Overview of CSRS data use for Public Health
March 15, 2017
2
Overdose DataNorth Carolina Poisonings
3
0.0
5.0
10.0
15.0
20.0
25.0
30.0
35.0
40.0
Death
s p
er
100,0
00 p
op
ula
tio
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
4
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
6
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
Source: CSRS- Division of Mental Health, Developmental Disability and
Substance Abuse Services (MH/DD/SAS)
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
tal n
um
be
r o
f re
gis
tra
nts
pe
r ye
ar
2007-2008 2009 2010 2011 2012 2013 2014 2015-2016
Source: CSRS- Division of Mental Health, Developmental Disability and
Substance Abuse Services (MH/DD/SAS)
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
Source: CSRS- Division of Mental Health, Developmental Disability and
Substance Abuse Services (MH/DD/SAS)
CSRS live link
Source: CSRS- Division of Mental Health, Developmental Disability and
Substance Abuse Services (MH/DD/SAS)
CSRS live link
Source: CSRS- Division of Mental Health, Developmental Disability and
Substance Abuse Services (MH/DD/SAS)
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
18
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
20
Local Health Director Regions
21
Overdose Deaths in North Carolina Counties
22
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
23
Medication or Drug Overdose by Intent
24
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
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
er
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
mb
er
of
de
ath
s
Local Health Director Region 7 Residents, 1999-2015
All IntentsUnintentionalSelf-InflictedUndeterminedAssault
25
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
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
mb
er
of
de
ath
s
Wilson County Residents, 1999-2015
All IntentsUnintentionalSelf-InflictedUndeterminedAssault
26
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
Medication or Drug Overdose Deaths by Intent
27
Type of Substance Contributing to Overdose Death
28
Source: N.C. State Center for Health Statistics, Vital Statistics-Deaths, 1999-2015
*2015 Provisional Data (August 2016)
Analysis by Injury Epidemiology and Surveillance Unit
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
mb
er
of
de
ath
s
Prescription Opioid
Cocaine
Heroin
Methadone
Synthetics
77
59
40
6
33
0
10
20
30
40
50
60
70
80
90
1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Nu
mb
er
of
de
ath
s
Local Health Director Region 7 Residents, 1999-2015
Prescription OpioidHeroinCocaineMethadoneSynthetics
29
Substances Contributing to Unintentional Medication or Drug Overdose Deaths
Source: N.C. State Center for Health Statistics, Vital Statistics-Deaths, 1999-2015
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
0
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
mb
er
of
de
ath
s
Wilson County Residents, 1999-2015
Prescription OpioidHeroinCocaineMethadoneSynthetics
30
Substances Contributing to Unintentional Medication or Drug Overdose Deaths
Source: N.C. State Center for Health Statistics, Vital Statistics-Deaths, 1999-2015
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)
31
Demographics of Overdose Deaths
32
Economic and Societal Costs of Poisoning Deaths
33
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.
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
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
34
Prevention, Treatment, and Harm Reduction
35
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
Analysis: Injury Epidemiology and Surveillance Unit
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
36
Opioid Overdose Reversals with Naloxone
Source: North Carolina Harm Reduction Coalition, March 2017
Analysis: Injury Epidemiology and Surveillance Unit
# 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
37
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
Outpatient Dispensing per 100 persons in
North Carolina, 2011-2015 82.9
Outpatient Dispensing per 100 persons in
Local Health Director Region 7, 2011-2015 12.2
Outpatient Dispensing per 100 persons in
North Carolina, 2011-2015 82.9
38
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
39
Scott Proescholdbell, MPHInjury and Violence Prevention Branch
NC Division of Public Health
www.injuryfreenc.ncdhhs.gov
¿Preguntas?