ED visits for suspected opioid-related overdoses in 45 states rose by about 30% as a share of all ED visits from 2016 to 2017, according to a CDC's "Vital Signs" report released Tuesday.
For the report, CDC researchers examined trends in opioid overdoses by reviewing ED and hospital billing data on opioid-involved overdoses from July 2016 through September 2017 for 52 jurisdictions across 45 states.
This is different from CDC researchers' typical methodology for examining the opioid misuse crisis, which involves reviewing data on deaths from opioids—but "looking at ED data can help us get information before people die," acting CDC Director Anne Schuchat said.
Overall, the researchers found a total of 142,557 ED visits for suspected opioid-related overdoses from July 2016 through September 2017 in 52 jurisdictions across 45 states. According to CDC, increases occurred in the share of ED visits related to opioid overdoses in most states examined.
The data suggest that rate increases in ED visits varied across regions—though the margin of error in CDC's estimates in many instances were large. For instance, CDC data show from July 2016 through September 2017 the share of ED visits related to opioid overdoses increased by:
- 70% in the Midwest, with a 9.2% average quarterly change (with a 95% confidence interval of 4.1% to 14.6%);
- 40% in the West, with a 6.9% average quarterly change (with a 95% confidence interval of 3.4% to 10.5%);
- 21% in the Northeast, with a 4.7% average quarterly change (with a 95% confidence interval of -2.4% to 12.2% );
- 20% in the Southwest, with an 11.4% average quarterly change (with a 95% confidence interval of 1.1% to 22.9%); and
- 14% in the Southeast, with a 5.5% average quarterly change (with a 95% confidence interval of 0.6% to 10.6%).
According to the report, the highest suspected opioid overdose rate increases occurred in large central metropolitan areas, defined as regions with a population of 1 million residents or more. The researchers said the rate increases were spread among every demographic group, including men and women.
"The bottom line is that no area of the United States is exempt from this epidemic," Schuchat said. She added that based on the data CDC believes EDs "are essential hubs in this fast-moving epidemic" and wants "more hand-off in the emergency department between resuscitation or saving a life and addressing the longer-term needs for that individual or their support system," such as starting a medication-assisted treatment for opioid misuse.
Schuchat said the rise in opioid-related overdoes in certain states and cities might be attributed to changes in the type and volume of illicit opioids available.
Jessica Hulsey Nickel, president and CEO of the Addiction Policy Forum, said ED staff need to receive better training to ensure individuals who have substance misuse disorders receive follow-up treatments, because such individuals are often sent home from the ED without further treatment and overdose again. Nickel said, "We can use this near-death experience—use it as moment to change that person's life."
Andrew Kolodny, co-director of opioid policy research at Brandeis University's Heller School for Social Policy and Management, said "Overall as a nation, we are still failing to adequately respond to the opioid addiction epidemic." Kolodny added, "There's been a lot of talk from Congress and from the administration and a recognition that we need to do something about this problem. But nothing yet has happened" (Stobbe, AP/Sacramento Bee, 3/6; Ross Johnson, Modern Healthcare, 3/6; Stein, "Shots," NPR, 3/6; Bernstein, "To Your Health," Washington Post, 3/6; George, MedPage Today, 3/6; "Vital Signs," CDC, 3/6).
Learn more: How to combat the opioid epidemic
Opioid misuse and abuse is one of the most pressing public health issues in the U.S., and hospitals and health systems are on the front lines. Currently, most health systems focus their opioid management efforts on select medical specialties.
This report outlines three imperatives to guide hospitals and health systems in their efforts to reduce the impact of inappropriate opioid prescribing and misuse.