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Among approximately 45 million ED visits reported by the 16 ESOOS states from July 2016 through September 2017, a total of 119,198 (26.7 per 10,000 visits) were suspected opioid overdoses.
Despite data from the 2016 National Survey on Drug Use and Health indicating that heroin use and opioid misuse might be stabilizing (10), this analysis suggests that prevalence of suspected opioid overdose ED visits substantially increased in NSSP (29.7%) and ESOOS (34.5%) states from third quarter 2016 to third quarter 2017.
Increases in the Midwest in NSSP and all five Midwestern ESOOS states (Illinois, Indiana, Missouri, Ohio, and Wisconsin) are consistent with opioid overdose death trends (2).
The increases in opioid overdose rates in ESOOS metropolitan counties, specifically in large central (54.1%), medium (42.6%), and small metropolitan (36.9%) counties from third quarter 2016 to third quarter 2017 are consistent with previous reports indicating that heroin overdose hospitalizations, ED visits, and deaths were highest in metropolitan areas (2-5).
First, NSSP and ESOOS case definitions might underestimate or overestimate opioid overdoses based on coding differences in hospitals, the availability of ICD-10-CM diagnostic codes, and the quality of chief complaint data (13).
Data were entered into the State Unintentional Drug Overdose Reporting System (SUDORS), the component of ESOOS designed for tracking fatal opioid overdoses.
This analysis of opioid overdose deaths in 10 states participating in the ESOOS program found that illicitly manufactured fentanyl is a key factor driving opioid overdose deaths and that fentanyl analogs are increasingly contributing to a complex illicit opioid market with significant public health implications.
In response to this concern, CDC expanded ESOOS to 32 states and the District of Columbia in 2017 and added funding for all 33 recipients to improve forensic toxicologic testing of opioid overdose deaths to include capacity to test for a wider range of fentanyl analogs.