Drug Poisoning Trends and Current Status US England

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Drug Poisoning: Trends and Current Status US, England & Wales, Canada Lois A. Fingerhut

Drug Poisoning: Trends and Current Status US, England & Wales, Canada Lois A. Fingerhut US, National Center for Health Statistics Clare Griffiths UK, Office of National Statistics Kathryn Wilkins Canada, Statistics Canada

Definitional issues: Drug poisoning mortality • • ICD-9 vs ICD-10 • • Multiple cause:

Definitional issues: Drug poisoning mortality • • ICD-9 vs ICD-10 • • Multiple cause: T codes for substances Underlying cause: external cause codes (X & Y codes) Mental health “F” codes • Nondependent abuse • Dependent abuse • Alcohol intoxication (not included here) • Adverse effects codes (not included here)

ICD-9 vs ICD-10 Substance selection • ICD-9 underlying cause codes for poisoning more specific

ICD-9 vs ICD-10 Substance selection • ICD-9 underlying cause codes for poisoning more specific than ICD-10 codes • ICD-10, to get specific substances • Literals from the death certificate • Code the multiple cause data

ICD mortality coding by country ICD-9 ICD-10 UCOD England 1990 -2000 2001 -2002 and

ICD mortality coding by country ICD-9 ICD-10 UCOD England 1990 -2000 2001 -2002 and Wales Canada 1990 -1999 2000 -2002 United States 1990 - 1998 1999 -2002 Substancespecific Literals from text files From underlying cause Multiple cause coding

ICD ‘definitions’ of drug poisoning ICD-9 ICD-10 Nondependent abuse of drugs 305. 2 -.

ICD ‘definitions’ of drug poisoning ICD-9 ICD-10 Nondependent abuse of drugs 305. 2 -. 9 F 11 -16, 18 -19 (not. 2) Dependent abuse 304 F 11 -16, 18 -19(. 2) Unintentional E 850 -E 858 X 40 -X 44 Suicide E 950(. 0 -5) X 60 -X 64 Undetermined E 980(. 0 -. 5) Y 10 -Y 14 Homicide E 962. 0 X 85 [Alcohol intoxication 305. 0 F 10. 0]

Drug poisoning death rates: US, 2002

Drug poisoning death rates: US, 2002

Drug poisoning deaths, ages 35 -54

Drug poisoning deaths, ages 35 -54

Drug poisoning death rates, males 35 -54 years

Drug poisoning death rates, males 35 -54 years

Drug poisoning death rates, males, 25 -34 years

Drug poisoning death rates, males, 25 -34 years

Drug poisoning death rates, females, 35 -54 years

Drug poisoning death rates, females, 35 -54 years

Abuse-related (mental health codes) death rates, males 35 -54 years

Abuse-related (mental health codes) death rates, males 35 -54 years

Canada: Leading substance categories based on underlying cause of death: No further specificity available

Canada: Leading substance categories based on underlying cause of death: No further specificity available 1) Opiates and related narcotics 2) Tranquilizers and other psychotropic agents 3) Local anaesthetics (includes cocaine)

England & Wales: Leading specified substances mentioned in drug deaths for those 35 -54

England & Wales: Leading specified substances mentioned in drug deaths for those 35 -54 years: [not ICD coded]: 1993 -2002 1) Antidepressants (23%) 2) Paracetamol (22%) 3) Heroin/morphine (17%) 4) Methadone (9%) 5) Benzodiazepines (7%)

US: Leading specified substances mentioned in drug deaths for those 35 -54 years: 2002

US: Leading specified substances mentioned in drug deaths for those 35 -54 years: 2002 1. 2. 3. 4. 5. 6. 7. 8. Cocaine T 40. 5: 25% Other specified opioids T 40. 2: 21% Antidepressants T 43. 0 -T 43. 2: 11% Alcohol T 51: 11% Carbon Monoxide T 58: 8% Heroin T 40. 1: 10% Benzodiazepines T 42. 4: 9% Methadone T 40. 3 10%

Next Steps • Recommend adding certain ICD codes from Mental and Behavioral Disorders (F

Next Steps • Recommend adding certain ICD codes from Mental and Behavioral Disorders (F 10 -F 19) to classification of poisoning deaths • Nondependent abuse? • Dependent abuse? • Alcohol intoxication? • Drug status- legal/illegal use • International variation- a topic to be researched….

Questions… • Lois A Fingerhut: US NCHS LFingerhut@cdc. gov • Clare Griffiths UK ONS

Questions… • Lois A Fingerhut: US NCHS LFingerhut@cdc. gov • Clare Griffiths UK ONS Clare. Griffiths@ons. gsi. gov. uk • Kathryn Wilkins Canada Statistics Canada Kathryn. Wilkins@statcan. ca