Though a wealth of information regarding opioid-related fatal overdoses has been identified and analyzed, quantifying the impact of non-fatal overdoses has been a much more difficult task, in Vermont and nationally. As the prevalence of Opioid Use Disorder (OUD) increases, efforts are being made to identify trends of OUD morbidity, in addition to mortality. A study published in the American Society of Interventional Pain Physicians' (ASIPP) Pain Physician Journal in 2016 details the results of a meta-analysis of prescription opioid overdose incidents. Using articles published between 1999 and 2014, the study found that between 1997 and 2005 the number of emergency department visits which involved non-fatal prescription opioid-related overdoses were 7 times the number of prescription opioid-related deaths. Additionally, while this study revealed that prescription opioid-related death rates increased from 0.08 to 0.38 per 100,000 individuals between 1993 and 2009, these rates were considerably lower than the rates for non-fatal events, which increased from 2 to almost 15 per 100,000 individuals in the same period. It is important to note that opioid-related overdose incidents which receive an EMS response are only a subset of emergency department visits. Indeed, the study acknowledges that "opioid overdose data from emergency department visits and national inpatient discharges may significantly under-represent the amount of harm from prescription opioids in the US." With this in mind, studies of emergency department data remain important when assessing trends in non-fatal opioid-related overdose incidents until more coordinated efforts to collect and analyse direct EMS data occur. By collecting local EMS data, as above, we may in the future determine a base-line rate of occurrence, and may be able to track such a rate along side mortality rates for a more fulsome view of opioid use in Vermont.
Understanding the effect of OUD beyond overdose deaths is an important element of creating an effective response to the increasing epidemic. As noted by the National Institute of Health (NIH), for every unintentional overdose death related to an opioid analgesic nationally, 9 persons are admitted for substance abuse treatment, 35 visit emergency departments, 161 report drug abuse or dependence, and 461 report non-medical uses of opioid analgesics. At a state level, rates of opioid use and treatment per opioid-related fatal overdose are reported by the Vermont Department of Health, noting that for every overdose 1,482 people receive at least one prescription for an opioid analgesic, 235 used prescription pain relievers in a non-medical fashion, and 113 people receive at least one MAT service for OUD. As efforts to understand the volume of incidents that Emergency Medical Service (EMS) providers are responding to in Vermont increase, a baseline of information on opioid-related non-fatal overdoses in Chittenden County will take shape. Over time, this baseline can be used to assess if incidents are increasing in frequency, or decreasing, and can help to guide the actions of service providers.