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Trends in U.S. Emergency Department Visits for Opioid Overdose, 1993–2010

Authors

  • Kohei Hasegawa MD, MPH,

    Corresponding author
    1. Department of Emergency Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
    • Reprint requests to: Kohei Hasegawa, MD, MPH, Department of Emergency Medicine, Massachusetts General Hospital, 326 Cambridge Street, Suite 410, Boston, MA 02114, USA. Tel: 617-726-5276; Fax: 617-724-4050; E-mail: khasegawa1@partners.org.

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  • Janice A. Espinola MPH,

    1. Department of Emergency Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
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  • David F. M. Brown MD,

    1. Department of Emergency Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
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  • Carlos A. Camargo Jr. MD, DrPH

    1. Department of Emergency Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
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  • Conflicts of Interests: Dr. Camargo has consulted for Intelliject (Richmond, VA). The other authors have no financial relationships relevant to this article to disclose.
  • Financial Support: Dr. Hasegawa was supported, in part, by Eleanor and Miles Shore Fellowship Program (Boston, MA). The funding organization had no role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Abstract

Objective

Emergency department (ED) visits for opioid overdose provide an important marker of acute morbidity. We sought to evaluate national trends of ED visits for opioid overdose.

Design, Setting, and Participants

The National Hospital Ambulatory Medical Care Survey, 1993–2010, was used to identify ED visits for opioid overdose.

Outcome Measures

Outcome measures were national ED visit rates for opioid overdose per 100,000 U.S. population and per 100,000 ED visits.

Results

From 1993 to 2010, there were approximately 731,000 ED visits (95% CI, 586,000–877,000 visits) for opioid overdose, representing an overall rate of 14 ED visits (95% CI, 12–17 visits) per 100,000 population and 37 ED visits (95% CI, 31–45 visits) per 100,000 ED visits. Of these, 41% (95% CI, 33–50%) were for prescription opioid overdose. Between 1993 and 2010, the national visit rate increased from 7 to 27 per 100,000 population (+307%; Ptrend = 0.03), and from 19 to 63 per 100,000 ED visits (+235%; Ptrend < 0.001). Stratified analyses of the visit rate per population showed upward, but nonsignificant, trends across multiple demographic groups and U.S. regions. In stratified analyses of the visit rate per 100,000 ED visits, the rate increased significantly in several groups: age <20 years (+1188%; Ptrend = 0.002), age 20–29 years (+155%; Ptrend = 0.04), age ≥50 years (+231%; Ptrend = 0.04), female (+234%; Ptrend = 0.001), male (+80%; Ptrend = 0.04), whites (+187%; Ptrend < 0.001), and patients in the South (+371%; Ptrend < 0.001).

Conclusion

In a nationally representative database of U.S. ED visits, we found that the ED visit rate for opioid overdose quadrupled from 1993 to 2010. Our findings suggest that previous prevention measures may not be adequate.

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