndrome in a newborn are iden fied by the ICD 9 CM code listed in any of the diagnosis fields. A sec on on NAS hospitaliza ons was added to this report to describe another aspect and burden of drug abuse and addic on in the Commonwealth. References: 1. Consensus Recommenda ons for Na onal and State Poisoning Surveillance, The Safe States Alliance, Atlanta, GA, April Bunn TL, Slavova S, Drug Overdose Morbidity and Mortality in Kentucky, 2 21, KIPRC, Xiang Y, Zhao W, Xiang H, Smith GA. ED Visits for Drug related Poisoning in the United States, 27. Am J Emerg Med. 212 Feb: 3(2):