Using ED data to track trends in nonfatal drug overdoses is a critical strategy for expanding overdose surveillance and tailoring prevention resources to populations most affected, including initiation of medication-assisted treatment in ED settings and subsequent linkage to care for substance use disorders.

In 2017, drug overdoses caused 70,237 deaths in the United States, a 9.6% rate increase from 2016 (1). Monitoring nonfatal drug overdoses treated in emergency departments (EDs) is also important to inform community prevention and response activities. Analysis of discharge data provides insights into the prevalence and trends of nonfatal drug overdoses, highlighting opportunities for public health action to prevent overdoses. Using discharge data from the Healthcare Cost and Utilization Project’s (HCUP) Nationwide Emergency Department Sample (NEDS), CDC identified nonfatal overdoses for all drugs, all opioids, nonheroin opioids, heroin, benzodiazepines, and cocaine and examined changes from 2016 to 2017, stratified by drug type and by patient, facility, and visit characteristics. In 2017, the most recent year for which population-level estimates of nonfatal overdoses can be generated, a total of 967,615 nonfatal drug overdoses were treated in EDs, an increase of 4.3% from 2016, which included 305,623 opioid-involved overdoses, a 3.1% increase from 2016. From 2016 to 2017, the nonfatal overdose rates for all drug types increased significantly except for those involving benzodiazepines. These findings highlight the importance of continued surveillance of nonfatal drug overdoses treated in EDs to inform public health actions and, working collaboratively with clinical and public safety partners, to link patients to needed recovery and treatment resources (e.g., medication-assisted treatment).

The 2017 HCUP NEDS data set is a nationally representative, stratified sample of ED visits from nonfederal, hospital-based EDs in 36 U.S. states and the District of Columbia.* Hospital discharge data represent the reference standard in nonfatal overdose surveillance and allow generation of population-level estimates to examine rate changes over time. Using 2016 and 2017 NEDS data, six drug overdose indicators were classified using International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) discharge diagnosis codes: 1) all-drugs, 2) all opioids, 3) nonheroin opioids, 4) heroin, 5) benzodiazepines, and 6) cocaine. All diagnosis fields were searched for initial encounter† visits for intent (i.e., unintentional, intentional self-harm, assault, and undetermined).§ Polysubstance overdoses could be classified under multiple overdose indicators; thus, groups are not mutually exclusive.

Annual rates for drug overdose per 100,000 population were calculated by sex, age group, U.S. Census region of facility,¶ county urbanization level of facility,** and intent. All rates, except age group, were age-adjusted.†† Absolute and relative rate changes§§ were calculated from 2016 to 2017 by patient, facility, and visit characteristics for each overdose indicator; z-tests were used to compare changes that occurred from 2016 to 2017 and for pairwise comparisons between groups for 2017 rates, with p-values <0.05 considered statistically significant. Only selected comparisons were tested for statistical significance, and all results presented were statistically significant. Analyses were conducted using SAS (version 9.4; SAS Institute) to account for HCUP’s complex survey design and weighting.

In 2017, there were 967,615 nonfatal drug overdose ED visits (300.2 per 100,000 population) (Table 1). From 2016 to 2017, rates for nonfatal overdoses increased for those involving all drugs (4.3%), all opioids (3.1%), nonheroin opioids (3.6%), heroin (3.6%), and cocaine (32.9%), whereas the rate for overdoses involving benzodiazepines decreased 5.2% (Table 1) (Table 2) (Table 3).

In 2017, the highest overdose rates for all drugs were among females (308.2), persons aged 15–34 years (range = 427.1–476.4), persons in the Midwest (378.6), and persons in micropolitan (nonmetro) counties (363.3) (Table 1). From 2016 to 2017, overdose rates for all drugs increased 5.0% among males and 3.7% among females. The highest overdose rates for all opioids were among males (112.6), persons aged 25–34 years (209.3), persons in the Midwest (129.2), and persons in medium metro counties (111.4). Rates for all opioid overdoses decreased 4.7% among persons aged 0–14 years, 10.5% in persons aged 15–19 years, and 9.6% among persons aged 20–24 years. In the Midwest, overdose rates for all drugs increased by 6.1% and for all opioids by 7.9%; in the South rates for all drugs and all opioids increased by 3.2% and 5.2%, respectively; and in the West by 8.1% and 3.9%, respectively. In the Northeast, the overdose rate for all drugs remained stable, and the overdose rate for all opioids decreased 5.8%.

Overdose rates for nonheroin opioids and heroin were highest among males (44.5 and 66.7, respectively), persons aged 25–34 years (63.7 and 144.3, respectively), persons in the Midwest (51.2 and 77.0, respectively), and those in medium metro counties (51.6 and 57.8, respectively) (Table 2). Increases in rates for heroin overdose were observed among males (4.1%) and females (3.0%), whereas rates for nonheroin opioid overdoses increased only among males (7.0%). Heroin overdose rates decreased 50% among persons aged 0–14 years, 21.8% among persons aged 15–19 years, and 14.1% among persons aged 20–24 years. Rates for overdoses involving nonheroin opioids and heroin increased 8.5% and 8.6% in the Midwest, respectively, and 3.4% and 8.2%, respectively, in the South. Heroin overdose rates also increased 11.3% in the West. In the Northeast, the rate for heroin-involved overdoses decreased 8.8%.

In 2017, the highest overdose rates for benzodiazepines were among females (42.3), persons aged 20–44 years (range = 50.5–51.0), persons in the Midwest (41.4), and persons in medium metro counties (43.5) (Table 3). The rates for cocaine overdoses in 2017 were highest among males (15.2), persons aged 25–34 years (19.6) and aged 45–54 years (20.5), as well as persons in the South census region (15.1) and large central metro counties (16.5). From 2016 to 2017, rates for benzodiazepine overdoses decreased 5.1% among males and 5.2% among females. Benzodiazepine overdose rates decreased among most age groups, and cocaine-involved overdoses rates increased across all age groups. All regions of the country experienced decreases in the rates of benzodiazepine overdoses and increases in the rates of cocaine overdoses.

In large central metro counties, overdose rates increased for all drugs (11.7%), all opioids (15.2%), nonheroin opioids (11.9%), heroin (21.4%), benzodiazepines (4.7%), and cocaine (71.9%) (Table 1) (Table 2) (Table 3). Most overdoses were unintentional (75% overall; range = 48% for benzodiazepines to 91% for heroin). A consistent finding across all overdose indicators, except for benzodiazepines, was that unintentional overdoses significantly increased from 2016 to 2017. Intentional self-harm overdoses increased 4.8% for all drugs but decreased 6.7% for all opioids, 7.4% for nonheroin opioids, and 3.4% for benzodiazepines.