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 Medicine, opioid-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.