Nevada Opioid Surveillance - January 2020
Opioid Surveillance*Data for 2019 are preliminary.2010 - 2019*Hospital Billing: January 1, 2010 - June 30, 2019*Death Registry System Data: January 1, 2010 -December 31, 2019*Office of AnalyticsDepartment of Health and Human ServicesSteve SisolakGovernorState of NevadaRichard Whitley, MSDirectorDepartment of Health and Human Services
Office of AnalyticsDepartment of Health and Human ServicesPrepared By and Additional Information:Office of AnalyticsState of Nevada4126 Technology Way, Suite 201Carson City, Nevada 89706data@dhhs.nv.govThank you to following for providing leadership, data and technical support for this report:Kyra Morgan, MSChief BiostatisticianOffice of AnalyticsDepartment of Health and Human ServicesState of NevadaJen ThompsonHealth Program Specialist IIOffice of AnalyticsDepartment of Health and Human ServicesState of NevadaCraig OsborneBiostatistician IIOffice of AnalyticsDepartment of Health and Human ServicesState of NevadaData as of 1/2020Page 1 of 11
Office of AnalyticsDepartment of Health and Human ServicesTechnical NotesEmergency Department Encounters and Inpatient VisitsData 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 medicalbilling. Therefore, 2015 data consists of two distinct coding schemes, ICD-9-CM and ICD-10-CM respectively. Due to thischange in coding schemes, hospital billing data from October 2015 forward may not be directly comparable to previousdata.The following ICD Codes are included in these data:Opioid Related DisordersAll Diagnosis304.0Opioid type dependence ICD-9-CM304.7Combinations of opioid type drug with any other drug dependence ICD-9-CM305.5Nondependent opioid abuse ICD-9-CMF11Opioid related disorders ICD-10-CMOpiate PoisoningPrincipal Diagnosis965.0Poisoning by opiates and related narcotics ICD-9-CMT40.0Poisoning by, adverse effect of and underdosing of opium ICD-10-CMT40.1Poisoning by and adverse effect of heroin ICD-10-CMT40.2Poisoning by, adverse effect of and underdosing of other opioids ICD-10-CMT40.3Poisoning by, adverse effect of and underdosing of methadone ICD-10-CMT40.4Poisoning by, adverse effect of and underdosing of other synthetic narcotics ICD-10-CMT40.6Poisoning by, adverse effect of and underdosing of other and unspecified narcotics ICD-10-CMAll DiagnosisE850.0-E850.2Accidental poisoning by heroin, methadone, and other opiates ICD-9-CMDeathsData 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-X44Accidental poisonings by drugsX60-X64Intentional self poisoning by drugsX85Assault by drug poisoningY10-Y14Drug poisoning of underdetermined intentOpioids listed as a contributing cause of death:T40.0Opium T40.1HeroinT40.2Natural and semi-synthetic opioidsT40.3MethadoneT40.4Synthetic opioidsT40.6Other 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 1/2020Page 2 of 11
Office of AnalyticsDepartment of Health and Human ServicesSummaryFrom 2010 to 2018 emergency department encounters increased by 97% and inpatient admissions increased by97%. The rate of emergency department encounters per 100,000 Nevada residents increased from 109.5 to 215.4,and the rate per 100,000 Nevada residents of inpatient admissions increased from 161.2 to 317.2.Opioid-related hospitalization visits, from 2010 to 2018, with stays 15 or more days has increased by 119%.In terms of demographics in 2018, 73% of the opioid-related emergency department encounters were White nonHispanic. In the hospital, 73% of the inpatient admissions were White non-Hispanic and were most prevalentamong 25-34 years old Nevada residents (28%).In 2018 Medicaid paid 48% of the opioid-related Emergency department encounters and 40% of the opioid-relatedinpatient admissions.From 2010 to 2018, opioid poisonings in the emergency department decreased by 16%, and inpatient admissionsdecreased by 28%. The rate per 100,000 Nevada residents in the emergency department decreased from 28.8 to24.2 and inpatient admissions rates per 100,000 Nevada population decreased from 22.1 to 16.0.In 2018: Heroin was included in 47% of the emergency department encounters and 21% of the inpatientadmissions. Methadone was included in 3% of the emergency department encounters and 6% of the inpatientadmissions. Other opioids and narcotics accounted for 51% of the emergency department encounters and 73% of theinpatient admissions.From 2010 to 2018, the number of opioid-related overdose deaths decreased. The rate per 100,000 Nevadaresidents for opioid-related overdose deaths decreased by 24% from 16.2 to 12.2.From 2010 to 2018, each year Roughly 85% of all benzodiazepine-related overdose deaths also involve opioids. Roughly 30% of all opioid-related overdose deaths also involve benzodiazepines.In 2018, heroin accounted for 24%, natural and semi-synthetic, 48%, methadone, 7%, synthetic Opioids, 19%, andunspecified narcotics, 2%, of all opioid-related overdose deaths.In terms of demographics in 2019, 75% of the opioid-related overdose deaths were White non-Hispanic and opioidrelated deaths were most prevalent among 45-54 years old Nevada residents.Opioid-related overdose deaths, in 2019, were more prevalent among the male gender.Opioid-related overdose deaths in Nevada by suicide accounted for 13% of all opioid-related deaths. Nevada hashad 530 opioid-related suicide deaths between 2010 and 2019.Data as of 1/2020Page 3 of 11
Office of AnalyticsDepartment of Health and Human ServicesOpioid-Related Hospital DataIn 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, hospitalbilling data from October 2015 forward may not be directly comparable to previous data.EmergencyDepartmentEncounters (ED)YearEmergencyDepartment CrudeRatesPercentChangeInpatientAdmissions (IP)InpatientCrude .820177,165239.920186,530215.42019*3,047Percent Change 2010-2018Rates are per 100,000 State of Nevada Population.97%97%Opioid-Related Hospitalizations by Quarter, Nevada Residents, 2010-2019*ICD-9-CM ICD-10-CMNumber of Hospital 22013201420152016Emergency Room Encounters (ED)201720182019*Inpatient Admissions (IP)Opioid-Related Hospital Data, Nevada Residents, 2010-2019*Number of Hospital Encounters3,000ICD-9-CM pioid Related Disorders ED2014Poisonings ED201520162017Opioid Related Disorders IP20182019*Poisonings IPA 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), NevadaResidents, 25 114139159164218221321267229121*Data for 2019 are preliminary and includes Quarter 1 and 2.Data as of 1/2020Page 4 of 11
Office of AnalyticsDepartment of Health and Human ServicesIn 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,2018White non-HispanicHispanicBlack non-HispanicNative American orAlaskan Native%73%7%12%Crude Rates309.152.4297.21%131.01%1%4%1%Opioid-Related Inpatient Admissions by Race/Ethnicity, Nevada Residents,2018White non-Hispanic12%HispanicBlack non-HispanicAsian or Pacific IslanderOtherUnknown1%25.87%4%1%73%Native American orAlaskan NativeAsian or PacificIslanderOtherRates are per 100,000 State of Nevada Population.White non-HispanicHispanicBlack non-HispanicNative American orAlaskan Native%73%6%11%Crude Rates451.062.6382.21%182.31%33.7Asian or Pacific IslanderOtherUnknown6%3%1%1%White non-HispanicHispanicBlack non-Hispanic11%Native American orAlaskan NativeAsian or PacificIslanderOther6%6%3%73%Rates are per 100,000 State of Nevada Population.UnknownUnknownOpioid-Related Inpatient Admissions by Age Group, Nevada 63666925Opioid-Related Emergency Department Encounters by Age Group, Nevada Residents, 83754815346838141,2071,1021,00948065 126177204275329462718693734337Opioid-Related Inpatient Admissions by Age Group Crude Rates,Nevada Residents, 2010-2018600.0600.0500.0500.0Rate per 100,000Rate per 100,000Opioid-Related Emergency Department Encounters by Age Group Crude Rates,Nevada Residents, 2010-201865 020110-1465 01865 *Data for 2019 are preliminary and includes Quarter 1 and 2.Data as of 1/2020Page 5 of 11
Office of AnalyticsDepartment of Health and Human ServicesOpioid-Related Hospital Data by Month, Nevada Residents, 2010-2019*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.1,000ICD-9-CM900ICD-10-CMNumber of Hospital y Room Encounters2017Inpatient ata for 2019 are preliminary and includes Quarter 1 and 2.Data as of 1/2020Page 6 of 11
Office of AnalyticsDepartment of Health and Human ServicesIn 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 incoding 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, 2010-2019*Number of Encounters by 7Self Pay1,126 1,094 1,216HMO376433462Commercial Insurer9599120Negotiated Discounts HAMPUS OR CHAMPVA312639County Indigent Referral15716566All Workers Compensation588Missing/Unknown15064Total2,963 3,188 nt of Encounters by %Self Pay38%34%35%HMO13%14%13%Commercial Insurer3%3%3%Negotiated Discounts (PPO)5%6%6%Charity5%5%5%Miscellaneous2%1%1%CHAMPUS OR CHAMPVA1%1%1%County Indigent Referral5%5%2%All Workers Compensation0%0%0%Missing/Unknown0%2%2%Total100% 100% ated Inpatient Hospital Admissions by Payer, Nevada Residents, 2010-2019*Number of Admission by Payer201020112012Medicare1,303 1,353 1,631Medicaid681718814HMO575593801Commercial Insurer327697361CHAMPUS OR CHAMPVA83112194Self Pay448446515Negotiated Discounts (PPO)296297433County Indigent ll Workers Compensation12511Other Blue Cross/Blue Shield100Total4,145 4,602 5,029*Data for 2019 are preliminary and includes Quarter 1 and 40369480209219110
Opioid-related overdose deaths, in 2019, were more prevalent among the male gender. Opioid-related overdose deaths in Nevada by suicide accounted for 13% of all opioid-related deaths. Nevada has had 530 opioid-related suicide deaths between 2010 and 2019.
4 Post-op Opioid Use Study of 39,140 opioid-naïve patients having major surgery 49.2% D/C with opioid prescription 3.1% on opioids 90 days after surgery 5 Post-op Opioid Use Study of 391,139 opioid- naïve patients having short-stay surgery 7.7% were prescribed opioids 1 year after surgery
5 Purpose The purpose of this needs assessment is to identify the opioid use disorder (OUD) crisis in Nevada related to: the geographical and demographic areas where opioid misuse and related harms are most prevalent; all existing activities and funding sources in the state/jurisdiction that address opioid use prevention, treatment and recovery activities; and
1. Avoid initiation of long -term, high-dose opioid therapy for chronic pain 2. Recommend individualized assessment of risks & benefits and individualized implementation of opioid dose reduction Recommend against tapering without assessment of or discussion with patient Recommend against abrupt opioid tapering 3.
Opioid use disorder — a combination of opioid dependence and opioid abuse — is a medical condition that causes clinically significant patient impairment and distress. OUD includes the misuse of a range of opioid-classified drugs,
Opioid overdose was the main cause of the estimated 99,000-253,000 deaths worldwide related to illicit drug use in 2010.1 Opioid overdose is both preventable and, if witnessed, treatable (reversible). In its resolution 55/7 on promoting measures to prevent drug overdose, in particular opioid overdose, the
Naloxone for Opioid Overdose: FAQs Background Opioid prescribing doubled from the late 1990s to 2012, when pain treatment became the subject of several quality initiatives and practice guidelines.1-3 Prescription opioid overdose deaths quadrupled between 1999 and 2010, while heroin overdoses increased by 50%.4 Now, opioid
An opioid use disorder or addiction is rare with short-term medical use, but longer-term use can lead to opioid dependence, tolerance, and possibly addiction. 3. One large dose of an opioid can slow or stop the breathing, leading to an overdose that can be fatal. Risks of overdose are increased when an opioid is taken with alcohol or sedatives.
academic writing, the purpose of which is to explore complex concepts and issues. Terms like Zin essence or to summarise, are more appropriate. The use of the word Ztalking [ is unsuitable because the law is a concept and concepts are not capable of talking! Words that could be used instead include state, articulate or describe. Sentences Try to express a single idea or point in each sentence .
