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Drug Overdose Deaths,
Hospitalizations,
and Emergency
Department Visits
in Kentucky,
2000 - 2012
Kentucky Injury Preven on and Research Center
Drug Overdose Deaths, Hospitaliza ons,
and Emergency Department Visits
in Kentucky, 2000‐2012 January, 2014
Prepared by
Svetla Slavova, PhD
Terry L. Bunn, PhD
Joshua W. Lambert, MS
Released by
Kentucky Injury Preven on and Research Center (KIPRC)
333 Waller Avenue, Suite 242
Lexington, Kentucky 40504
For more informa on contact
Svetla Slavova
E‐mail: [email protected]
Table of Contents:
Executive summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
Drug overdose deaths, 2000‐2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Drug overdose hospitalizations, 2000‐2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12
Drug overdose emergency department visits, 2008‐2012. . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Medicaid recipient opiate overdose hospitalizations and emergency department visits. . . 27
Opioid‐related disease condition hospitalizations, 2000‐2012. . . . . . . . . . . . . . . . . . . . . . . . .32
Neonatal abstinence syndrome hospitalizations, 2000‐2012. . . . . . . . . . . . . . . . . . . . . . . . . .37
Appendix A. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Conclusions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
About this report . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
1
2
Execu ve Summary
1. The total number of Kentucky resident drug overdose deaths leveled off from 2011 to 2012 (1,022
deaths in 2011 and 1,031 deaths in 2012).
2. The Kentucky resident age‐adjusted drug overdose mortality rate decreased from 24.2 in 2011 to 23.9
in 2012 (1.2% decrease).
3. Pharmaceu cal opioids remained the primary cause of Kentucky resident drug overdose deaths in
2012; pharmaceu cal opioids accounted for 471 drug overdose deaths.
4. Heroin contributed to 129 Kentucky resident drug overdose deaths in 2012, a 207% increase from the
42 heroin‐involved deaths recorded in 2011.
5. Benzodiazepines contributed to 362 Kentucky resident overdose deaths in 2012, decreasing 16% from
2011.
6. Kentucky age‐adjusted drug overdose hospitaliza on rates decreased 2.4% from 2011 to 2012, from
146.6 hospitaliza ons/100,000 popula on in 2011 to 143.1 in 2012.
7. Intent to self‐harm was the primary reason for 2012 Kentucky resident inpa ent hospitaliza ons, simi‐
lar to years 2000‐2011.
8. Benzodiazepines were the primary drugs involved in Kentucky resident inpa ent hospitaliza ons in
2012 decreasing 11% to 1,686 hospitaliza ons in 2012.
9. Pharmaceu cal opioids were the second leading drug type involved in drug overdose related hospitali‐
za ons in 2012, decreasing 8% from 1,610 hospitaliza ons in 2011 to 1,483 in 2012.
10. Total charges for drug overdose hospitaliza ons rose 7% from $121.1 million in 2011 to $129.3 million
in 2012.
11. The primary expected payer source for Kentucky resident drug overdose inpa ent hospitaliza ons was
Medicare followed by Medicaid for 2011 and 2012; Medicare was billed $41.3 million and Medicaid
was billed $34.1 million in 2012.
12. Casey, Carroll, Nicholas, Powell, and Johnson coun es had the highest Kentucky resident drug over‐
dose emergency department (ED) visit rates, 2008‐2012.
3
Execu ve Summary (cont’d)
13. Kentucky resident drug overdose ED visit numbers and rates leveled off in 2012 from 6,496 visits and
an age‐adjusted rate of 153.1 visits/100,000 popula on in 2011 to 6,492 visits and an age‐adjusted
rate of 153.0 in 2012.
14. Kentucky resident drug overdose ED visit charges increased 5% from $14.6 million in 2011 to $15.3 mil‐
lion in 2012.
15. Self‐pays were the primary payer billed for drug overdose ED admissions in 2012 at $5 million; Medi‐
caid was billed $4.2 million and commercial insurance was billed $3.6 million.
16. Benzodiazepines were the primary drugs involved in Kentucky drug overdose ED visits in 2012 with 856
visits; pharmaceu cal opioid involvement decreased 6% to 721 visits in 2012.
17. Heroin involvement in drug overdose related ED visits increased 197% from 266 ED visits in 2011 to
789 visits in 2012.
18. Medicaid recipient total drug overdose ED charges totaled $740,000 in 2012, a 27% increase from a
total of $584,000 charged in 2011.
19. Medicaid recipient total drug overdose inpa ent hospitaliza on charges totaled $11 million in 2012,
approximately the same as in 2011.
20. Kentucky resident opioid‐related disease condi on hospitaliza on charges totaled $167 million in
2012; Medicaid was billed for $55 million.
21. There were 824 Kentucky resident neonatal abs nence syndrome hospitaliza ons. Associated charges
amounted to $40 million; Medicaid was charged $35 million.
22. Of the 9,713 pharmaceu cal opioid or heroin related hospitaliza ons in 2012, viral hepa s was co‐
diagnosed for 1,653 (17%) of them with associated charges of $37 million.
23. There were 1,192 hospitaliza ons involving opioid drug dependence and viral hepa s in 2012, a 22%
increase over the 976 hospitaliza ons in 2011.
4
Drug Overdose
Deaths
2000‐2012
5
246
339
435
551 525
621
711673
747 746
996 1,022 1,031
0
200
400
600
800
1000
1200
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
To
tal N
um
be
r
Kentucky Resident Drug Overdose Deaths, 2000‐2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Vital Statistics electronic death certificate file. Data for 2009‐2012 are provisional and subject to change.
6.1
8.3
10.6
13.412.7
14.8
16.915.8
17.4 17.3
23.3 24.2 23.9
0
5
10
15
20
25
30
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Mo
rtal
ity
Rat
e (
# D
eat
hs
/10
0,0
00
Po
pu
lati
on
)
Kentucky Resident Age‐Adjusted Drug Overdose Mortality Rates, 2000‐2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Vital Statistics electronic death certificate file. Data for 2009‐2012 are provisional and subject to change.
6
161
206
276
322
322
400
443
435
444 459
614
613
622
84
132 158
228
203 220
268
238
303
287
382 409
409
0
100
200
300
400
500
600
700
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
To
tal N
um
be
r
Kentucky Resident Drug Overdose Deaths by Gender, 2000‐2012
Male
Female
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Vital Statistics electronic death certificate file. Data for 2009‐2012 are provisional and subject to change.
8.0
10.2
13.7
15.8
15.7
19.4
21.5
20.6 21.3
21.6
28.9
29.3
29.2
4.0
6.4
7.6
10.8
9.7 10.4 12.4
11.0
13.8
13.1
17.6 19.1
18.5
0
5
10
15
20
25
30
35
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Mo
rtal
ity
Rat
e (
# D
eat
hs/
10
0,0
00
Po
pu
lati
on
)
Kentucky Resident Age‐Adjusted Drug Overdose Mortality Rates by Gender, 2000‐2012
Male
Female
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Vital Statistics electronic death certificate file. Data for 2009‐2012 are provisional and subject to change.
7
204 265
355
472
443
533 590
546
620
612
874 912
911
33 48 59
45 46 47 65 67
60
56
55
50 62
9
26
20 33
34 41 54
60 67 78
67
59 58
0
100
200
300
400
500
600
700
800
900
1000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
To
tal N
um
be
r
Kentucky Resident Drug Overdose Deaths by Intent, 2000‐2012
Unintentional
Self Harm
Undetermined
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Vital Statistics electronic death certificate file. Data for 2009‐2012 are provisional and subject to change.
5.0
6.5
8.7
11.5
10.7
12.7 14.0
12.8
14.5
14.2
20.1 20.9
20.8
0.8 1.2 1.4
1.1
1.1 1.1
1.5 1.6
1.4
1.3
1.3
1.1 1.4
0.2 0.6
0.5 0.8 0.8 1.0 1.3 1.4
1.6 1.8
1.5
1.4 1.3
0
5
10
15
20
25
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Cru
de
Mo
rtal
ity
Rat
e (
# D
eat
hs/
10
0,0
00
Po
pu
lati
on
)
Kentucky Resident Crude Drug Overdose Mortality Rates by Intent, 2000‐2012
Unintentional
Self Harm
Undetermined
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Vital Statistics electronic death certificate file. Data for 2009‐2012 are provisional and subject to change.
8
Ke
ntu
cky
Re
sid
ent
Dru
g O
verd
ose
De
ath
s b
y C
on
trib
uti
ng
Dru
gs
Ye
ar
Co
ntr
ibu
tin
g D
rug
ICD‐1
0 c
od
e 2
00
2
20
03
20
04
2
00
5
20
06
2
00
7
20
08
2
00
9
20
10
20
11
2
01
2
No
no
pio
id a
nal
gesi
cs
T39
16
25
23
2
83
3 2
73
6 9
77
8
Antiep
ileptic, sed
ative‐hypnotic, anti‐
Parkinsonism, antidep
ressant, and
other psychotropic drugs, not
elsewhere classified.
T42, T43
87
87
78
84
51
64
93
98
307
467
405
Ben
zodiazepines
T42.4
45
29
31
41
23
33
54
84
279
430
362
Nar
coti
cs a
nd
psy
cho
dys
lep
tics
no
t e
lse
wh
ere
cla
ssif
ied
T
36‐T
38
.9, T
40
(.0‐.
9),
T
41
, T4
4, T
45
(.0‐.
4),
T
45
(.6‐.
9), T
46‐T
50
.8
18
8
22
9
23
1
30
0
29
6
28
2
29
9
31
2
52
2
65
6
67
7
Opiates/opioids
T40(.0‐.4)
149
193
190
239
248
243
265
285
480
568
569
H
eroin
T40.1
0 1
0
0 1
0 4
14
34
42
129
Pharmaceutical O
pioids
T40.0, T40(.2‐.4)
149
192
190
239
247
243
262
271
449
538
471
Methadone
T40.3
73
116
118
136
126
106
89
53
96
95
76
Cocaine
T40.5
30
27
32
53
48
36
36
15
31
25
50
Other and unspecified narcotics
T40.6
22
23
26
28
15
14
17
22
30
79
89
Dru
gs n
ot
els
ewh
ere
cla
ssif
ied
or
un
spec
ifie
d
T5
0.9
22
2
28
4
28
4
32
72
74
2
81
27
9
27
3
60
67
93
79
6
T5
0.9
On
ly
17
3
21
8
20
5
23
32
22
2
21
23
2
21
5
28
93
07
29
9
9
10
276
257
203
42
92
90
52
78
25
54
54
16
24
205
188
173
129
76
66
66
64
50
50
34
20
15
0 50 100 150 200 250 300
Alprazolam
Oxycodone
Hydrocodone
Heroin
Methadone
Oxymorphone
Morphine
Diazepam
Cocaine
Clonazepam
Fentanyl
Tramadol
Hydromorphone
Total Number
Occurrences of Specific Drugs among the Contributing Causes for Kentucky Resident Drug Overdose Deaths, 2011‐2012
2012
2011
Produced by the Kentucky Injury Prevention and Research Center, November 2013. Data source: Kentucky Vital Statistics electronic death certificate file. Data for 2009‐2012 are provisional and subject to change.
11
12
Drug Overdose
Hospitaliza ons
2000‐2012
13
3,372
4,0244,312 4,531 4,626 4,524
4,9635,244 5,320
5,626 5,749
6,422 6,296
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
To
tal N
um
be
r
Kentucky Resident Drug Overdose Hospitalizations, 2000‐2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
82.6
98.4105.1 110 111.6
108.1
117.6123.3 124
129.7 132.1
146.6143.1
0
20
40
60
80
100
120
140
160
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Age
‐Ad
just
ed
Ra
te (
# h
osp
ita
liza
tio
ns/
10
0,0
00
p
op
ula
tio
n)
Kentucky Resident Age‐Adjusted Drug Overdose Hospitalization Rates, 2000‐2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
14
1,383
1,581
1,724
1,853
1,909
1,933
2,127
2,144
2,173
2,336
2,410 2,688
2,619
1,989
2,443
2,588
2,678
2,717
2,591 2,836 3,100
3,147
3,290
3,339
3,734
3,677
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
To
tal N
um
be
r
Kentucky Resident Drug Overdose Hospitalizations by Gender, 2000‐2012
Male
Female
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
69.7 79.6 86.5 91.9
94.4
94.8 103.3
102.7
104.1
110.8
113.7 125.6
121.8
95
116.7
123.1
127.2
128.8
121.5 131.8 143.3
143.2
148.9
150
167.3
163.6
0
20
40
60
80
100
120
140
160
180
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Ho
spit
aliz
atio
n R
ate
(#
ho
spit
aliz
atio
ns/
10
0,0
00
po
pu
lati
on
)
Kentucky Resident Age‐Adjusted Drug Overdose Hospitalization Rates by Gender, 2000‐2012
Male
Female
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
15
751
987
957 1,080
1,147
1,271
1,404
1,497 1,691
1,999
1,955
2,252
2,221
1,738 2,027 2,254
2,281
2,346
2,186 2,398
2,521
2,566
2,497
2,530 2,708
2,642
404 486
536
509
560
542 610
665
726
719 823 1,014
1,018
477
523
561 660
569
525
549
558
333 407
441
445
409
0
500
1,000
1,500
2,000
2,500
3,000
2,000 2,001 2,002 2,003 2,004 2,005 2,006 2,007 2,008 2,009 2,010 2,011 2,012
Tota
l Nu
mb
er
Kentucky Resident Drug Overdose Hospitalizations by Intent, 2000‐2012
Unintentional Self Harm Undetermined No Ecode
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
18.5
24.3
23.4 26.2
27.7 30.4 33.3 35.2
39.4
46.3
45.0
51.5
50.7
42.9
49.8
55.1
55.4
56.6
52.3
56.8 59.2
59.8
57.9
58.2 62.0
60.3
10.0 11.9
13.1
12.4
13.5
13.0 14.5
15.6
16.9
16.7 18.9
23.2
23.2
11.8
12.9
13.7 16.0
13.7
12.6
13.0
13.1
7.8 9.4 10.1
10.2
9.3
0.0
10.0
20.0
30.0
40.0
50.0
60.0
70.0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Ho
spit
aliz
atio
n R
ate
(#
ho
spit
aliz
atio
ns/
10
0,0
00
po
pu
lati
on
)
Kentucky Resident Drug Overdose Hospitalization Rates by Intent , 2000‐2012
Unintentional Self/Harm Undetermined No Ecode
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
16
Ke
ntu
cky
Res
ide
nt
Dru
g O
verd
ose
Rel
ated
H
osp
ital
izat
ion
s
Yea
r
Dru
g Ty
pe
ICD‐
9‐C
M
Co
des
20
00
2
00
1
200
2
200
3
200
4
200
5 2
006
200
7 2
008
20
09
20
10
20
11
2
01
2
DR
UG
For ICD‐9‐CM codes see Appendix A
3,3
72
4,0
244
,31
24
,53
14
,62
64
,52
44
,96
35
,244
5
,320
5
,626
5,7
496
,422
6
,296
No
no
pio
id a
nal
gesi
cs
590
6
447
14
72
37
40
73
18
30
877
8
75
906
826
880
7
93
4‐Aminophen
ol
351
379
404
414
430
438
562
571
587
608
546
587
496
Op
iate
s/o
pio
ids
339
5
195
91
67
77
31
72
89
57
988
1
,065
1
,259
1,2
981
,668
1
,637
Heroin
8
10
16
21
14
11
41
30
39
62
48
62
170
Pharmaceutical O
pioids
332
509
577
658
718
717
921
961
1,030
1,201
1,254
1,610 1,483
M
ethadone
31
67
147
184
206
163
215
226
201
190
189
194
168
Co
cain
e 9
0
118
11
27
37
58
18
59
3 7
2 8
11
042
13
217
An
tid
ep
ress
ants
1
,781
2
,275
2,3
89
2,4
87
2,5
29
2,4
61
2,6
67
2,8
49
2,9
73
3,0
323
,044
3,4
79
3,2
50
Benzodiazepines
793
1,120
1,181
1,181
1,245
1,196
1,386
1,511
1,561
1,661
1,645
1,885 1,686
Psychostim
ulants
63
93
93
96
107
106
102
94
84
111
112
203
180
An
tico
agu
lan
ts
87
6
77
49
01
10
90
90
106
1
10
125
135
80
7
7
Oth
er U
nsp
ecif
ied
1
,755
1
,972
2,1
90
2,1
98
2,2
31
2,2
12
2,4
89
2,5
46
2,7
69
2,8
453
,009
3,3
69
3,4
10
17
10,385
12,367
13,76815,061
14,635 14,285
15,839
17,802 17,83219,004 18,664
21,594 21,344
0
5,000
10,000
15,000
20,000
25,000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Tota
l Day
s o
f H
osp
ital
Sta
y
Drug Overdose Hospitalizations by Total Length of Stay, 2000‐2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
$21.1$26.2
$33.7
$43.8$48.2
$50.6
$61.3
$69.3
$77.4
$87.8$93.0
$121.1
$129.3
$0.0
$20.0
$40.0
$60.0
$80.0
$100.0
$120.0
$140.0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Do
llars
(in
mill
ion
s)
Total Charges for Drug Overdose Hospitalizations, 2000‐2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
18
0
200
400
600
800
1,000
1,200
1,400
1,600
1,800
2,000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Tota
l Nu
mb
er
Kentucky Resident Drug Overdose Hospitalizations by Expected Payer, 2000‐2012
Commercial Medicaid Medicare Other Self Pay or Charity
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
$0
$5
$10
$15
$20
$25
$30
$35
$40
$45
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Do
llars
(in
mill
ion
s)
Kentucky Resident Total Drug Overdose Hospitalization Charges by Expected Payer, 2000‐2012
Commercial Medicaid Medicare Other Self Pay or Charity
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
19
20
Drug Overdose
Emergency Department Visits
2008‐2012
21
5,414
5,917 5,778
6,496 6,492
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
2008 2009 2010 2011 2012
To
tal N
um
be
r
Kentucky Resident Drug Overdose Emergency Department Visits, 2008‐2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
129.4
139.5 136.5
153.1 153.0
‐10
10
30
50
70
90
110
130
150
170
2008 2009 2010 2011 2012
Age‐adjusted rate (# ED visits/ 100,000 population)
Kentucky Resident Age‐Adjusted Drug Overdose Emergency Department Visit Rates, 2008‐2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
22
113.5 125.9
125.7 142.4
142.6
145 153.3
147
163.2
163.1
0
20
40
60
80
100
120
140
160
180
200
2008 2009 2010 2011 2012
Age
‐ad
just
ed
ra
te (
# E
D v
isit
s/1
00
,00
0 p
op
ula
tio
n)
Kentucky Resident Age‐Adjusted Drug Overdose Emergency Department Visit Rates by Gender, 2008‐2012
Male
Female
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
2,362 2,659
2,658
3,017
3,024
3,052 3,258
3,120
3,479
3,468
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
2008 2009 2010 2011 2012
To
tal N
um
be
r
Kentucky Resident Drug Overdose Emergency Department Visits by Gender, 2008‐2012
Male
Female
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
23
2,289 2,608
2,629
3,157
3,354
1,715
1,742
1,642
1,646
1,547
766 869
900 1,084
1,092
634
690
596
599
490
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
2008 2009 2010 2011 2012
To
tal N
um
be
r
Kentucky Resident Drug Overdose Emergency Department Visits by Intent, 2008‐2012
Unintentional Self Harm Undetermined No Ecode
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
53.4
60.5
60.6
72.3 76.6
40.0
40.4
37.8
37.7
35.3
17.9 20.1
20.6 24.7
24.9
14.8
16.0
13.7
13.7
11.2
0
10
20
30
40
50
60
70
80
90
2008 2009 2010 2011 2012
Cru
de
ra
te (
# E
D v
isit
s/1
00
,00
0 p
op
ula
tio
n)
Kentucky Resident Crude Drug Overdose Emergency Department Visit Rates by Intent, 2008‐2012
Unintentional Self Harm Undetermined No Ecode
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
24
$2.9
$2.9 $3.1
$3.8
$3.6
$2.8
$3.4
$3.2
$3.7 $4.2
$1.5 $1.7 $1.8
$2.5
$2.3
$0.3
$0.2
$0.3
$0.3
$0.3
$1.9
$3.3 $3.6
$4.3
$5.0
$0
$1
$2
$3
$4
$5
$6
2008 2009 2010 2011 2012
Do
llars
(in
mill
ion
s)
Kentucky Resident Total Drug Overdose Emergency Department Visit Charges by Expected Payer, 2008‐2012
Commercial Medicaid Medicare Other Self Pay or Charity
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
$9.4
$11.4$12.0
$14.6
$15.3
$0
$2
$4
$6
$8
$10
$12
$14
$16
$18
2008 2009 2010 2011 2012
Do
llars
(in
mill
ion
s)
Kentucky Resident Total Drug Overdose Emergency Department Visit Charges, 2008‐2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
25
Kentucky Resident Drug Overdose Related ED Visits Year
For
ICD‐9‐C
M c
od
es
see
Ap
pe
nd
ix A
2008 2009 2010 2011 2012
DRUG Involved 5,414 5,917 5,778 6,496 6,492
Nonopioid analgesics, Antipyretics, and Antirheumatics 805 831 776 764 737
4‐Aminophenol derivatives 428 462 418 420 379
Opiates/opioids 590 725 816 1,026 1,488
Heroin 73 142 211 266 789
Pharmaceutical Opioids 518 585 614 769 721
Methadone 54 48 52 43 58
Cocaine 42 37 45 67 88
Antidepressants, barbiturates and other antiepileptics, sedative‐ hypnotics, and psychotropic drugs not elsewhere classified
2,033 2,179 2,075 2,320 2,200
Benzodiazepines 804 907 866 939 856
Psychostimulants with abuse potential including methamphetamine, MDMA (Ecstasy)
133 143 140 199 172
Anticoagulants 65 104 88 57 54
Other specified and unspecified drugs 3,195 3,500 3,455 3,864 3,651
804
907
866 939
856
518 585
614
769
721
73
142 211 266
789
42
37 45 67 88
‐100
100
300
500
700
900
1,100
2008 2009 2010 2011 2012
To
tal N
um
be
r
Kentucky Resident Drug Overdose Emergency Department Visits by Drugs Involved, 2008‐2012
Benzodiazepine Pharmaceutical Opioids Heroin Cocaine
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
26
27
Medicaid Recipient
Opiate Overdose
Hospitaliza ons and
Emergency Department Visits
28
18
49
38 46
64 72 77
76
96
138
136
191
173
28
43 46
45
59
47
61 63 74
73
87 92 101
15 16
33
23
36
49 59
45
61 64
83
104 110
13
13 17
17
17 19 29
25
12 15 20
15 24
0
50
100
150
200
250
2,000 2,001 2,002 2,003 2,004 2,005 2,006 2,007 2,008 2,009 2,010 2,011 2,012
Tota
l Nu
mb
er
Medicaid Recipient Opiate Overdose Hospitalizations by Intent, 2000‐2012
Unintentional Self Harm Undetermined No Ecode
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
32 41 52
51 55
75
90
70
90 102
128 148
128
42
80 83
80
121
112
137
139 153
188 198
254
280
0
50
100
150
200
250
300
350
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Tota
l Nu
mb
er
Medicaid Recipient Opiate Overdose Hospitalizations by Gender, 2000‐2012
Male
Female
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
29
$4.1
$5.6
$6.7
$11.4
$11.1
$0
$2
$4
$6
$8
$10
$12
2008 2009 2010 2011 2012
Do
llars
(in
mill
ion
s)Medicaid Recipient Total Opiate Overdose Inpatient Hospitalization Charges,
2008‐2012
Total Charges
Operating Room Charges
Other Charges
Oncology Charges
Pharmacy Charges
Radiology Charges
Room & Board Charges
Labor & Delivery Charges
Anesthesia Charges
Ancillary Charges
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
30
53
71
63
89
108
77
94 101
114
146
0
20
40
60
80
100
120
140
160
2008 2009 2010 2011 2012
To
tal N
um
be
r
Medicaid Recipient Opiate Overdose Emergency Department Visits by Gender, 2008‐2012
Male
Female
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
54
68 73
101
136
33 38
27
35 40
36
52 56
55
71
7 7 8
12
7
0
20
40
60
80
100
120
140
160
2008 2009 2010 2011 2012
To
tal N
um
be
r
Medicaid Recipient Opiate Overdose Emergency Department Visits by Intent, 2008‐2012
Unintentional Self Harm Undetermined No Ecode
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
31
$306
$405
$472
$584
$740
$0
$100
$200
$300
$400
$500
$600
$700
$800
$900
2008 2009 2010 2011 2012
Do
llars
(in
th
ou
san
ds)
Medicaid Recipient Opiate Overdose Total Emergency Department Charges, 2008‐2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
32
Opioid‐Related
Disease Condi on
Hospitaliza ons
2000‐2012
33
Note: 6.7% of all opioid‐related disease condi on hospitaliza ons listed also an ICD‐9‐CM code for drug overdose
2,209
3,1423,357
3,860
4,385
4,677
5,4645,725
6,400
6,909
7,3897,891
8,465
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
8,000
9,000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
To
tal N
um
be
rKentucky Resident Opioid‐Related Disease Condition Hospitalizations,
2000‐2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
361
481 658
787
828
890 1,124
1,158
1,193
1,358
1,661
1,771
2,005
1,850
2,673
2,707
3,083 3,564
3,795 4,356
4,578 5,220
5,572
5,757
6,147
6,491
0
1,000
2,000
3,000
4,000
5,000
6,000
7,000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
To
tal N
um
be
r
Kentucky Resident Opioid‐Related Disease Condition Hospitalizations by Condition Type, 2000‐2012
Nondependent opioid abuse Opioid type drug dependence
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
Note: 0.3% of all opioid‐related disease condi on hospitaliza ons listed both condi on types
34
1,216
1,718
1,793
2,013
2,241
2,355 2,770
2,890 3,231
3,430 3,711
3,803
3,855
993
1,424
1,564 1,847 2,144
2,322 2,694
2,835 3,168 3,479
3,678 4,088
4,610
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
5,000
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
To
tal N
um
be
r
Kentucky Resident Opioid‐Related Disease Condition Hospitalizations by Gender, 2000‐2012
Male
Female
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
$13.9$21.6
$27.7 $34.7$41.6
$48.6
$62.1$66.1
$84.5
$104.0
$122.1
$144.1
$166.6
$0.0
$20.0
$40.0
$60.0
$80.0
$100.0
$120.0
$140.0
$160.0
$180.0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Do
llars
(in
mill
ion
s)
Kentucky Resident Opioid‐Related Disease Condition Hospitalization Charges, 2000‐2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
35
$4.1
$5.2
$8.3
$7.5
$5.2
$5.6
$10.3
$8.8
$17.3
$13.8
$17.7
$20.8
$22.8
$5.0
$6.7
$8.3
$10.8
$14.4
$15.0
$19.4
$22.7
$27.0
$36.9
$41.4
$49.3
$55.4
$2.5
$4.2
$5.2
$6.8
$7.8
$9.8
$12.8
$13.2
$17.0
$21.7
$23.7
$31.3
$39.6
$1.0
$2.3
$2.2
$3.5
$5.5
$8.2
$6.9
$6.3
$2.7
$1.4
$2.0
$1.2
$2.9
$1.2
$3.3
$3.8
$6.0
$8.7
$10.0
$12.7
$15.0
$20.5
$30.3
$37.3
$41.4
$45.9
$0.0 $10.0 $20.0 $30.0 $40.0 $50.0 $60.0 $70.0
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Dollars (in millions)
Kentucky Resident Opioid‐Related Disease Condition Hospitalization Charges by Expected Payer, 2000‐2012
Self Pay or Charity
Other
Medicare
Medicaid
Commercial
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
36
8
20
20
34
43
33
56
45
53
85
85
114
144
24
29
35
59
65
89
113
108
135
157
208
293
378
72
118
138
203
210
277
394
435
545
633
702
976
1,192
0 200 400 600 800 1,000 1,200
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
Total Number
Ye
ar
Kentucky Resident Hospitalizations Involving Opioid Drug Overdose or an Opioid‐Related Disease Condition
AND Viral Hepatitis,
2000‐2012
Opioid type drug dependence & Viral hepatitis
Nondependent opioid abuse & Viral hepatitis
Drug overdoses due to the effect of opiates andrelated narcotics &Viral hepatitis
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky Outpatient Services Database, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
37
Neonatal Abs nence
Syndrome
Hospitaliza ons
2000‐2012
38
2862
93 128166
175
227275
329
435485
678
824
0
100
200
300
400
500
600
700
800
900
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
To
tal N
um
be
r
Kentucky Resident Neonatal Abstinence Syndrome Hospitalizations, 2000‐2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
$0.2$1.5 $1.3 $2.4 $3.2
$4.0$5.2
$7.5
$15.0
$23.8$25.0
$36.0
$40.2
$0.0
$5.0
$10.0
$15.0
$20.0
$25.0
$30.0
$35.0
$40.0
$45.0
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012
Do
llars
(in
mill
ion
s)
Kentucky Resident Neonatal Abstinence Syndrome Hospitalization Charges, 2000‐2012
Produced by the Kentucky Injury Prevention and Research Center, January 2014. Data source: Kentucky inpatient hospitalization discharge data, Office of Health Policy. Data for 2010‐2012 are provisional and subject to change.
39
Kentucky Resident Neonatal Abstinence Syndrome Hospitalizations by Expected Payer, 2000‐2012
Commercial Medicaid Self‐Pay or Charity
Other
Year
2000 5 20 <5 <5
2001 16 41 <5 <5
2002 11 67 8 7
2003 21 99 <5 <5
2004 14 139 <5 9
2005 12 147 7 9
2006 11 202 9 5
2007 23 224 16 12
2008 37 270 18 <5
2009 38 355 40 <5
2010 42 402 35 6
2011 90 526 55 7
2012 59 694 54 17
Kentucky Resident Neonatal Abstinence Syndrome Hospitalization Charges by Expected Payer, 2000‐2012
Commercial Medicaid Self‐Pay or Charity
Other Total
Year
2000 $75,463 $155,642 $4,318 $1,074 $235,423
2001 $989,491 $464,827 $11,180 $20,927 $1,465,498
2002 $181,443 $932,251 $24,374 $113,947 $1,138,068
2003 $685,212 $1,597,333 $9,166 $145,842 $2,291,710
2004 $262,538 $2,731,983 $50,125 $189,625 $3,044,646
2005 $471,640 $3,201,153 $46,089 $276,770 $3,718,883
2006 $161,693 $4,802,755 $138,686 $134,258 $5,103,135
2007 $697,463 $6,001,220 $414,598 $355,295 $7,113,281
2008 $2,700,471 $11,503,166 $685,389 $96,154 $14,889,026
2009 $3,142,217 $19,266,407 $1,198,435 $227,639 $23,607,058
2010 $2,156,244 $21,052,317 $1,231,209 $580,403 $24,439,769
2011 $6,360,864 $28,130,564 $1,267,251 $232,167 $35,758,679
2012 $3,287,661 $34,876,300 $1,606,756 $476,472 $39,770,716
Note: Counts less than 5 were suppressed by state data management policy.
40
For more informa on, please refer to:
Consensus Recommenda ons for Na onal and State Poisoning Surveillance, Safe States, April 2012.
APPENDIX A
ICD‐9‐CM codes for acute poisonings due to the effects of drugs (drug overdoses)
Type of Poison
ICD‐9‐CM codes
DRUG E850‐E585, E950(.0‐.5), E962.0, E980(.0‐.5), 960‐979
‐Nonopioid analgesics, Antipyretics, and Antirheumatics
E850(.3‐.8), 965(.1‐.8)
‐‐4‐Aminophenol derivatives E850.4, 965.4
‐Opiates/opioids E850(.0‐.2), 965.0
‐‐Heroin E850.0, 965.01
‐‐Pharmaceutical Opioids E850(.1‐.2), 965(.00,.02‐.09)
‐‐‐Methadone E850.1,965.02
‐Cocaine E854.3, E855.2, 968.5, 970.81
‐Antidepressants, barbiturates and other antiepileptics, sedative‐hypnotics, and psychotropic drugs not elsewhere classified
E851‐E853, E854(.0‐.2,.8), E855.0, E950(.1‐.3), E980(.1‐.3), 966, 967,
969, 970(.0,.1,.89)
‐‐Benzodiazepines E853.2, 969.4
‐‐Psychostimulants with abuse potential including methamphetamine, MDMA (Ecstasy)
E854.2, 969.7
‐Anticoagulants 964.2
‐Other specified and unspecified drugs E850(.9), E855(.1,.3‐.9), E856‐E858, E950(.0,.4,.5), E962.0, E980(.0,.4,.5), 960‐963, 964(.0,.1,.3‐.9), 965.9, 968(.0‐.4,.6‐.9), 970(.9),971‐979,
41
Conclusions
The combina on of mul ple preven on approaches such as mandatory enrollment and use of the
Kentucky All Schedule Prescrip on Electronic Repor ng system by prescribers and dispensers, physician
ownership of pain clinics, prescriber guidelines for pain treatment, and increased law enforcement resulted
in substan al decreases in Kentucky resident prescrip on drug overdose deaths, inpa ent hospitaliza ons,
and ED admissions from 2011 to 2012.
With that said, pharmaceu cal opioids remained the primary drugs involved in drug overdose
deaths; benzodiazepines were the primary drugs involved in drug overdose‐related inpa ent hospitaliza‐
ons and ED visits. Pharmaceu cal opioid involvement decreased 12% for drug overdose deaths, 8% for in‐
pa ent hospitaliza ons, and 6% for ED visits from 2011‐2012. Correspondingly, benzodiazepine involve‐
ment decreased 16% for drug overdose deaths, 11% for inpa ent hospitaliza ons, and 9% for ED visits from
2011‐2012. Raising awareness of the dangers of mixing benzodiazepines with opioids should be an empha‐
sis of physician con nuing educa on for relaying to opioid pa ents during medical consulta ons.
While the contribu on of prescrip on opioids and benzodiazepines to drug overdoses decreased
from 2011 to 2012, there was a precipitous increase in heroin involvement in drug overdose deaths, inpa‐
ent hospitaliza ons, and ED visits over the same me period. Heroin involvement increased 207% for drug
overdose deaths, 174% for inpa ent hospitaliza ons, and 197% for ED visits. Opioid‐related hospitaliza ons
and ED visits are costly in more than only financial erms. Disease condi ons already present or those caused
by opiate addic on such as viral hepa s also exert an enormous societal as well as financial toll on the
commonwealth’s popula on. Increased law enforcement, adjudica on, legisla on, and heroin abuse treat‐
ment should be a major priority for Kentucky to reduce heroin‐related deaths, and hospitaliza ons.
Total inpa ent hospitaliza on charges for drug overdoses rose 7% in 2012 to $129.3 million. Like‐
wise, drug overdose ED charges rose 5% to $15.3 million in 2012. The primary expected payers for drug
overdose related inpa ent hospitaliza ons were Medicare ($41.3 million) and Medicaid ($34.1 million). Self
‐pays were the largest expected payer for drug overdose ED visits ($5 million) followed by Medicaid ($4.2
million).
Medicaid recipient opiate overdose ED charges increased 27% in 2012 to $740,000. Inpa ent hospi‐
taliza ons of Medicaid recipients for opiate overdoses leveled off in 2012 at $11 million. Elevated Medicaid
charges illustrate the need for naloxone (an opiate an dote) reimbursement by Medicaid so that Medicaid
recipients are not charged for its purchase. Intranasal administra on of naloxone during an opiate overdose
has been credited with saving countless lives.
A mul pronged strategy to reduce substance abuse in the Commonwealth of Kentucky involves the
basic elements of the public health model that includes comprehensive surveillance and tracking of drug
overdoses, iden fica on of the risk factors that result in drug overdoses, development of interven ons to
prevent drug overdoses, and the widespread adop on of substance abuse preven on interven ons. In ad‐
di on, increased con nuing educa on of physicians on drug abuse and treatment, increased law enforce‐
ment, increased adjudica on, and increased substance abuse treatment facili es are necessary to decrease
the extraordinary toll of substance abuse on Kentucky ci zens who are addicted.
41
42
About This Report
This report presents drug overdose morbidity and mortality data for Kentucky residents, using
mul ple data sources:
‐ Kentucky Death Cer ficate Files, Kentucky Office of Vital Sta s cs, 2000‐2012 (data captured as of October
21, 2013). The 2009‐2012 files are provisional and subject to change.
‐ Kentucky Inpa ent Hospitaliza on (IH) Discharge Files, Cabinet for Health and Family Services, Office of
Health Policy, 2000‐2012 (data for 2010‐2012 are provisional and subject to change).
‐ Kentucky Emergency Department (ED) Discharge Files, Cabinet for Health and Family Services, Office of
Health Policy, 2008‐2012 (data for 2010‐2012 are provisional and subject to change).
Drug overdose mortality and morbidity case selec on was based on opera onal defini ons of acute
drug poisoning (also called “drug overdose”) by the Injury Surveillance Workgroup on Poisoning (ISW7) in
their Consensus Recommenda ons for Na onal and State Poisoning Surveillance, The Safe States Alliance,
Atlanta, GA, April 2012.1
Drug Overdose Deaths:
Each death cer ficate contains one underlying cause of death and mul ple contribu ng causes of
death. The underlying cause of death is defined as the reason that ini ated the chain of events leading di‐
rectly to death. The underlying and contribu ng causes of death are coded according to the Interna onal
Classifica on of Diseases, 10th revision (ICD‐10) [www.who.int/classifica ons/icd10/].
Defini on: Drug overdose deaths were iden fied as deaths with an underlying cause of death in the follow‐
ing range: X40‐X44(accidental/uninten onal drug poisoning), X60‐X64(suicide by drug poisoning), X85
(homicide by drug poisoning), and Y10‐Y14 (drug poisoning with undetermined intent).
The types of drugs contribu ng to drug overdose deaths were iden fied using ICD‐10 codes T36‐
T50.9 listed in any of the mul ple causes of death fields. Contribu ng drugs were reported in standardized
categories, following the ISW7 Poisoning Matrix for ICD‐10 Coded Mortality Data.1
Drug Overdose Hospitaliza ons and ED Visits :
IH and ED data were coded according to the Interna onal Classifica on of Disease, 9th revision, Clini‐
cal Modifica on (ICD‐9‐CM, www.icd9cm.chrisendres.com). The ICD‐9‐CM system describes an injury using
diagnosis codes and E‐codes. The Kentucky IH and ED data systems include up to 25 diagnosis code fields per
case. The first diagnosis code is called the principal diagnosis code. The principal diagnosis for a hospitalized
pa ent is the main reason for the pa ent’s hospital stay and is based on the clinical findings during the pa‐
ent’s stay. For ED data, the primary diagnosis code is the diagnosis established to be the main reason for
the visit to the emergency department. Other condi ons/diagnoses that exist at the me of the IH/ED visit
and affect the diagnosis, treatment, or length of stay in the health facility, are also coded in the remaining 24
diagnosis code fields in the IH/ED datasets and are called secondary diagnoses. Injury diagnoses should be
supplemented (when circumstances of the injury are known) with addi onal codes called E‐codes. E‐codes
are separated into three groups: external‐cause‐of‐injury codes, place‐of‐injury codes, and ac vity codes.
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The external‐cause‐of‐injury code describes the external cause (in this case, poisoning) and the in‐tent of injury. Based on the external‐cause‐of‐injury code, a drug poisoning can be classified by intent as accidental (uninten onal, E850‐E858), inten onal (self‐harm, E950.0‐E950.5; or assault, E962.0), or unde‐termined (E980.0‐E980.5 when based on insufficient documenta on in the medical chart to determine whether the drug overdose was accidental or inten onal). Some injury records in the IH or ED datasets, however, are not supplemented with E‐codes at all. We treat such records as a separate category and refer to them as “missing intent” or “no E‐code”. IH and ED electronic records may contain up to three designat‐ed E‐code fields. On average, more than 90 percent of the Kentucky HD and ED cases with poisoning diag‐noses are supplemented with valid external‐cause‐of‐injury codes. Defini on: A hospitaliza on or emergency department visit was considered a drug overdose if 1) any of the ICD‐9‐CM codes in the range 960‐979 were listed in any diagnosis (principal or secondary) fields; or 2) any of the ICD‐9‐CM codes in the range E850‐E858, E950.0‐E950.5, E962.0, or E980.0‐E980.5 were listed in the E‐code fields. This Injury Surveillance Workgroup on Poisoning1 defini on is a broader defini on than the defini‐on used in the 2012 report2 on drug overdose morbidity and mortality in Kentucky. Therefore, if compar‐
ing the morbidity sec ons in the current and in the 2012 report, one will no ce about a 30% increase in the reported cases of drug overdose hospitaliza ons or ED visits. The 2012 report was based on defini ons de‐rived from the external‐cause‐of‐injury matrix and didn’t capture encounters of care where the principal diagnosis was not a drug overdose but the secondary diagnosis was drug overdose. A study on drug over‐dose ED visits in the U.S. suggested that mild or moderate drug overdoses were likely to have the drug poisoning as their primary diagnosis but severe drug poisoning cases were likely to have a cri cal illness as the primary diagnosis.3 Severe drug overdoses can result in acute respiratory, heart, or renal failure that may be listed as principal diagnoses with a drug overdose listed as the secondary diagnosis. As the state enacts policies and plans for adequate substance abuse treatment resources, the most comprehensive defi‐ni on to track and enumerate total drug overdose hospitaliza ons and ED visits was used to provide a more accurate picture of the magnitude of substance abuse and misuse, the specific drugs involved, and the specific popula ons at higher risk for drug overdoses.
Only records for KY residents treated in Kentucky acute care hospitals or Kentucky emergency de‐partments are included in this report. Data for Kentucky residents treated in neighboring states were not available and not included in this report. Therefore, the presented counts and rates likely underes mate the full extent of drug overdoses in Kentucky. Reported frequencies reflect the number of visits/hospitaliza ons since follow‐up visits and readmissions for one and the same drug overdose could not be iden fied. Age‐adjusted morbidity and mortality rates were based on 2000 U.S. standard popula on data. For each of the three data sets, the number of cases classified as assault was low (48 ED visits from 2008 –2012, 35 hospitaliza ons from 2000 –2012 and seven fatali es from 2000 –2012) and were not included in the figures or discussed in this report. A sec on on mental disorder hospitaliza ons involving opiates/opioids was included in the report in order to describe disease condi ons induced by opium, heroin, and/or opioid analgesics. The case selec on followed the ISW71 framework and included hospitaliza ons related to opioid type dependence, drug de‐pendence on combina ons of opioid type drugs with any other, or nondependent opioid abuse, iden fied by any of the following ICD‐9‐CM codes in any of the diagnosis fields: 304 (.00‐.02, .70‐.72), 305 (.50‐.52).
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In the hospital discharge dataset, drug overdoses due to the effect of opiates and related narco cs were iden fied as records with any of the ICD‐9‐CM code 965(.00‐.09) in any of the diagnosis fields. Viral hepa s cases we iden fied by ICD‐9‐CM code 070 in any of the diagnosis fields. Neonatal Abs nence Syndrome (NAS) is a drug withdrawal syndrome in a newborn that is caused by the mother’s drug abuse during pregnancy. Hospitaliza ons involving drug withdrawal syndrome in a new‐born are iden fied by the ICD‐9‐CM code 779.5 listed in any of the diagnosis fields. A sec on on NAS hospi‐taliza ons was added to this report to describe another aspect and burden of drug abuse and addic on in the Commonwealth. References: 1. Consensus Recommenda ons for Na onal and State Poisoning Surveillance, The Safe States Alliance, At‐lanta, GA, April 2012. 2. Bunn TL, Slavova S, Drug Overdose Morbidity and Mortality in Kentucky, 2000‐2010, KIPRC, 2012. 3. Xiang Y, Zhao W, Xiang H, Smith GA. ED Visits for Drug‐related Poisoning in the United States, 2007. Am J Emerg Med. 2012 Feb: 30(2):293‐301.
