Overview of CSRS data use for Public Health - …...Medication or drug overdose: X40-X44, X60-X64,...

Overview of CSRS data use for Public Health

March 15, 2017

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Overdose DataNorth Carolina Poisonings

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0.0

5.0

10.0

15.0

20.0

25.0

30.0

35.0

40.0

Death

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er

100,0

00 p

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n

Year

Motor Vehicle Traffic (Unintentional)

Drug Poisoning (All Intents)

α β

Death Rates* for Two Selected Causes of Injury, North Carolina, 1968-2015

*Per 100,00, age-adjusted to the 2000 U.S. Standard Populationα - Transition from ICD-8 to ICD-9β – Transition from ICD-9 to ICD-10

National Vital Statistics System, http://wonder.cdc.gov, multiple cause datasetSource: Death files, 1968-2015, CDC WONDERAnalysis by Injury Epidemiology and Surveillance Unit

1989 – Pain added as 5th Vital Sign

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Data Source: State Center for Health Statistics, Death Certificate Data (Unintentional medication or drug (X40-X44).Does not include non-resident or out of state resident deaths.

Economic impact: CDC WISQARS, Cost of Injury Reports, National Center for Injury Prevention and Control, CDC for all medication and drug deaths

(any intent). Base year (2010) costs indexed to state 2015 prices. Unintentional cost are estimated to be $1.6 billion for these deaths.

$1.8 BILLION total combined costs

for 2015 alone

Unintentional Medication & Drug Deaths by County North Carolina Residents, 2011-2015*

Drug Overdose Deaths & Emergency

Department Visits, NC 2015

Overdose E.D. visits

dwarf overdose deaths

20,371Emergency

Department visits

1,215 deaths

The average NC county has about one overdose death per

month but just under one overdose ED visit per day

Source: N.C. State Center for Health Statistics, Vital Statistics-Deaths, 2015; NC DETECT, 2015. Analysis: N.C. Injury Epidemiology and Surveillance Unit

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CSRS Data

Photo used under Creative Commons from

bunkejer4

Controlled Substances Reporting System (CSRS)

• North Carolina’s statewide

prescription drug monitoring program

(PDMP)

• Established by NC law to improve the

state’s ability to identify people who

abuse and misuse prescription drugs

classified as Schedule II-V (drugs with

abuse potential)

• Assists clinicians to determine if or

how to prescribe an opioid to patients

using other controlled substances

• Assists clinicians in identifying and

referring for treatment patients

misusing controlled substances

Task Force to Prevent Deaths from Unintentional Drug Overdoses recommends

creation of NC PDMP

2003

Legislature establishes CSRS, statewide database

to track dispensing of Schedule II-V controlled

substances

2005

CSRS becomes operational 2007

Legislative revisions to

CSRS2013

North Carolina Controlled Substance Reporting System

Legislative Revisions to CSRS:

• Requires 72-hour reporting (but encourages 24)

• Physician-dispensed medications reported

• Veterinarians and < 48 hour supplies exempt

• Documents method of payment

• Delegate accounts approved by DHHS

• Allow alerts to physicians and pharmacists

• Allow alerts to N.C. Medical Board

• Allow SBI Diversion and Environmental Crimes Unit to share with other SBI

• Allow reports to law enforcement with court order

Senate Bill 222 (2013)

CSRS Data Overview

• Nearly 115 million controlled substance prescriptions in

database (July 2007 – May 2014)

• Approximately 19 million prescriptions per year

• Over 6.6 million queries have been made of the system

– Average of over 5,500 queries per day

• Over 25,000 dispensers and practitioners currently registered

to use the system

Source: CSRS- Division of Mental Health, Developmental Disability and

Substance Abuse Services (MH/DD/SAS)

Top 10 Prescribed Controlled SubstancesNorth Carolina Controlled Substance Reporting System, 6/2014-5/2015

Source: N.C. Controlled Substance Reporting System, 6/2014-5/2015

Analysis: Injury Epidemiology and Surveillance Unit

Opioids

CSRS Registration TrendsCumulative Number of Registrants per Year

As of August 30, 2016



286

2,492

591

4,669

974

7,046

1,415

9,184

2,337

11,243

4,938

13,480

7,046

16,589

9,128

22,062

0

5,000

10,000

15,000

20,000

25,000

Dispenser Prescriber

To

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r o

f re

gis

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nts

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2007-2008 2009 2010 2011 2012 2013 2014 2015-2016



CSRS Web Data Overview

• Prescription Rates by County (2011-2016)

– Benzo

– Opioid

– Opioid (MME)

– Stimulant

• CSRS Utilization by County (August-December 2016)

– Delegate Account

– Pharmacist

– Prescriber

• Data available at the county level

• Available less than six months on web, very new and subject

to change as system improves



CSRS live link

https://www.ncdhhs.gov/divisions/mhddsas/ncdcu/prescription-rates-by-county



CSRS live link

https://www.ncdhhs.gov/divisions/mhddsa/ncdcu/csrs-utilization-by-county



CSRS Data Utilization

• Encourage use of CSRS

• Encourage use of CDC Prescribing Guidelines

• Monitor dispensing and utilization rates

– High opioid dispensing rates linked to high rates of opioid overdose

Rates of Unintentional/Undetermined Prescription Opioid Overdose Deaths & Outpatient Opioid Analgesic Prescriptions Dispensed

North Carolina Residents, 2011-2015

Data Source: Mortality- State Center for Health Statistics, NC Division of Public Health, 2011-

2015/Population-National Center for Health Statistics, 2011-2015/Opioid Dispensing-

Controlled Substance Reporting System, 2011-2015

Analysis: Injury and Epidemiology Surveillance Unit

Overdose: (X40-X44 & Y10-Y14) and prescription opioid T-codes

Average mortality rate: 6.4 per 100,000

persons

Average dispensing rate: 82.9 Rx per 100

persons

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County SpecificOverdose Slides

Medication and Drug Overdoses in

March 15, 2017

Wilson County, 1999-2015

• For counties with low counts, regional data is provided to

allow more reliable analyses, trends not available at

local-level

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Local Health Director Regions

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Overdose Deaths in North Carolina Counties

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Rate of Medication or Drug Overdose Deaths by County

per 100,000 residents, 2013-2015

Not reported

< 10 deaths in 2013-2015

Source: N.C. State Center for Health Statistics, Vital Statistics-Deaths, 1999-2015

Analysis by Injury Epidemiology and Surveillance Unit

Medication or drug overdose: X40-X44, X60-X64, Y10-Y14, X85

Rate of Overdose Deaths, Wilson

County Residents, 2013-2015 8.6

Rate of Overdose Deaths, North

Carolina Residents, 2013-2015 13.5

Rate of Overdose Deaths, Local Health

Director Region 7 Residents, 2013-2015 9.5Rate of Overdose Deaths, North

Carolina Residents, 2013-2015 13.5

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Medication or Drug Overdose by Intent

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Medication or Drug Overdose Deaths by IntentNorth Carolina Residents, 1999-2015

1498

1268

190

40

0

200

400

600

800

1,000

1,200

1,400

1,600

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Nu

mb

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of

de

ath

s

All intents

Unintentional

Self-inflicted

Undetermined

Assault

176

148

23

100

20

40

60

80

100

120

140

160

180

200

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Nu

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Local Health Director Region 7 Residents, 1999-2015

All IntentsUnintentionalSelf-InflictedUndeterminedAssault

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Medication or Drug Overdose Deaths by Intent

9

6

2

1

00

1

2

3

4

5

6

7

8

9

10

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Nu

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Wilson County Residents, 1999-2015

All IntentsUnintentionalSelf-InflictedUndeterminedAssault

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Medication or Drug Overdose Deaths by Intent

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Type of Substance Contributing to Overdose Death

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*2015 Provisional Data (August 2016)


Substances Contributing to Unintentional Medication or

Drug Overdose DeathsNorth Carolina Residents, 1999-2015

745

293

364

103

254

0

100

200

300

400

500

600

700

800

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Nu

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Prescription Opioid

Cocaine

Heroin

Methadone

Synthetics

77

59

40

6

33

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60

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90

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

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Local Health Director Region 7 Residents, 1999-2015

Prescription OpioidHeroinCocaineMethadoneSynthetics

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Substances Contributing to Unintentional Medication or Drug Overdose Deaths


Analysis by Injury Epidemiology and Surveillance Unit. Codes Used: cdeath1-cdeath21 and Rx Opioids:

T40.2 (Other Opioids), T40.3 (Methadone) and/or T40.4 (Other synthetic opioid) / Heroin: T40.1/ Cocaine:

T40.4 (Other Synthetic Opioid) / Methadone: T40.3 / Synthetics: any mention of T40.4 (Other Synthetic

Opioids)

2

3

2

0

1

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0.5

1

1.5

2

2.5

3

3.5

4

4.5

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015

Nu

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s

Wilson County Residents, 1999-2015

Prescription OpioidHeroinCocaineMethadoneSynthetics

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Substances Contributing to Unintentional Medication or Drug Overdose Deaths


Analysis by Injury Epidemiology and Surveillance Unit. Codes Used: cdeath1-cdeath21 and Rx Opioids:

T40.2 (Other Opioids), T40.3 (Methadone) and/or T40.4 (Other synthetic opioid) / Heroin: T40.1/ Cocaine:

T40.4 (Other Synthetic Opioid) / Methadone: T40.3 / Synthetics: any mention of T40.4 (Other Synthetic

Opioids)

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Demographics of Overdose Deaths

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Economic and Societal Costs of Poisoning Deaths

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Estimated Total Lifetime Costs

Medical and Work Loss from Poisoning Fatalities, 2015

Costs Source: National Center for Injury Prevention and Control, CDC. Data & Statistics

(WISQARS): Cost of Injury Reports. Indexed to 2015.




Total Medical Costs in Wilson

County, 2015

Total Work Loss Costs in Wilson

County, 2015

Combined Cost

$ 49,428

$ 10,920,778

$ 10,970,206

Cost per capita in Wilson

County, 2015 $ 134.25

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Prevention, Treatment, and Harm Reduction

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Number of Pharmacies under Standing Order by CountyMarch 2017 (N=1,362)

Source: Division of Public Health and North Carolina Harm Reduction Coalition March 2017


Pharmacies in Wilson County under

Standing Order, as of 2017 11

Pharmacies in Local Health Director Region

7 under Standing Order, as of 2017 233

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Opioid Overdose Reversals with Naloxone

Source: North Carolina Harm Reduction Coalition, March 2017


# of Naloxone reversals reported by the North Carolina Harm Reduction

Coalition by County: 8/1/2013 - 2/28/2017 (6,158 total reversals reported)

# of Naloxone reversals reported by NC Law Enforcement by County: 1/1/2015 - 2/28/2017 (482 total reversals reported)

Harm Reduction Reversals in Wilson

County, as of 2017 31

Law Enforcement Reversals in Wilson

County, as of 2017 0Law Enforcement Agencies in Wilson

County carrying Naloxone, as of 2017 1

Harm Reduction Reversals in Local Health

Director Region 7, as of 2017 527

Law Enforcement Reversals in Local Health

Director Region 7 as of 2017 3

Law Enforcement Agencies in Local Health

Director Region 7 carrying Naloxone, 2017 17

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Rate of Unintentional/Undetermined Prescription Opioid Overdose

Deaths and Rate of Outpatient Prescriptions Dispensed for Opioids North Carolina Residents, 2011-2015

Source: Mortality – State Center for Health Statistics, NC Division of Public Health, 2011-2015. Population-

National Center for Health Statistics, 2011-2015. Opioid Dispensing – Controlled Substance Reporting

System, 2011-2015. Analysis: Injury Epidemiology and Surveillance Unit

Outpatient Dispensing per 100 persons in

Wilson County, 2011-2015 81.0


North Carolina, 2011-2015 82.9


Local Health Director Region 7, 2011-2015 12.2


North Carolina, 2011-2015 82.9

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Availability of Substance Abuse Treatment Facilities, SAMHSA

Source: Behavioral Health Treatment Services Locator – SAMHSA, Substance Abuse Treatment Facilities,

Accessed 10/2016. Medication Assisted Therapy, Opioid Treatment Program Directory – SAMHSA, Accessed

10/2016.

Substance Abuse Treatment Facilities

in Wilson County 3Opioid Treatment Programs in Wilson

County 1

Substance Abuse Treatment Facilities

in Local Health Director Region 7 55Opioid Treatment Programs in Local

Health Director Region 7 9

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Scott Proescholdbell, MPHInjury and Violence Prevention Branch

NC Division of Public Health

[email protected]

www.injuryfreenc.ncdhhs.gov

¿Preguntas?

http://www.injuryfreenc.ncdhhs.gov/

Overview of CSRS data use for Public Health - …...Medication or drug overdose: X40-X44, X60-X64,...

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