All Opioids

Suspected overdose estimates for a given point in time may change as information on the ED visit is updated, so data should be interpreted with caution. For the most recent quarter change, the fourth quarter (October-December) of 2018 to the first quarter (January-March) of 2019, ESOOS states, including the District of Columbia, reported a 7.2% decrease in opioid overdoses.

Overall, suspected opioid overdoses in ESOOS states, including the District of Columbia, increased 3.5% from the first quarter of 2018 to the first quarter of 2019. Ten states (Alaska, Connecticut, Georgia, Illinois, Michigan, Minnesota, Pennsylvania, Tennessee, Utah, and Washington) reported a significant annual increase in all drug overdoses during this time period. Significant decreases in all drug overdoses during this time period occurred in the District of Columbia and seven states (Indiana, Maine, Maryland, Massachusetts, Missouri, New Jersey, and New Hampshire).1

Opioid Overdose ED Visits Map Q1 2018 to Q1 2019

CDC’s Enhanced State Opioid Overdose Surveillance (ESOOS) Program:* Trends† in Emergency Department Visits for Suspected Opioid Overdose§ for Selected States Providing Data, Q4 2016 (October 1, 2016-December 31, 2016) to Q4 2018 (October 1, 2018-December 31, 2018),¶ by State
Yearly Percent Change Quarterly Percent Change
Q4 2016 to Q4 2017 Q1 2017 to Q1 2018 Q2 2017 to Q2 2018 Q3 2017 to Q3 2018 Q4 2017 to Q4 2018 Q1 2018 to Q1 2019 Category, Q1 2018 to Q4 2016 to Q1 2017 Q1 2017 to Q2 2017 Q2 2017 to Q3 2017 Q3 2017 to Q4 2017 Q4 2017 to Q1 2018 Q1 2018 to Q2 2018 Q2 2018 to Q3 2018 Q3 2018 to Q4 2018 Q4 2018 to Q1 2019
(20 states) (24 states) (24 states) (25 states) (29 states) (27 states) Q1 2019 (20 states) (24 states) (24 states) (26 states) (30 states) (30 states) (30 states) (30 states) (28 states)
Overall 5.43 -10.26 -10.9 -6.3 0.44 3.51 Significant increase 6.47 13.01 -0.56 -9.32 -10.02 12.82 2.8 -4.29 -7.2
State
Alaska . . . . 8.28 79.18 Significant increase . . . . -32.77 30.38 1.83 21.31 11.24
California -1.33 12.86 1.57 7.71 14.37 . Data not available/not reported -12.08 23.98 2.62 -11.79 0.56 11.58 8.82 -6.34 .
Connecticut . . . . 29.27 16.71 Significant increase . . . . -8.99 49.67 1.81 -6.8 -17.83
Delaware . 35.36 21.24 25.96 19.08 9.05 No significant change . 35.49 15.36 -6.14 -7.73 21.36 19.85 -11.26 -15.51
District of Columbia -9.5 -28.54 -56.24 -47.22 -36 -21.95 Significant decrease -4.41 58.24 -19.18 -25.97 -24.53 -3.1 -2.51 -10.23 -7.95
Florida§ Data not available/not reported
Georgia -4.83 -15.07 -3.47 -10.05 9.63 25.63 Significant increase -2.87 -8.84 0.4 7.06 -13.33 3.62 -6.44 30.48 -0.67
Illinois 16.26 7.05 11.33 -8.66 17.05 5.15 Significant increase 3.85 1.81 29.16 -14.87 -4.38 5.89 5.97 9.09 -14.1
Indiana 81.36 34.82 31.34 4.08 -20.33 -13.53 Significant decrease 10.41 10.48 21.98 21.88 -17.92 7.63 -3.34 -6.7 -10.91
Kentucky 17.61 -25.72 -27.85 . . . Data not available/not reported 43.21 -1.68 10.65 -6.51 -9.56 -4.49 . . .
Louisiana . . . . 8.33 . Data not available/not reported . . . . 15.06 -3.33 2.13 -4.64 .
Maine 22.39 8.35 -4.85 -21.88 -24.02 -24.24 Significant decrease -4.14 18.66 5.87 1.63 -15.14 4.2 -13.07 -1.15 -15.39
Maryland -13.48 -6.6 -25.69 -25.34 1.59 -9.32 Significant decrease -1.34 24.92 -18.77 -13.58 6.5 -0.61 -18.38 17.59 -4.94
Massachusetts -14.39 -7.58 2.92 -17.85 -4.36 -5.98 Significant decrease -11.69 3.1 18.98 -20.98 -4.66 14.81 -5.03 -8 -6.27
Michigan . . . . 10.16 27.66 Significant increase . . . . 0 7.93 7.27 -4.85 15.89
Minnesota . -3.38 -1.03 -17.38 8.34 65.15 Significant increase . -2.5 33.27 -1.44 -24.56 -0.13 11.26 29.24 15
Missouri -1.42 1.58 7 -4.91 -0.2 -20.27 Significant decrease -2.07 10.25 7.02 -14.68 0.91 16.13 -4.9 -10.45 -19.39
Nevada -6.62 3.35 1.71 -9.81 -7.79 -10.72 No significant change -8.51 10.86 1.83 -9.59 1.26 9.1 -9.71 -7.56 -1.96
New Hampshire -13.43 -7.06 -32.46 -23.82 -23.83 -23.87 Significant decrease -17.91 29.67 -8.76 -10.86 -11.87 -5.77 2.91 -10.86 -11.92
New Jersey 1.47 -8.62 9.42 20.57 14.17 -6.9 Significant decrease 9.48 6 -6.25 -6.73 -1.4 26.93 3.3 -11.68 -19.6
New Mexico -10.72 -12.33 11.14 7.57 -12.64 9.78 No significant change 2.93 -5.53 -9.62 1.58 1.08 19.76 -12.52 -17.51 27.02
North Carolina 13.55 2.96 -2.62 -11.18 -7.99 -3.55 No significant change 2.27 14.35 12.69 -13.84 -7.27 8.15 2.79 -10.74 -2.79
Ohio -4.3 -49.41 -54.15 -19.62 -26.7 1.6 No significant change 25.86 21.66 -31.99 -8.1 -33.46 10.26 19.22 -16.19 -7.78
Oklahoma§ Data not available/not reported
Pennsylvania 19.95 -21.85 -20.42 -5.38 -1.01 15.26 Significant increase 18.24 25.27 -5.75 -14.08 -22.96 27.57 12.06 -10.11 -10.31
Rhode Island . . . . . . Data not available/not reported . . . . . . 1.94 7.19 -9.98
Tennessee . . . 15.6 3.23 21.99 Significant increase . . . 19.41 -7.99 5.42 -0.2 6.64 8.72
Utah . 161.27 128.35 100.09 36 15.78 Significant increase . 15.73 14.45 58.43 24.5 1.15 0.29 7.68 5.99
Vermont . -2.22 33.23 -5.16 -20.38 -21.37 No significant change . -14.02 33.46 -7.42 -7.96 17.15 -4.99 -22.28 -9.11
Virginia 7.67 -15.51 -2.32 4.82 0.53 -5.46 No significant change 8.11 11.26 -4.35 -6.42 -15.17 28.64 2.64 -10.25 -20.22
Washington -3.78 10.97 14.24 Significant increase . . . -5.17 -7.68 15.7 -5.02 9.37 -4.96
West Virginia -41.86 -39.18 -35.35 10.65 1.61 6.53 No significant change -14.41 -0.64 -20.52 -13.98 -10.46 5.61 36.02 -21 -6.13
Wisconsin 14.43 -39.4 -23.36 -40.52 3.96 7.23 No significant change 64.65 0.51 -2.64 -28.97 -12.81 27.12 -24.44 24.15 -10.07

* Data come from states participating in CDC’s Enhanced State Opioid Overdose Surveillance (ESOOS) program and are current as of April 15, 2019. Every three months, states share overdose data from emergency department (ED) visits to CDC, including syndromic or hospital billing data to identify all drug, opioid, and/or heroin overdoses that presented in the ED and demographic characteristics of those who overdosed, such as sex, age, and county of patient residence. States have several options for how they relay their ED data to CDC. States choose to share ED visits for suspected overdoses (e.g., all drug, opioid, and heroin) either directly with CDC using a secure server or they can allow CDC to have access to their states’ data in the National Syndromic Surveillance Program’s (NSSP) BioSense platform. The number of states included in the calculations of quarterly and yearly change will vary and will increase over time as additional states share data with CDC. Comparisons between states should not be made due to variations in data quality, completeness, and reporting across states.

To account for changes occurring across time, quarterly and yearly trends for the rate of ED visits involving suspected drug overdoses (e.g., ED visits involving drug overdoses divided by total ED visits and multiplied by 10,000) were analyzed by U.S. state. Yearly change, controlling for seasonal effects, was estimated as the change from the final quarter of previous year to the final quarter of the current year (e.g., fourth quarter 2017 to fourth quarter 2018). Quarterly rate changes were calculated for all quarters. Significance testing was conducted using chi-square tests. Data table provides the yearly and quarterly rate changes by state. Bolded estimates indicate statistically significant results between quarters.

§ The case definitions used by states draw from multiple fields within emergency department (ED) data. Please see more information on the “Case Definition” webpage or CDC’s March 2018 Vital Signs.

¶ The following are several important caveats to consider when interpreting the data presented: (1) Data sent from facilities to health departments may be delayed or may stop for a period of time. When facilities begin sharing data again, information about visits during the lapse may never be shared; (2) For syndromic data, information from ~70% of visits arrive within 48 hours as the chief complaint of the visit. However, the chief complaint field may be incomplete. As updates to visits arrive weeks later, relevant overdose discharge diagnosis codes or revised chief complaint text may be received. Therefore, rates may change over time as the visit records are completed and new drug overdose visits are identified; (3) Because these data are not finalized based on toxicological results, they are not considered confirmed cases, but “suspected” overdoses. Data collected from syndromic surveillance should not be interpreted or represented as exact counts; and (4) Data likely represent an undercount, given inaccuracies in coding and missing chief complaint information.

** The funded ESOOS state did not provide CDC enough quarters of data to calculate yearly percent change. Some states provided enough data to calculate some quarterly changes.

†† The funded ESOOS state does not provide CDC estimates for emergency department visits for suspected opioid overdose.

§ The funded ESOOS state does not provide CDC emergency department data.

Opioid Overdose Bar Chart Q1 2017 to Q1 2019

CDC’s Enhanced State Opioid Overdose Surveillance (ESOOS) Program:* Annual percent changes† in Opioid Overdoses§ for Selected States Providing Data,¶ Q1 2017 (January 1, 2017-March 31, 2017) to Q1 2019 (January 1, 2019-March 31, 2019), by Sex and Age Group
Yearly Percent Change
Q1 2017 to Q1 2018 Q2 2017 to Q2 2018 Q3 2017 to Q3 2018 Q4 2017 to Q4 2018 Q1 2018 to Q1 2019
(24 states) (24 states) (25 states) (29 states) (27 states)
Overall -10.26 -10.9 -6.3 0.44 3.51
Sex
Male -11.59 -11.18 -7.42 0.52 2.86
Female -8.38 -10.7 -5.1 -0.39 3.9
Age group
11-24 -16.47 -16.52 -15.39 -10.39 -12.72
25-34 -11.16 -11.06 -7.75 -7.62 2.18
35-54 -6.89 -8.58 -4.12 6.94 4.76
55 and up -6.94 -8.39 0.2 12.83 15.15

* Data come from states participating in CDC’s Enhanced State Opioid Overdose Surveillance (ESOOS) program. Every three months, states share overdose data from emergency department (ED) visits to CDC, including syndromic or hospital billing data to identify all drug, opioid, and/or heroin overdoses that presented in the ED and demographic characteristics of those who overdosed, such as sex, age, and county of patient residence. States have several options for how they relay their ED data to CDC. States choose to share ED visits for suspected overdoses (e.g., all drug, opioid, and heroin) either directly with CDC using a secure server or they can allow CDC to have access to their states’ data in the National Syndromic Surveillance Program’s (NSSP) BioSense platform. The number of states included in the calculations of quarterly and yearly change will vary and will increase over time as additional states share data with CDC. Comparisons between states should not be made due to variations in data quality, completeness, and reporting across states.

† To account for changes occurring across time, quarterly and yearly trends for the rate of ED visits involving suspected drug overdoses (e.g., ED visits involving drug overdoses divided by total ED visits and multiplied by 10,000) were analyzed overall and by sex, age group, and U.S. state. Quarterly rate changes were calculated for all quarters. Yearly change, controlling for seasonal effects, was estimated as the change from the final quarter of previous year to the final quarter of the current year (e.g., fourth quarter 2016 to fourth quarter 2017). Significance testing was conducted using chi-square tests. Data table provides quarterly and yearly estimates of change for all ESOOS states with available data overall, and by sex and age. Bolded estimates indicate statistically significant results between quarters.

§ The case definitions used by states draw from multiple fields within emergency department (ED) data. Please see more information on the Case Definiton webpage or CDC’s March 2018 Vital Signs.

¶ The following are several important caveats to consider when interpreting the data presented: (1) Data sent from facilities to health departments may be delayed or may stop for a period of time. When facilities begin sharing data again, information about visits during the lapse may never be shared; (2) For syndromic data, information from ~70% of visits arrive within 48 hours as the chief complaint of the visit. However, the chief complaint field may be incomplete. As updates to visits arrive weeks later, relevant overdose discharge diagnosis codes or revised chief complaint text may be received. Therefore, rates may change over time as the visit records are completed and new drug overdose visits are identified; (3) Because these data are not finalized based on toxicological results, they are not considered confirmed cases, but “suspected” overdoses. Data collected from syndromic surveillance should not be interpreted or represented as exact counts; and (4) Data likely represent an undercount, given inaccuracies in coding and missing chief complaint information.

CDC Guideline for Prescribing Opioids for Chronic Pain