Nevada Opioid Surveillance 2010 - 2017
Office of Analytics Department of Health and Human Services
Brian Sandoval Governor State of Nevada
Richard Whitley, MS Director Department of Health and Human Services
Prepared By and Additional Information: Office of Analytics State of Nevada 4126 Technology Way, Suite 201 Carson City, Nevada 89706 (775) 684.5897
Thank you to following for providing leadership, data and technical support for this report: Kyra Morgan, MS Chief Biostatistician Office of Analytics Department of Health and Human Services State of Nevada
Amy Lucas, MS Health Resource Analyst Office of Analytics Department of Health and Human Services State of Nevada
Jen Thompson Health Program Specialist II Office of Analytics Department of Health and Human Services State of Nevada
Office of Analytics Department of Health and Human Services Emergency Department Encounters and Inpatient Visits Data Source: Division of Public and Behavioral Health, Hospital Inpatient and Emergency Department Billing Data. Data Provided by: Center for Health Information Analysis. In October 2015, ICD-10-CM codes were implemented. Previous to October 2015, ICD-9-CM codes were used for medical billing. Therefore, 2015 data consists of two distinct coding schemes, ICD-9-CM and ICD-10-CM respectively. Due to this change in coding schemes, hospital billing data from October 2015 forward may not be directly comparable to previous data. The following ICD Codes are included in these data: Opioid Related Disorders All Diagnosis 304.0 Opioid type dependence ICD-9-CM 304.7 Combinations of opioid type drug with any other drug dependence ICD-9-CM 305.5 Nondependent opioid abuse ICD-9-CM F11 Opioid related disorders ICD-10-CM Opiate Poisoning Principal Diagnosis 965.0 Poisoning by opiates and related narcotics ICD-9-CM T40.0 Poisoning by, adverse effect of and underdosing of opium ICD-10-CM T40.1 Poisoning by and adverse effect of heroin ICD-10-CM T40.2 Poisoning by, adverse effect of and underdosing of other opioids ICD-10-CM T40.3 Poisoning by, adverse effect of and underdosing of methadone ICD-10-CM T40.4 Poisoning by, adverse effect of and underdosing of other synthetic narcotics ICD-10-CM T40.6 Poisoning by, adverse effect of and underdosing of other and unspecified narcotics ICD-10-CM All Diagnosis E850.0-E850.2 Accidental poisoning by heroin, methadone, and other opiates ICD-9-CM
Deaths *Data are preliminary and are subject to changes. Data Source: Division of Public and Behavioral Health, Electronic Death Registry System. Deaths with any of the following ICD-10 codes as an underlying cause of death were first selected: X40-X44 Accidental poisonings by drugs X60-X64 Intentional self poisoning by drugs X85 Assault by drug poisoning Y10-Y14 Drug poisoning of underdetermined intent Opioids listed as a contributing cause of death: T40.0 Opium~ T40.1 Heroin T40.2 Natural and semi-synthetic opioids T40.3 Methadone T40.4 Synthetic opioids T40.6 Other and unspecified opioids ~Opium was included in analysis, since there have been 0 deaths related to opium it is not included in the tables and charts.
Data as of 4/2018
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Office of Analytics Department of Health and Human Services
Opioid-Related Hospital Data, Nevada Residents, 2010-2017 In October 2015, ICD-10-CM codes were implemented. Previous to October 2015, ICD-9-CM codes were used for medical billing. Therefore, 2015 data consists of two distinct coding schemes, ICD-9-CM and ICD-10-CM respectively. Due to this change in coding schemes, hospital billing data from October 2015 forward may not be directly comparable to previous data.
Emergency Room Encounters (ED)
Year
Emergency Room Crude Rates
2010 2,963 2011 3,188 2012 3,473 2013 4,122 2014 4,543 2015 5,695 2016 7,495 2017 7,125 Percent Change 2010-2017
Percent Change
109.5 117.1 126.3 147.2 159.8 196.5 253.8 238.7
Inpatient Admissions (IP)
Inpatient Crude Rates
4,362 4,755 5,042 5,067 5,517 7,022 8,621 8,661
161.2 174.7 183.3 180.9 194.0 242.3 291.9 290.1
7% 8% 17% 9% 23% 29% -6% 118%
Percent Change
8% 5% -1% 7% 25% 20% -1% 80%
Rates are per 100,000 Nevada Population.
Opioid-Related Hospitalizations by Quarter, Nevada Residents, 2010-2017 Number of Hospital Encounters
2,500
ICD-9-CM ICD-10-CM 2,000
1,500
1,000
500
0 2010
2011
2012
2013
2014
Emergency Room Encounters (ED)
2015
Inpatient Admissions (IP)
2016 ED
2017
IP
Opioid-Related Hospitalizations by Quarter, ICD Group and Year, Nevada Residents, 2010-2017 2,500
Number of Hospital Encounters
ICD-9-CM ICD-10-CM 2,000
1,500
1,000
500
0 2010
2011
2012
2013
Opioid Related Disorders IP
2014
Poisonings IP
2015
Opioid Related Disorders ED
2016
2017
Poisonings ED
A person can be included in more than one drug group, and therefore the counts above are not mutually exclusive.
Opioid-Related Hospitalization (Inpatient) Visits by Length of Stay (Days), Nevada Residents, 2010-2017 Year 2010 2011 2012 2013 2014 2015 2016 2017
0-1 648 691 670 754 740 880 985 1,104
2-4 1,833 1,977 1,953 1,952 2,124 2,771 3,209 3,357
5-9 1,158 1,339 1,531 1,483 1,604 2,196 2,916 2,725
10-14 380 403 467 411 505 592 721 705
15-19 132 132 160 192 215 245 312 322
20-24 97 74 102 111 111 117 169 182
Data as of 4/2018
25+ 114 139 159 164 218 221 309 266
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Office of Analytics Department of Health and Human Services
In October 2015, ICD-10-CM codes were implemented. Previous to October 2015, ICD-9-CM codes were used for medical billing. Therefore, 2015 data consists of two distinct coding schemes, ICD-9-CM and ICD-10-CM respectively. Due to this change in coding schemes, hospital billing data from October 2015 forward may not be directly comparable to previous data.
Opioid-Related Emergency Department Encounters by Race/Ethnicity, Nevada Residents, 2017 White Black Hispanic Native American or Alaskan Asian or Pacific Islander Other Unknown
Opioid-Related Inpatient Admissions by Race/Ethnicity, Nevada Residents, 2017
Crude Rates
% 73% 12% 8% 1% 1% 4% 1%
339.4 329.0 67.7 164.9 26.9
1% 4% 1%
White White Black Hispanic Black Native American or Alaskan Hispanic Asian or Pacific Islander Other Native American or Alaskan Unknown
1%
8%
12%
Crude Rates
% 74% 10% 6% 1% 1% 5% 3%
413.0 345.6 58.4 312.4 30.8
6%
1% 5% 1%
3%
White Black Hispanic
10%
Native American or Alaskan Asian or Pacific Islander
Asian or Pacific Islander
Rates are per 100,000 Nevada population.
73%
74%
Rates are per 100,000 Nevada population.
Other
Other Unknown Unknown
Opioid-Related Emergency Department Encounters by Age Group, Nevada Residents, 2010-2017
2,500
0-14 46 37 42 35 33 41 29 37
15-24 605 661 669 726 683 765 898 790
25-34 682 798 855 1,109 1,253 1,664 1,953 1,999
35-44 522 492 569 712 786 968 1,343 1,347
45-54 654 648 653 731 776 981 1,347 1,162
55-64 328 375 481 534 683 814 1,207 1,099
Opioid-Related Emergency Department Encounters by Age Group, Nevada Residents, 2010-2017
2,000 1,500 1,000 500 0 2010
2011 0-14
2012 15-24
2013 25-34
35-44
2014 45-54
2015 55-64
2016
Opioid-Related Inpatient Admissions by Age Group, Nevada Residents, 2010-2017
65+ 126 177 204 275 329 462 718 691
2017
Year 2010 2011 2012 2013 2014 2015 2016 2017
Number of Hospital Encounters
Number of Hospital Encounters
Year 2010 2011 2012 2013 2014 2015 2016 2017
0-14 15 25 29 31 26 26 36 36
15-24 614 905 818 733 796 773 876 682
25-34 739 837 806 963 1,025 1,681 1,931 1,903
35-44 713 708 740 684 802 1,061 1,310 1,328
45-54 1,057 979 1,052 967 950 1,268 1,510 1,472
55-64 767 796 981 1,022 1,125 1,279 1,635 1,696
65+ 457 505 616 667 793 934 1,323 1,544
Opioid-Related Inpatient Admissions by Age Group, Nevada Residents, 2010-2017
2,500 2,000 1,500 1,000 500 0 2010
2011 0-14
65+
Data as of 4/2018
2012 15-24
2013 25-34
2014 35-44
45-54
2015 55-64
2016
2017
65+
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January February March April May June July August September October November December January February March April May June July August September October November December January February March April May June July August September October November December January February March April May June July August September October November December January February March April May June July August September October November December January February March April May June July August September October November December January February March April May June July August September October November December January February March April May June July August September October November December
Number of Hospital Encounters
Office of Analytics Department of Health and Human Services
Opioid-Related Hospital Data by Month, Nevada Residents, 2010-2017
In October 2015, ICD-10-CM codes were implemented. Previous to October 2015, ICD-9-CM codes were used for medical billing. Therefore, 2015 data consists of two distinct coding schemes, ICD-9-CM and ICD-10-CM respectively. Due to this change in coding schemes, hospital billing data from October 2015 forward may not be directly comparable to previous data.
900
800 ICD-9-CM ICD-10-CM
700
600
500
400
300
200
100
2010 2011 2012 2013
Emergency Room Encounters
Data as of 4/2018
2014 2015 2016 2017
Inpatient Admissions
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Office of Analytics Department of Health and Human Services In October 2015, ICD-10-CM codes were implemented. Previous to October 2015, ICD-9-CM codes were used for medical billing. Therefore, 2015 data consists of two distinct coding schemes, ICD-9CM and ICD-10-CM respectively. Due to this change in coding schemes, hospital billing data from October 2015 forward may not be directly comparable to previous data.
Opioid-Related Emergency Department Encounters by Payer, Nevada Residents, 2010-2017 Number of Encounters by Payer 2010 2011 2012 Medicaid 400 435 462 Self Pay 1,126 1,094 1,216 Medicare 405 480 597 HMO 376 433 462 Commercial Insurer 95 99 120 Negotiated Discounts (PPO) 159 189 224 Charity 160 166 176 Miscellaneous 48 43 39 County Indigent Referral 157 165 66 CHAMPUS OR CHAMPVA 31 26 39 All Workers Compensation 5 8 8 Missing 1 43 52 Unknown 7 12 Total 2,963 3,188 3,473
2013 597 1,445 744 456 173 228 125 169 57 51 9 34 34 4,122
2014 1,631 850 844 343 369 221 87 133 5 47 9 3 1 4,543
2015 2,544 701 1,081 354 510 241 58 118 7 74 2 5 5,695
2016 3,592 669 1,633 404 612 276 127 77 10 74 15 4 2 7,495
2017 3,433 601 1,487 397 605 339 89 66 7 78 15 8 7,125
Percent of Encounters by Payer 2010 2011 2012 2013 2014 2015 2016 2017 Medicaid 13% 14% 13% 14% 36% 45% 48% 48% Self Pay 38% 34% 35% 35% 19% 12% 9% 8% Medicare 14% 15% 17% 18% 19% 19% 22% 21% HMO 13% 14% 13% 11% 8% 6% 5% 6% Commercial Insurer 3% 3% 3% 4% 8% 9% 8% 8% Negotiated Discounts (PPO) 5% 6% 6% 6% 5% 4% 4% 5% Charity 5% 5% 5% 3% 2% 1% 2% 1% Miscellaneous 2% 1% 1% 4% 3% 2% 1% 1% County Indigent Referral 5% 5% 2% 1% 0% 0% 0% 0% CHAMPUS OR CHAMPVA 1% 1% 1% 1% 1% 1% 1% 1% All Workers Compensation 0% 0% 0% 0% 0% 0% 0% 0% Missing 0% 1% 1% 1% 0% 0% 0% 0% Unknown 0% 0% 0% 1% 0% 0% 0% 0% Total 100% 100% 100% 100% 100% 100% 100% 100%
Opioid-Related Inpatient Hospital Admissions by Payer, Nevada Residents, 2010-2017 Number of Admission by Payer 2010 2011 2012 Medicare 1,303 1,353 1,631 Medicaid 681 718 814 HMO 575 593 801 Commercial Insurer 327 697 361 Self Pay 448 446 515 Negotiated Discounts (PPO) 296 297 433 CHAMPUS OR CHAMPVA 83 112 194 County Indigent Referral 312 237 217 Miscellaneous 76 82 37 Charity 31 62 15 All Workers Compensation 12 5 11 Other Blue Cross/Blue Shield 1 Missing 217 153 9 Unknown 4 Total 4,362 4,755 5,042
2013 1,760 812 812 171 621 338 223 174 58 39 12 38 9 5,067
2014 1,816 1,554 774 345 352 263 319 3 48 21 6 16 5,517
2015 2,077 2,703 743 375 210 221 480 1 97 16 17 82 7,022
2016 2,618 3,301 659 546 189 277 650 0 320 21 12 0 28 0 8,621
2017 2,921 3,278 587 490 174 365 535 0 238 11 17 0 45 0 8,661
Percent of Admission by Payer 2010 2011 2012 2013 2014 2015 2016 2017 Medicare 30% 28% 32% 35% 33% 30% 30% 34% Medicaid 16% 15% 16% 16% 28% 38% 38% 38% HMO 13% 12% 16% 16% 14% 11% 8% 7% Commercial Insurer 7% 15% 7% 3% 6% 5% 6% 6% Self Pay 10% 9% 10% 12% 6% 3% 2% 2% Negotiated Discounts (PPO) 7% 6% 9% 7% 5% 3% 3% 4% CHAMPUS OR CHAMPVA 2% 2% 4% 4% 6% 7% 8% 6% County Indigent Referral 7% 5% 4% 3% 0% 0% 0% 0% Miscellaneous 2% 2% 1% 1% 1% 1% 4% 3% Charity 1% 1% 0% 1% 0% 0% 0% 0% All Workers Compensation 0% 0% 0% 0% 0% 0% 0% 0% Other Blue Cross/Blue Shield 0% 0% 0% 0% 0% 0% 0% 0% Missing 5% 3% 0% 1% 0% 1% 0% 1% Unknown 0% 0% 0% 0% 0% 0% 0% 0% Total 100% 100% 100% 100% 100% 100% 100% 100%
Data as of 4/2018
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Office of Analytics Department of Health and Human Services
Opioid-Related Poisonings - Emergency Department Encounters and Inpatient Hospital Admissions, Nevada Residents, 2010-2016 In October 2015, ICD-10-CM codes were implemented. Previous to October 2015, ICD-9-CM codes were used for medical billing. Therefore, 2015 data consists of two distinct coding schemes, ICD-9CM and ICD-10-CM respectively. Due to this change in coding schemes, hospital billing data from October 2015 forward may not be directly comparable to previous data. Opioid-related poisoning is a subset of the opioid -related hospitalization data. The following ICD-9-CM/ICD-10-CM for poisoning include the principal diagnosis: 965.0 ICD-9, T40.0-T40.4, and T40.6 ICD-10, and all E-code diagnosis: E850.0-E850.2 ICD-9. Emergency Room Crude Rates
2010 779 2011 791 2012 766 2013 732 2014 749 2015 760 2016 791 2017 829 Percent Change 2010-2017
Percent Change
28.8 29.1 27.9 26.1 26.3 26.2 26.8 27.8
1% -4% -6% 1% 0% 2% 4% -4%
Inpatient Admissions
Inpatient Crude Rates
599 646 600 653 576 579 576 535
22.1 23.7 21.8 23.3 20.3 20.0 19.5 17.9
Opioid-Related Poisonings (ED and IP), Nevada Residents, 2010-2017
Percent Change
Number of Hospital Encounters
Emergency Room Encounters
Year
7% -8% 7% -13% -1% -2% -8% -19%
Rates are per 100,000 Nevada population
900 800
779
Heroin
Methadone
2010 2011 2012 2013 2014 2015 2016* 2017*
136 158 154 172 233 272 297 317
54 53 36 29 32 36 20 30
600 500
599
600
653
500 400 300 200 100 0
Heroin
2015
2016*
535
0 Emergency Room Encounters
Inpatient Admissions
Heroin
Methadone
Other Opioids and Narcotics
85 67 62 59 47 57 43 41
459 532 496 528 478 453 453 411
Opioid-Related Poisonings - Inpatient Admissions, Nevada Residents, 2010-2017
600
2014
576
100
593 2010 61 585 2011 59 582 2012 50 532 2013 79 488 2014 59 456 2015 78 474 2016* 80 482 2017* 83 A person can be included in more than one drug group, and therefore the counts above are not mutually exclusive. For 2016 and 2017, the use of E-Codes was eliminated and counts will be mutually exclusive.
2013
579
576
200
Year
Number of Hospital Encounters
Number of Hospital Encounters
646
300
Other Opioids and Narcotics
700
2012
760
Opioid-Related Poisonings - Inpatient Admissions, Nevada Residents, 2010-2017
800
2011
829
791
749
732
400
Opioid-Related Poisonings - Emergency Department Encounters, Nevada Residents, 2010-2017
2010
766
700
Opioid-Related Poisonings - Emergency Department Encounters, Nevada Residents, 2010-2017 Year
791
2017*
600 500 400 300 200 100 0
Methadone
Data as of 4/2018
2010
2011
2012
2013
2014
2015
2016*
2017*
Other Opioids and Narcotics
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Office of Analytics Department of Health and Human Services
Opioid-Related Overdose Deaths, Nevada Residents, 2010-2017*
Year
Opioid-Related Overdose Deaths
Crude Rates
2010* 436 2011* 460 2012* 436 2013* 395 2014* 366 2015* 409 2016* 387 2017* 388 Percent Change 2010-2017
16.1 16.9 15.9 14.1 12.9 14.1 13.1 13.0
Opioid and Benzodiazepine Related Overdose Deaths 139 143 140 106 109 117 126 101
Benzodiazepine Related Overdose Deaths
Percent Change
161 165 162 126 125 129 155 118
5% -6% -11% -9% 10% -7% -1% -19.3%
Rates are per 100,000 Nevada Population.
Each year: • Roughly 85% of all benzodiazepine-related overdose deaths also involve opioids.
• Roughly 30% of all opioid-related overdose deaths also involve benzodiazepines.
Opioid-Related Overdose Deaths, Nevada Residents, 2010-2017* Number of Deaths
500 400
460
436
436
395
300
366
409
387
388
2015*
2016*
2017*
200 100 0 2010*
2011*
2012*
2013*
2014*
Opioid-Related Overdose Deaths by Drug Category, Nevada Residents, 2010-2017* Year
Heroin
2010* 2011* 2012* 2013* 2014* 2015* 2016* 2017*
19 40 42 48 61 79 79 88
Natural and SemiSynthetic 298 301 301 241 217 254 227 227
Methadone
Synthetic Opioids
Unspecified Narcotic
98 96 68 69 63 57 52 45
39 45 25 25 31 31 49 61
44 46 40 39 37 37 26 16
A person can be included in more than one drug group, and therefore the counts above are not mutually exclusive. 350
Opioid-Related Overdose Deaths by Drug Category, Nevada Residents, 2010-2017* 298
301
301
Number of Deaths
300
254
241
250
217
227
227
2016*
2017*
200 150 100 50 0 2010* Heroin
2011*
2012*
Natural and Semi-Synthetic
2013*
2014*
Methadone
2015* Synthetic Opioids
Unspecified Narcotic
* Data are preliminary and are subject to changes.
Data as of 4/2018
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Office of Analytics Department of Health and Human Services
Opioid-Related Deaths by Race/Ethnicity, Nevada Residents, 2017* Race/Ethnicity White Black Hispanic Native American Asian Unknown
% 79% 7% 11% 1% 2% 1%
Crude Rates 19.8 10.4 4.8 5.8 2.1
1%
2% White
11%
Black 79%
Hispanic
7%
Native American Asian
Rates are per 100,000 Nevada Population.
Opioid-Related Deaths by Age Group, Nevada Residents, 2010-2017* Year 2010* 2011* 2012* 2013* 2014* 2015* 2016* 2017*
0-14 0 3 0 0 1 3 1 0
15-24 46 54 36 33 33 30 34 37
25-34 72 84 70 75 62 76 70 71
35-44 92 89 80 65 62 74 67 68
45-54 122 126 134 112 96 96 93 93
55-64 81 81 88 80 74 92 92 76
65+ 23 23 28 30 38 38 30 43
Opioid-Related Deaths by Age Group, Nevada Residents, 2010-2017* 160
Number of Deaths
140
120 100 80 60
40 20 0 2010*
2011*
2012* 0-14
15-24
2013* 25-34
2014* 35-44
2015*
45-54
55-64
2016*
2017*
65+
Opioid-Related Deaths by Intent, Nevada Residents, 2010-2017* Cause of Death Accident Suicide Assult/Homicide Events of Undetermined Intent Total (2010-2017)
N 2,760 433 5 79 3,277
% 84% 13% 0% 2% 100%
Crude Rates 12.2 1.9 0.0 0.3 14.5
Opioid-Related Deaths by Sex, Nevada Residents, 2010-2017* Year 2010* 2011* 2012* 2013* 2014* 2015* 2016* 2017*
Male 239 278 226 214 196 220 212 212
Crude Rates 17.5 20.2 16.3 15.2 13.7 15.1 14.3 14.2
Female 197 182 210 181 170 189 175 176
Crude Rates 14.7 13.5 15.4 13.0 12.0 13.1 11.9 11.8
Rates are per 100,000 Nevada Population. *Data are preliminary and are subject to changes.
Data as of 4/2018
8
2010* 2011* 2012* 2013*
Data as of 4/2018
2014* 2015* 2016*
November
September
July
May
March
January
November
September
July
May
March
January
November
September
July
May
March
January
November
September
July
May
March
January
November
September
July
May
March
January
November
September
July
May
March
January
November
September
July
May
March
January
November
September
July
May
March
January
Number of Deaths
Office of Analytics Department of Health and Human Services
Opioid-Related Deaths by Month, Nevada Residents, 2010-2017*
60
50
40
30
20
10
0
2017*
*Data are preliminary and are subject to changes.
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