Keep the Public of Chittenden County Informed About the Climate of Opioid Use and 1 more...less...

The Public are Informed About the Climate of Opioid Use in Chittenden County

Number of Opioid-Related Emergency Department Visits at UVM Medical Center

12Sep 2017

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Story Behind the Curve

As the sole hospital in Chittenden County, the University of Vermont Medical Center has begun to track opioid-related emergency department visits for the county since the beginning of 2015. The average rate of opioid-related ED incidents per month increased from 6.17 incidents per month in 2015 to 14.17 incidents per month in 2016, and in 2017 the average rate is currently 12.5 incidents per month. Though the increase from 2015 to 2016 may more likely be due to a difference in data collection methods year to year than a genuine increase in overdose incidents, it is important to recognize the dramatic increase in opioid-related ED visits which has taken place since early 1990. As reported by an Oxford Journal article written on behalf of the American Academy of Pain Medicineopioid-related ED visits quadrupled nationally from 1993 to 2010, and later, according to a Healthcare Cost and Utilization Project (H-CUP) study, between 2005 and 2014 the rate of opioid related emergency department visits among the 30 analyzed states nearly doubled, and the rate of opioid-related inpatient stays among the 44 analyzed states increased 64%. By population, a SAMHSA report on the Drug Abuse Warning Network (DAWN) 2011 estimated a national rate of 83 heroin-related ED visits per 100,000 population in 2011. By comparison, Chittenden county experienced a rate of 45.85 opioid-related ED visits per 100,000 population in 2015 and 105.34 per 100,000 in 2016, though it is difficult to assess if either of these rates represent an appropriate baseline rate, with an average of the two rates likely being the most appropriate estimate. 

Nationally, researchers from Rhode Island and The Miriam hospitals and the Stanford University School of Medicine report in the Journal of the American Medical Association that in 2010 heroin was involved in 16.1% of opioid-related ED visits in the US. While there has not been an updated national study, of all ED incidents identified by UVM Medical Center as opioid-related since 2015, 58.6% were specifically identified as heroin-related. Though this is certainly not a direct comparison, is does reflect the shift from prescription opioid misuse to misuse of heroin as prescription levels have decreased nationwide. Specifically, a SAMHSA CBHSQ report notes that narcotic pain reliever-related ED visits involving non-medical use of pharmaceuticals increased 117% from 2005 to 2011 nationally, but leveled off from 2008 to 2011. Emergency department visits involving Oxycodone, the most common narcotic pain reliever among visits involving non-medical use of pharmaceuticals at the time, increased from 2005 to 2009, but leveled off from 2009 to 2011. Additionally, a New England Journal of Medicine report, The Shifting Patterns of Prescription Opioid and Heroin Abuse in the US, illustrates the increase in reported heroin misuse between 2008 and 2014 directly corresponds to the decrease in reported prescription opioid misuse in the same time period, and so it would be safe to assume that the current levels of heroin involvement in Chittenden county align with this trend. 

Citation

This information was collected by the University of Vermont Medical Center's Emergency Department. Opioid-related emergency department visits are also reported, in aggregate, by the Division of Alcohol and Drug Abuse Programs (ADAP) within the Vermont Department of Health, with slight variations in methodology. For instance, aggregate opioid-related emergency department visits from across Vermont, as collected by the Early Aberration Reporting System (EARS), have been reported in the Opioid Misuse, Abuse & Dependence in Vermont Data Brief, and aggregate emergency department discharge rates for opioid overdose, as recorded in the Vermont Uniform Hospital Discharge Data Set, have been reported in the Opioids in Vermont: Prevalence, Risk, and Impact data brief.

Visits to the UVM Medical Center Emergency Department have been cataloged using ICD 10 CM codes, which help track the types of incidents the ED handles. All incidents reported here have codes specifically denoting:

  • Poisoning by specific opioids (opium, heroin, methadone), accidental or intentional in nature
  • Poisoning by "other opioids", accidental or intentional in nature
  • Poisoning by "other synthetic narcotics", accidental or intentional in nature
  • Poisoning by cocaine, accidental or intentional in nature
  • Poisoning by "unspecified narcotics" or "other narcotics", accidental or intentional in nature

Some codes related to non-opioid poisoning have been included because there is a known concurrence of opioids with other illicit narcotics, known as multi-drug or poly-drug use. However, it should be noted that over 80% of all reported incidents have been assigned an opioid-specific code.

Last Updated: October 2017

Strategy

One of the CCOA's goals is to coordinate information sharing between Alliance members to increase positive outcomes for all service providers. Using complimentary data sets to better understand how to align resources for those in need is one of the ways coordination is taking place. Understanding how many overdose incidents occur county-wide, and comparing the total volume to the number of incidents that occur at the emergency department, will help provide context for emergency service providers as they tailor their response to opioid-related overdoses. The SAMHSA report on the Drug Abuse Warning Network (DAWN) 2011 also noted that only 1.9% of individuals involved in opioid-related overdose incidents died in the ED or in the hospital after being treated at the ED, and the Oxford Journal article written on behalf of the American Academy of Pain Medicine notes that 50% of ED visits for opioid-related overdose incidents did not result in hospitalization. Currently, any Vermonter may decline to be transferred to a hospital for any reason, even after an overdose event. By combining ED data with EMS data, we aim to provide EMS professionals with the resources they need to make sure that all individuals suffering from opioid-related overdose incidents will experience positive outcomes in the best possible healthcare setting.

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