Stimulant overdose surveillance report, Georgia, 2020

Stimulant Overdose Surveillance Report Georgia 2020
Drug Surveillance Unit Epidemiology Section Georgia Department of Public Health
https://dph.georgia.gov/epidemiology/drug-surveillance-unit
Stimulant Overdose Surveillance Report, Georgia, 2020 / Page 1

Stimulant Overdose Surveillance, Georgia, 2020
The purpose of this report is to describe fatal (mortality) and nonfatal (morbidity) stimulant poisoning hospitalizations and deaths in Georgia during 2018, 2019, and 2020, including those involving prescription stimulants (e.g., Adderall, Ritalin, etc.), and illicit stimulants (e.g., cocaine, methamphetamine, etc.). Stimulant overdose data was analyzed by the Georgia Department of Public Health (DPH) Epidemiology Program, Drug Surveillance Unit, using Georgia hospital discharge inpatient and emergency department (ED) visit data, and DPH Vital Records death data.
Key Findings
Stimulant poisoning morbidity and mortality are increasing in Georgia. Mortality From 2018 to 2019, stimulant poisoning deaths increased by 7%, from 775 to 830 deaths. From 2019 to 2020, stimulant poisoning deaths increased by 20%, from 830 to 996 deaths. In 2020, there were more deaths from amphetamine poisoning than any other stimulant. White persons were 1.2 times more likely to die from stimulant poisoning and 3.8 times more likely to die
from amphetamine poisoning than black persons. Black persons were 2.7 times more likely to die from cocaine poisoning than white persons. Males aged 35-44 died more frequently from stimulant poisoning than males and females in any other age
group.
Morbidity
From 2018 to 2019, stimulant poisoning hospitalizations decreased by <1% and stimulant poisoning emergency department visits decreased by <1%.
From 2019 to 2020, stimulant poisoning hospitalizations decreased by 6.2% and stimulant poisoning emergency department visits decreased by 6.0%.
In Georgia in 2020: o 2,515 emergency department visits and 1,632 hospitalizations were due to stimulant poisoning. o 1,091 emergency department visits and 908 hospitalizations were due to cocaine poisoning. o 1,214 emergency department visits and 733 hospitalizations were due to amphetamine poisoning.
White persons were 2.4 times more likely to visit an ED and 2.7 times more likely to be hospitalized due to amphetamine poisoning than black persons.
Black persons were 6.7 times more likely to visit an ED and 8.2 times more likely to be hospitalized due to cocaine poisoning than white persons.
Males aged 35-44 years visited an ED and were hospitalized due to amphetamine poisoning more frequently than males and females in any other age group.
Note: further information about opioid-related hospitalizations and deaths in Georgia can be found in the Drug Surveillance published online at https://dph.georgia.gov/epidemiology/drug-surveillance-unit.
Stimulant Overdose Surveillance Report, Georgia, 2020 / Page 2

Deaths Involving Stimulants (Mortality), Georgia, 2020
Data Source
Drug-related deaths were derived from DPH Vital Records death certificates for all deaths that occurred in Georgia during 2018-2020. Data records are continuously updated (corrected, amended or deleted) as more information becomes available, therefore, reports represent the most current data, and future reports may reflect updated data.
Case Definitions (Note: categories are not mutually exclusive, includes only drug overdose deaths caused by acute poisoning)
Deaths involving ANY DRUG: May involve any over-the-counter, prescription, or illicit drug
Deaths with any of the following ICD-10 codes as any underlying cause of death: X40-44, X60-64, X85, Y10-14
Deaths involving ALL STIMULANTS: Includes prescription stimulants (e.g. Adderall, Ritalin, etc.), over-the-counter stimulants (e.g. caffeine, ephedrine, etc.) and illicit stimulants (e.g. cocaine, methamphetamine, ecstasy, etc.) 1. Deaths with any of the following ICD-10 codes as any underlying cause of death: X40-44, X60-64, X85, Y10-14
AND any of the following ICD-10 codes as any other listed cause of death: T40.5, T43.6 OR 2. Any cause of death text field contains the following keywords: 5F-ADB, adderall, amphetamine, bath salt, bath
salts, bathsalt, biphetamine, BK-DMBDB, bk-dmbdb, cathinone, coca leaf, cocaine, concerta, crack, crystal meth, dexedrine, dextroamphetamine, ecstasy, ephedrine, flakka, focalin, khat, levoamphetamine, lisdexamfetamine, MDA, MDMA, methamphetamine, methylin, mollie, molly, pseudoephedrine, psychostimulant, ritalin, speed, speedball, stimulant, vyvanse
Deaths involving COCAINE 1. Deaths with any of the following ICD-10 codes as any underlying cause of death: X40-44, X60-64, X85, Y10-14
AND the following ICD-10 code as any other listed cause of death: T40.5 OR 2. Any cause of death text field contains the following keywords: coca leaf, cocaine, crack
Deaths involving OTHER STIMULANTS with abuse potential Includes prescription stimulants (e.g. Adderall, Ritalin, Concerta, etc.), over-the-counter (e.g. caffeine) and illicit stimulants (e.g. crystal meth, ecstasy, MDMA, etc.) 1. Deaths with any of the following ICD-10 codes as any underlying cause of death: X40-44, X60-64, X85, Y10-14
AND any of the following ICD-10 codes as any other listed cause of death: T43.6 OR 2. Any cause of death text field contains the following keywords: 5F-ADB, adderall, amphetamine, bath salt, bath salts,
bathsalt, biphetamine, BK-DMBDB, bk-dmbdb, cathinone, concerta, crystal meth, dexedrine, dextroamphetamine, ecstasy, ephedrine, flakka, focalin, khat, levoamphetamine, lisdexamfetamine, MDA, MDMA, methamphetamine, methylin, mollie, molly, pseudoephedrine, psychostimulant, ritalin, speed, speedball, stimulant, Vyvanse
Other Definitions or Limitations
Overdose death county represents the county of residence.
Rate indicates deaths per 100,000 population using Census data as the denominator, and all rates are age-adjusted unless age category is presented.
Rates for categories with fewer than 5 deaths may not be accurate and are not presented in this report.
ICD-10 Code Description
X40-X44 (accidental poisoning by drugs), X60-X64 (intentional self-poisoning by drugs), X85 (assault by drug poisoning), Y10-Y14 (drug poisoning of undetermined intent), T40.5 (poisoning by cocaine), T43.6 (poisoning by psychostimulants with abuse potential)
Stimulant Overdose Surveillance Report, Georgia, 2020 / Page 3

Emergency Department Visits and Hospitalizations Involving Stimulants (Morbidity), Georgia, 2020
Data Source
Nonfatal ED visits or hospitalizations were derived from Georgia hospital discharge inpatient and ED visit data, and included all ED visits or hospitalizations occurring in a non-Federal acute care hospital in Georgia, among Georgia residents, with a discharge diagnosis indicating disorders or poisoning due to stimulant use during 2018-2020. Data records are continuously updated (corrected, amended or deleted) as more information becomes available, therefore, reports represent the most current data, and future reports may reflect updated data.
Case Definitions (Note: categories are not mutually exclusive)
ED visit or hospitalization involving poisoning by any drug May include any over-the-counter, prescription, or illicit drug
Any mention of ICD-10CM codes: T36-T50 AND 5th or 6th character: 1-4, and a 7th character of A or missing
ED visit or hospitalization involving use of ALL STIMULANTS Includes prescription stimulants (e.g. Adderall, Ritalin, etc.), over-the-counter stimulants (e.g. caffeine, ephedrine, etc.) and illicit stimulants (e.g. speed, ecstasy, methamphetamine, etc.)
Any mention of ICD-10CM codes: T40.5X, T43.60, T43.61, T43.62, T43.63, T43.69, T44.99, T50.5X, T65.21, T65.22 AND 5th or 6th character: 1-4, and a 7th character of A or missing
ED visit or hospitalization involving use of COCAINE Any mention of ICD-10CM codes: T40.5X AND 5th or 6th character: 1-4, and a 7th character of A or missing
ED visit or hospitalization involving use of AMPHETAMINES Includes prescription amphetamines (e.g. Adderall, etc.) and illicit amphetamines (e.g. speed, ecstasy, methamphetamine, etc.)
Any mention of ICD-10CM codes: T43.62 AND 6th character: 1-4, and a 7th character of A or missing
ED visit or hospitalization involving use of OTHER STIMULANTS Includes over-the-counter stimulants (e.g. caffeine, nicotine [chewing tobacco, cigarettes, nicotine insecticides, etc.], decongestants [ephedrine, pseudoephedrine, dopamine, etc.]) and prescription stimulants [Ritalin, appetite suppressants]). 1. Any mention of ICD-10CM codes: T43.60, T43.61, T43.63, T43.69, T44.99, T50.5X, T65.21, T65.22
AND 5th or 6th character: 1-4, and a 7th character of A or missing
Other definitions or limitations
County indicates the patient's county of residence.
Only Black and White are indicated for race because of incomplete or sparse data on other races and ethnicities.
Patients that were admitted through the ED and subsequently hospitalized appear in both the ED and inpatient data.
Rate indicates ED visits or hospitalizations per 100,000 population using Census data as the denominator, and all rates are age-adjusted unless age category is presented.
Rates for categories with <5 ED visits or hospitalizations may not be accurate and are not presented in this report.
ICD-10 CM Code Description
Poisoning by: T36-T50 (range includes all drugs), T40.5X (cocaine), T43.60 (unspecified psychostimulants), T43.61 (caffeine), T43.62 (amphetamines), T43.63 (methylphenidate), T43.69 (other psychostimulants), T44.99 (incl. ephedrine) T50.5X (appetite suppressants) T65.21 (chewing tobacco), T65.22 (cigarettes); 5th or 6th Character: 1 (accidental, unintentional), 2 (intentional self-harm), 3 (assault), 4 (undetermined intent); 7th Character: A (initial encounter) or missing
Stimulant Overdose Surveillance Report, Georgia, 2020 / Page 4

Drug Deaths Involving Stimulants (Mortality)
*Note: Categories are not mutually exclusive and may include any over-the-counter, prescription, or illicit substances. Statistics refer to all overdose deaths in the state of Georgia (permanent residents and nonresidents).

Number of Deaths

Drug Overdose Deaths, by Drug Type and Year, Georgia, 2012-2020

2500

All Drug Overdose

All Stimulants

Cocaine

Amphetamines

All Opioids

2000

1500

1000

500

0 2012

2013

2014

2015

2016 Year

2017

2018

2019

2020

Drug Overdose Deaths, by Drug Type and Year, Georgia, 2018-2020

Number of Deaths

2500 2000 1500 1000
500

1950 1582 1582

2018 2019 2020

996 775 830

367 388 412

475 517 653

1309 962 959

0 All Drug Overdose

All Stimulants

Cocaine Drug Type

Amphetamine

All Opioids

From 2018 to 2019, there was a 7% increase in stimulant poisoning deaths, a 6% increase in cocaine poisoning deaths, and a 9% increase in amphetamine poisoning deaths.
From 2019 to 2020, there was a 20% increase in stimulant poisoning deaths, a 6% increase in cocaine poisoning deaths, and a 26% increase in amphetamine poisoning deaths.
From 2018 to 2019 there was a <1% decrease in opioid poisoning deaths. From 2019 to 2020, there was a 36% increase in opioid poisoning deaths.
Stimulant Overdose Surveillance Report, Georgia, 2020 / Page 5

Deaths/ 100,000 population

Stimulant-Related Overdose Death Rates, by Age and Drug Type, Georgia, 2020

All Stimulants Cocaine Amphetamines 25

20

15

10

5

0

Total

<1

1-4

5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

Age Category (Years)

Persons aged 35-44 years died more frequently from amphetamine poisoning than from cocaine poisoning. Persons aged 55 years or older died more frequently from cocaine poisoning than from amphetamine
poisoning. Persons aged 35-44 had the highest rates for both amphetamine poisoning deaths and cocaine poisoning.

Deaths/ 100,000 population

Drug Overdose Death Rates, by Race and Drug Type, Georgia, 2020

18

16

14

12

10.6

10

8.8

8

6

4

2

0 All Stimulants

White Black 16.0

7.6 All Opioids

7.0 2.6
Cocaine Drug Type

8.7 2.3
Amphetamines

5.6 1.9
Heroin

White persons were 1.2 times more likely to die from stimulant poisoning, 2.1 times more likely to die from opioid poisoning, and 3.8 times more likely to die from amphetamine poisoning than black persons.
Black persons were 2.7 times more likely to die from cocaine poisoning than white persons.

Stimulant Overdose Surveillance Report, Georgia, 2020 / Page 6

Deaths/ 100,000 population

Drug Overdose Death Rates, by Sex and Drug Type, Georgia, 2020

18

16

14

13.4

12

10

8

6

5.5

4

2

0 All Stimulants

Male Female 16.3

8.3 All Opioids

5.8 2.0
Cocaine Drug Type

8.4 4.0
Amphetamines

5.8 2.1
Heroin

Males were 2.4 times more likely to die from stimulant poisoning than females, and 2.0 times more likely to die from opioid poisoning than females.
Males were 2.9 times more likely to die from a cocaine poisoning than females, and 2.1 times more likely to die from amphetamine poisoning than females.

Deaths/ 100,000 population

Stimulant-Related Overdose Death Rates, by Sex and Age, Georgia, 2020

35 30 25 20 15 10
5 0
All Ages <1

Male Female

1-4

5-14 15-24 25-34 35-44 45-54 55-64 65-74 75-84 85+

Drug Type

Males died more frequently from stimulant poisoning than females in every age category. Males aged 35-44 died more frequently from stimulant poisoning than males in any other age category. Females aged 35-44 died more frequently from stimulant poisoning than females in any other age category.

Stimulant Overdose Surveillance Report, Georgia, 2020 / Page 7

Emergency Department Visits and Hospitalizations (Morbidity) Involving Stimulants
*Note: Categories are not mutually exclusive and may include over-the-counter, prescription, or illicit substances in each.

Number of ED Visits

Drug-related Emergency Department Visits, by Drug Type and Year, 20182020

7000 6000 5000 4000 3000 2000 1000
0

2678 2676 2515 All Stimulants

2018 2019 2020

1236 1238 1091

1314 1228 1214

Cocaine

Amphetamines Drug Type

5832 4985 4874
All Opioids

ED visits due to stimulant poisoning decreased by <1% from 2018 to 2019, and decreased by 6.1% from 2019 to 2020.
ED visits due to cocaine poisoning increased by <1% while amphetamine poisoning decreased by 7% from 2018 to 2019.
ED visits due to cocaine poisoning and amphetamine poisoning decreased by 11.9% and 1.1% respectively from 2019 to 2020.

Drug-related Hospitalizations, by Drug Type and Year, 2018-2020

Number of Hospitalizations

2500 2000 1500 1000
500

1752 1739 1632

2018 2019 2020

977 1006 908

764 732 733

2345 2176 2045

0 All Stimulants

Cocaine

Amphetamines Drug Type

All Opioids

From 2018 to 2019, stimulant poisoning hospitalizations decreased by <1%, and decreased by 6.2% from 2019 to 2020.
From 2018 to 2019, cocaine poisoning hospitalizations increased by 3%, while amphetamine poisoning hospitalizations decreased by 4.1%.
From 2019 to 2020, cocaine poisoning hospitalizations decreased by 9.7% while amphetamine poisoning hospitalizations increased by 0.1%.

Stimulant Overdose Surveillance Report, Georgia, 2020 / Page 8

Stimulant-Specific Emergency Department Visits and Hospitalization, by

Drug Type, Georgia, 2018-2020

3000 2500

2678

All Stimulants Cocaine Amphetamines 2676

2515

ED Visits of Hospitalizations/ 100,000 population

2000 1500 1000
500

12361314

1752
977 764

12381228

1739
1006 732

10911214

1632 908 733

0 ED Visits

Hospitalizations

2018

ED Visits

Hospitalizations 2019

ED Visits

Hospitalizations 2020

From 2018 to 2019, cocaine poisoning ED visits increased by <1% while amphetamine poisoning visits decreased by 41.9%.
From 2019 to 2020, ED visits for cocaine poisoning and amphetamine poisoning visits decreased by 11.9% and 1.1% respectively.

Stimulant-related ED Visit Rates, by Drug Type and Age, Georgia, 2020
Amphetamines Cocaine
30.0 25.0 20.0 15.0 10.0
5.0 0.0

Stimulant-related Hospitalization Rates, by Drug Type and Age, Georgia,
2020
Amphetamines Cocaine
30 25 20 15 10
5 0

Hospitalizations/ 100,000 population

ED Visits/ 100,000 population

Age Category (Years)

Age Category (Years)

Persons aged 35-44 years were more likely to visit an ED or be hospitalized due to amphetamine poisoning than persons of other age categories.
Persons aged 55-64 years were more likely to visit an ED or be hospitalized due to cocaine poisoning than persons of other age categories

Stimulant Overdose Surveillance Report, Georgia, 2020 / Page 9

Stimulant-related ED Visit and Hospitalization Rates, by Drug Type and Race, Georgia, 2020

ED Visits of Hospitalizations/ 100,000 population

White Black

30

25

24.2

21.2

20

15

14.3

10

5.9

5

3.6

8.9

3.3

2.6

0 Amphatemines ED Visit

Cocaine ED Visit

Amphetamines Hospitalization Cocaine Hospitalization

Whites were 2.4 times more likely to visit an ED and 2.7 times more likely to be hospitalized due to amphetamine poisoning than Blacks.
Blacks were 6.7 times more likely to visit an ED and 8.2 times more likely to be hospitalized due to cocainepoisoning than Whites.

Amphetamine-related Hospitalization Rates, by Sex and
Age, Georgia, 2020
Male Female
25 20 15 10
5 0

Amphetamine-related ED Visit Rates, by Sex and Age, Georgia,
2020
Male Female
40 30 20 10
0

ED Visits/ 100,000 population

Hospitalizations/ 100,000 population

Age Category (Years)

Age Category (Years)

Males aged 35-44 years visited an ED and were hospitalized due to amphetamine poisoning more frequently than males and females in any other age category.
Both males and females aged 35-44 were hospitalized due to amphetamine poisoning most frequently than other age categories.

Stimulant Overdose Surveillance Report, Georgia, 2020 / Page 10

ED Visits/ 100,000 population Hospitalizations/ 100,000 population

Cocaine-related ED Visit Rates, by Sex and Age, Georgia, 2020
Male Female
50 40 30 20 10
0

Cocaine-related Hospitalization Rates, by Sex and Age, Georgia,
2020
Male Female
50 40 30 20 10
0

Age Category (Years)

Age Category (Years)

Males aged 55-64 years visited an ED due to cocaine poisoning more frequently than males and females in any other age category.
Males aged 55-64 years were hospitalized due to cocaine poisoning more frequently than males and females in any other age category.
Males in all age groups visited an ED or were hospitalized due to amphetamine or cocaine poisoning more frequently than females.

Stimulant Overdose Surveillance Report, Georgia, 2020 / Page 11

Deaths Involving Stimulants (Mortality) -- Georgia, 20182020

Number, and age-adjusted rate (cases per 100,000 population) Any category may include prescription and/ or illicit drugs, categories are not mutually exclusive

Any Drug

Any Opioid

Any Stimulant

Cocaine

Amphetamines

Year

No.

Rate

No.

Rate

No.

Rate

No.

Rate

No.

Rate

2020

1950

18.2

1309

12.2

996

9.3

412

3.8

653

6.1

2019

1580

14.9

958

9.0

828

7.8

387

3.6

516

4.9

2018

1582

15.0

962

9.1

775

7.4

367

3.5

475

4.5

ED Visits and Hospitalizations Involving Stimulants (Morbidity) -- Georgia, 20182020

Number, and age-adjusted rate (visits per 100,000 population) Any category may include prescription and/ or illicit drugs, categories are not mutually exclusive

Any Drug

Any Opioid

Any Stimulant

Cocaine

Amphetamines

ED Visits

Hospitalizations

ED Visits

Hospitalizations

ED Visits

Hospitalizations

ED Visits

Hospitalizations

ED Visits

Hospitalizations

Year No. Rate No.

Rate

No. Rate No.

Rate

No. Rate No.

Rate

No. Rate No.

Rate

No.

Rate

No.

Rate

2020 22944 214.4 8325

77.6 5832 54.4 2045

19.0

2515 23.5 1632

15.2 1091 10.2 908

8.5

1214

11.4

733

6.9

2019 23628 222.5 9384

88.4 4874 45.9 2175

20.5

2676 25.2 1739

16.4 1238 11.7 1006

9.5

1228

11.6

732

6.9

2018 23348 221.9 9400

89.6 4985 47.5 2353

22.5

2678 24.5 1738

16.5 1236 11.7 978

9.3

1314

12.5

765

7.3

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Morbidity and Mortality Involving Stimulants -- Georgia, 2020 (for Emergency Department (ED) visits, inpatient hospitalizations, and deaths)

Number and rate (cases or visits per 100,000 population; rate is age-adjusted except when age categories are presented) Any category may include prescription, and/ or illicit stimulants, categories are not mutually exclusive, rates for counts <5 are not presented

All Stimulants

ED Visits

Hospitalizations

Deaths

No.

Rate

No.

Rate

No.

Rate

Total

2515

23.4

1632

15.2

921

8.8

Age group

<1 year

4

N/A

3

N/A

0

N/A

1-4 years

73

14.0

4

N/A

0

N/A

5 -14 years

71

5.0

15

1.1

0

N/A

15-24 years

291

20.0

104

7.1

40

2.8

25-34 years

554

36.8

287

19.1

195

13.1

35-44 years

543

38.9

366

26.2

267

19.3

45-54 years

396

28.5

313

22.5

211

15.1

55-64 years

435

32.9

406

30.7

159

12.2

65-74 years

133

13.9

125

13.0

44

4.8

75-84 years

8

1.7

8

1.7

5

1.1

85+ years

7

4.5

1

N/A

0

N/A

Sex (age group)

Male

1685

32.4

1106

21.3

640

12.5

<1 year

3

N/A

1

N/A

0

N/A

1-4 years

32

12.1

2

N/A

0

N/A

5-14 years

24

3.3

3

N/A

0

N/A

15-24 years

183

24.7

68

9.2

23

3.1

25-34 years

376

50.2

186

24.8

138

18.6

35-44 years

365

54.2

230

34.2

186

28.0

45-54 years

265

39.4

208

30.9

141

21.0

55-64 years

320

50.8

302

47.9

117

18.9

Stimulant Overdose Surveillance Report, Georgia, 2020 / Page 13

65-74 years

105

24.1

98

22.5

30

7.1

75-84 years

7

3.5

7

3.5

5

2.6

85+ years

5

9.3

1

N/A

0

N/A

Female

828

15.2

525

9.5

281

5.2

<1 year

1

N/A

2

N/A

0

N/A

1-4 years

41

16.1

2

N/A

0

N/A

5-14 years

47

6.8

12

1.7

0

N/A

15-24 years

108

15.0

36

5.0

17

2.4

25-34 years

178

23.5

191

13.3

57

7.6

35-44 years

177

24.5

135

18.7

81

11.3

45-54 years

131

18.2

105

14.6

70

9.7

55-64 years

115

16.6

104

15.0

42

6.1

65-74 years

28

5.3

27

5.2

14

2.8

75-84 years

1

N/A

1

N/A

0

N/A

85+ years

1

N/A

0

N/A

0

N/A

Race

White

1205

19.4

708

11.2

673

10.6

Black

1120

32.4

823

24.3

305

8.7

Georgia Department of Public Health (DPH), Epidemiology Section, Drug Surveillance Unit https://dph.georgia.gov/epidemiology/drug-surveillance-unit
Stimulant Overdose Surveillance Report, Georgia, 2020 / Page 14