Opioids and Overdose Diagnoses

Concerns about opioid abuse and its effects continue to attract media attention. In response to the concerns, there have been public suggestions for additional funding to allow more patients to be treated, and to support specific treatment modalities or sources for care. A concern among providers and patients would be having the funding focus on only one type of addiction treatment or emphasize only illicit drugs. Reviewing the pattern of hospitalizations for drug overdoses shows why their concerns have merit. As seen in Figure 1 below, there is a bimodal distribution among overdose hospitalizations.  Peak hospitalizations are seen among people in their mid-20s to mid-30s, and among people in their 40s to late 50s. Data show the drugs leading to those overdoses change with age, as do patients’ usage behavior. Figure 2 shows the top five diagnoses for the younger patients (Group 1). These five diagnoses account for 31 percent of all overdoses among this age group. In this category, illicit drug overdoses account for just 10 percent of the top five diagnoses. The majority of overdoses occur because of prescription medications, and in particular, benzodiazepines. Benzodiazepines are drugs such as Librium, Valium, and Xanax that are used for depression, anxiety, seizures, and for muscle relaxation and sedation. While short-term use is generally safe, long-term use of benzodiazepines is controversial because of the potential for users to develop a heightened drug tolerance that can lead to prescription drug abuse. Drugs used for intentional harm are more likely to be prescription drugs. And of those, benzodiazepines appear to the most often abused. Figure 3 lists the top five diagnoses for older patients at the second peak among the patient group distribution (Group 2). Heroin poisoning is not in the top five diagnoses. Among this older group of patients, benzodiazepines are implicated in intentional and unintentional poisonings, just as they are in the younger patients. Self-inflicted benzodiazepine poisonings occur at a higher percentage within the top diagnoses. Ready access to prescriptions or polypharmacy as a result of multiple provider encounters may contribute to poisonings. Key factors associated with overdoses, as well as the causes of overdoses, differ as people age. A one-size-fits-all approach to drug overdoses is not likely to have a significant effect on overdose hospitalizations. These findings suggest that active prescription monitoring of substances in addition to opioids could help in limiting access to multiple drugs that can have serious consequences when over used or misused. (12/16)

Figure 1: Distribution of Overdose Diagnoses by Age (Virginia)

12-16 Figure 1

Data Period: Q3-2015 to Q2 2016 (1-year)

 

Figure 2: Top 5 Overdose Diagnoses for the 24-34 Age Range (Virginia)

ICD Code Description ICD Code % of Total Number of Overdose Codes
Poisoning by heroin, accidental (unintentional), initial encounter T401X1A 10.91% 110
Poisoning by benzodiazepines, intentional self-harm, initial encounter T424X2A 6.45% 65
Poisoning by other antipsychotics and neuroleptics, intentional self-harm, initial encounter T43592A 4.86% 49
Poisoning by benzodiazepine-based tranquilizers 9694 4.56% 46
Poisoning by aromatic analgesics, not elsewhere classified 9654 4.37% 44

Data Period: Q3-2015 to Q2 2016 (1-year)

 

Figure 3: Top 5 Overdose Diagnoses for the 48-58 Age Range (Virginia)

ICD Code Description ICD Code % of Total Number of Overdose Codes
Poisoning by benzodiazepines, intentional self-harm, initial encounter T424X2A 9.50% 98
Poisoning by other opioids, accidental (unintentional), initial encounter T402X1A 7.07% 73
Poisoning by benzodiazepines, accidental (unintentional), initial encounter T424X1A 5.33% 55
Poisoning by benzodiazepine-based tranquilizers 9694 5.04% 52
Poisoning by unspecified narcotics, accidental (unintentional), initial encounter T40601A 4.84% 50

Data Period: Q3-2015 to Q2 2016 (1-year)