CDC: Emergency Department Data Signal Worsening Opioid Epidemic

Emergency department (ED) visits in the United States for opioid overdoses are up, signaling that the epidemic is worsening, according to a recent CDC report.¹ Published in the CDC's latest Vital Signs, the report analyzes data available from ED visits for opioid overdoses across multiple states.

Data from 16 states in the CDC's Enhanced State Opioid Overdose Surveillance Program were examined to identify trends by state and rural/urban differences. The researchers also analyzed data from the National Syndromic Surveillance Program BioSense Platform covering 52 jurisdictions in 45 states. Overall, the researchers found that visits for suspected opioid overdoses rose 30% in the United States from July 2016 to September 2017 across 45 states, and 35% across the 16 states.

These were the key findings from the report:

• Eight states from 3 US regions reported substantial increases (25% or greater) in the rate of opioid overdose ED visits.
• Significant increases in all states reporting in the Midwest, including Wisconsin (109%), Illinois (66%), Indiana (35%), Ohio (28%), and Missouri (21%).
• There was considerable variation among states in the Northeast and Southeast, with some states reporting substantial increases and others reporting modest decreases.
• The highest rate of increases (54%) were seen in large central metropolitan areas.

From July 2016 to September 2017, opioid overdoses increased for:

• Men (30%) and women (24%).
• Individuals aged 25-34 (31%), 35-54 (36%), and 55 and over (32%).
• Most states (30% average), especially in the Midwest (70% average).

"Long before we receive data from death certificates, emergency department data can point to alarming increases in opioid overdoses," CDC Acting Director Anne Schuchat, MD, said in a press release.²

In an accompanying editorial published in the Annals of Emergency Medicine, the authors noted that EDs typically do not have consistent protocols or guidelines for what to do after the overdose is resolved. "The CDC Vital Signs report signaled that the ED is a critical entry point for primary and secondary prevention of opioid overdose," they said.³

The authors suggested that innovative systems-based protocols can promote overdose education and naloxone distribution. Additionally, initiating medication-assisted treatment with buprenorphine for patients presenting with opioid use disorder, with continuation in primary care, can reduce opioid use.

According to the CDC's report, health care providers can help by prescribing opioids only when benefits are likely to outweigh risks, determining a patient's prescription drug history and level of risk by accessing data from their state PDMP, and identifying mental health, social services, and treatment options for patients with opioid use disorder.

References

• Opioid Overdoses Treated in Emergency Departments. Vital Signs. CDC's website. https://www.cdc.gov/vitalsigns/opioid-overdoses/index.html. Accessed March 8, 2018.
• Emergency Data Show Rapid Increases in Opioid Overdoses [news release]. CDC's website. https://www.cdc.gov/media/releases/2018/p0306-vs-opioids-overdoses.html. Accessed March 8, 2018.
• Houry DE, Haegerich TM, Vivolo-Kantor A. Opportunities for Prevention and Intervention of Opioid Overdose in the Emergency Department. Annals of Emergency Medicine. 2018. Doi: https://doi.org/10.1016/j.annemergmed.2018.01.052