2014.ISDS.Abstracts.Final.pdf


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ISDS 2014 Conference Abstracts

Surveillance for Opioid Overdose in the Veterans Health 
Administration, 2004-2014
Carla Winston* and Mark Holodniy

U.S. Department of Veterans Affairs, Palo Alto, CA, USA

Objective
To examine inpatient admissions for opioid overdose among U.S. 

Veterans using national-level surveillance data.

Introduction
Drug poisoning, or overdose, is an epidemic problem in the United 

States1,2. In keeping with national trends, a recent study combining 
U.S. Veterans Health Administration (VHA) data with the National 
Death Index showed increases in opioid overdose mortality from 2001 
to 20093. One of the challenges in monitoring the overdose epidemic 
is that collecting cohort data to analyze overdose rates can be labor-
intensive. Moreover, analysts are often unable to collect real-time 
data on overdose events. To explore solutions to these challenges, we 
examined opioid overdose by using Veteran healthcare data already 
being collected for syndromic surveillance.

Methods
We analyzed data from the VHA Electronic Surveillance System 

for Early Notification of Community-based Epidemics (ESSENCE) 
platform for January 2004 through June 2014. After evaluating both 
inpatient and outpatient data, we restricted the analysis to admissions 
with a principal diagnosis of opioid poisoning in order to reflect 
severe acute events. We included any admissions with a principal 
diagnosis of 965.00 (opium alkaloids unspecified), 965.01 (heroin), 
965.02 (methadone), or 965.09 (other opiates and related narcotics). 
We calculated opioid poisoning rates per 1,000 inpatient admissions 
by age group and U.S. Census region.

Results
A total of 6,317 admissions with a principal diagnosis of opioid 

poisoning were reported out of 5,459,815 admissions. Death was 
the final outcome for 64 (1.0%) opioid admissions. Rates of opioid 
poisoning were highest among younger Veterans, and lowest among 
Veterans age 65 years and older (Table). Trends over time showed 
increases for all except 45–54 year olds (p=0.16; p <=0.02 for all 
other groups), for whom the opioid poisoning rate was initially 
highest during the study period. Overdose rates were highest in the 
Western United States, where trends were stable over time (p=0.46) 
compared with increases in other regions (p<0.01). Total rates appear 
to have peaked in 2010 and subsequently plateaued (Figure).

Conclusions
We found that surveillance data could effectively be mined for 

evaluating opioid poisoning among Veterans. Although we focused 
on principal diagnosis, trends in all opioid poisoning ICD-9 codes 
and supplemental E codes indicating causes of injuries paralleled our 
current findings. As a proof of concept similar to assessing suicidal 
ideation using telephone triage data4, we have used routine VHA 
surveillance data as a timely way to assess the opioid epidemic among 
Veterans. VHA is committed to reducing opioid morbidity through 
treatment and education5.

Opioid Poisoning Admissions, ICD-9 Codes 965.00-965.09, by Age

Keywords
opioids; overdose; trends; regional variation

Acknowledgments

The findings in this report are those of the authors and do not reflect the 
official position of the U.S. Department of Veterans Affairs.

References

1. Office of National Drug Control Policy. White House Summit on
the Opioid Epidemic. http://www.whitehouse.gov/blog/2014/06/19/
white-house-summit-opioid-epidemic Accessed August 14, 2014.

2. Centers for Disease Control and Prevention. Vital signs: overdoses
of prescription opioid pain relievers—United States, 1999-2008.
MMWR. 2011 Nov 4;60(43):1487-1492.

3. Bohnert AS, Ilgen MA, Trafton JA, et al. Trends and regional variation 
in opioid overdose mortality among Veterans Health Administration
patients, fiscal year 2001 to 2009. Clin J Pain. 2014 Jul 1; 30(7):605-
612.

4. Ludwig A, Lucero-Obusan C, Schirmer P, Holodniy M. Characteristics 
of Veterans accessing the Veterans Affairs telephone triage who have 
depression or suicidal ideation: opportunities for intervention. Online 
J Public Health Inform. 2013; 5(1): e136.

5. Veterans Health Administration. Implementation of opioid overdose
education and naloxone distribution to reduce risk of opioid-related 
death. Under Secretary for Health’s Information Letter, IL 10-2014. 
May 13, 2014.

*Carla Winston
E-mail: carla.winston@va.gov    

Online Journal of Public Health Informatics * ISSN 1947-2579 * http://ojphi.org * (1):e60, 201