By Taylor Knopf

New data from emergency departments in North Carolina show the rate of opioid overdose related visits continues to rise in the state, and the largest increases are in large central metropolitan areas.

North Carolina was one of 10 states noted as having significant quarterly increases between July 2016 and September 2017 in a recent report by the Centers for Disease Control and Prevention.

Suspected opioid overdose ED visits in the state increased by 31 percent during that time. That contrasts with the rest of the Southeast, which experienced a collective rate increase of 14 percent during that time.

The Midwest region showed the largest spike over the same year with a 69.7 percent increase in its rate of opioid overdose ED visits. Wisconsin had the highest rate increase at 109 percent.

graphs show gradual increases in rates of opioid-related ED visits for all regions. The south is second lowest.
Quarterly rate of suspected opioid overdose, by U.S. region. The Southeast Region: Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina and Tennessee. Data, graph courtesy of CDC.

The CDC reported that 63,632 drug overdose deaths occurred in 2016, a 21.4 percent increase from the year before. About 66 percent of those deaths were caused by prescription painkillers, illegal opioids or both, a 27.7 percent increase from 2015.

CDC researchers concluded that heroin and synthetic opioids, such as fentanyl are responsible for the rising rate of opioid-related deaths.

In contrast to reports which emphasize rural opioid use, the data suggest highly populated areas saw the greatest rate of opioid-related ED visits. Large metropolitan areas — with more than 1 million people — had a 54 percent increase.

Meanwhile micropolitan areas —  burgs with populations between 10,000 and 50,000 people — saw a smaller rate increase of 23.6 percent.

“Increases in opioid overdoses varied by region and urbanization level, indicating a need for localized responses,” CDC researchers concluded.

Rates of suspected opioid overdoses in emergency departments broken down by size of community. The six classification levels for counties are 1) Large central metro: part of a metropolitan statistical area with more than 1 million population and covers a principal city; 2) Large fringe metro: part of a metropolitan statistical area with more than 1 million population but does not cover a principal city; 3) Medium metro: part of a metropolitan statistical area with between 250,000 and 1 million residents; 4) Small metro: part of a metropolitan statistical area with fewer than 250,000 population; 5) Micropolitan (nonmetro): part of a micropolitan statistical area (has an urban cluster of more than 10,000 but fewer than 50,000 population); and 6) Noncore (nonmetro): not part of a metropolitan or micropolitan statistical area. Data, graph, courtesy of CDC.

“Educating ED physicians and staff members about appropriate services for immediate care and treatment and implementing a post-overdose protocol that includes naloxone provision and linking persons into treatment could assist EDs with preventing overdose,” they wrote.

Some relief

Fortunately, two states that have been hit hard by the opioid epidemic saw their opioid overdose ED rates go in a more positive direction.

Rates decreased by 15 percent in Kentucky and 5.3 percent in West Virginia.

“[…] Decreases in the Southeast (Kentucky and West Virginia) were unanticipated and might foreshadow changes in opioid overdose death trends in 2017,” CDC researchers wrote. “The significant decreases in Kentucky might be explained by fluctuations in drug supply and warrant confirmation.”

Some Northeastern states also reported small decreases, which study authors said might be related to various interventions, including more access to medication-assisted treatment.

The CDC used two data tracking systems to collect emergency department visit data: The CDC’s National Syndromic Surveillance Program (NSSP) and Enhanced State Opioid Overdose Surveillance (ESOOS). North Carolina takes part in ESOOS.

State law requires data from 125 hospitals with 24/7 emergency departments be reported to the N.C. Department of Public Health’s NC DETECT system at least once a day. The mandate went into effect in 2005 and was updated two years later to include data sharing with the CDC to better track public health trends.

Last year, the CDC “initiated a collaborative data sharing project with state health departments to share quarterly counts and rates of suspected drug overdoses, suspected opioid overdoses and suspected heroin overdoses … referred to as the ESOOS,” said Lana Deyneka, director of DPH’s Statewide Enhanced Surveillance and Hospital Based Public Health Epidemiologist Programs.

“A goal of the ESOOS is to share findings across participating states with the public through products such as web reports and journal articles,” she said.

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Taylor Knopf writes about mental health, including addiction and harm reduction. She lives in Raleigh and previously wrote for The News & Observer. Knopf has a bachelor's degree in sociology with a...