Stimulant overdose surveillance preliminary report, Georgia, 2016-2018

Stimulant Overdose Surveillance Preliminary Report Georgia 2016-2018
Drug Surveillance Unit Epidemiology Section Georgia Department of Public Health
https://dph.georgia.gov/drug-overdose-surveillance-unit
Stimulant Overdose Surveillance Report, Georgia, 2018 / Page 1

Stimulant Overdose Surveillance, Georgia, 2018
The purpose of this report is to describe fatal (mortality) and nonfatal (morbidity) stimulant-involved hospitalizations and deaths in Georgia during 2016, 2017, and 2018, 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-involved morbidity and mortality is increasing in Georgia. Mortality From 2016 to 2018, overdose deaths involving stimulants increased by 44%, from 487 to 703 deaths. From 2017 to 2018, overdose deaths involving stimulants increased by 11%, from 631 to 703 deaths. In 2018, amphetamines were involved in more deaths than any other stimulant. White persons were 1.6 times more likely to die from a drug overdose involving stimulants and 5.5 times more likely to die from a drug overdose involving amphetamines than Black persons, yet Black persons were 1.5 times more likely than white persons to die from a drug overdose involving cocaine. Males aged 25-64 years died more frequently from stimulant-involved overdose than males in any other age category and females of all age categories. Males aged 35-44 years had the highest stimulant-related death rate.
Morbidity From 2016 to 2018, hospitalizations involving stimulants increased by 21.9% and ED visits
involving stimulants increased by 18.5%. From 2017 to 2018, hospitalizations involving stimulants increased by 15.3% and ED visits
involving stimulants increased by 9.8%. In Georgia in 2018:
o Stimulants were involved in 2,769 ED visits and 1,752 hospitalizations. o Cocaine was involved in 1,241 ED visits and 977 hospitalizations. o Amphetamines were involved in 1,335 ED visits and 764 hospitalizations. White persons were 2.9 times more likely to visit an ED and 3.5 times more likely to be hospitalized for amphetamine-involved poisonings than black persons, yet Blacks were 6.6
Stimulant Overdose Surveillance Report, Georgia, 2018 / Page 2

times more likely to visit an ED and 9.0 times more likely to be hospitalized for cocaineinvolved poisonings than Whites. Males aged 25-34 years visited an ED and were hospitalized from amphetamine-involved poisoning more frequently than males and females in any other age category. Note: further information about opioid-related hospitalizations and deaths in Georgia can be found in the Opioid Overdose Surveillance Reports from 2016, 2017, and 2018 published online at https://dph.georgia.gov/drug-overdose-surveillance-unit
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Deaths involving Stimulants (Mortality), Georgia, 2018
Data Source Drug-related deaths were derived from DPH Vital Records death certificates for all deaths that occurred in Georgia during 2016-2018. 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
Stimulant Overdose Surveillance Report, Georgia, 2018 / Page 4

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 ageadjusted 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)
ED Visits and Hospitalizations involving Stimulants (Morbidity), Georgia, 2018
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 2016-2018. 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 (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
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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 Case Definitions 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 hospital 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 fewer than 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
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Drug Overdose 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, 2010-2018

1800 1600 1400 1200 1000
800 600 400 200
0

All Drug Overdose

All Stimulants

2010

2011

2012

2013

Cocaine

Amphetamines

All Opioids

2014 Year

2015

2016

2017

2018

Drug Overdose Deaths, by Drug Type and Year, Georgia, 2016-2018

1800 1600 1400 1200 1000
800 600 400 200
0

1617

1459

1446

All Drug Overdose

2016 2017 2018

703 631 487
All Stimulants

235 289 340
Cocaine Drug Type

386 425 272
Amphetamine

996

904

873

All Opioids

Stimulant Overdose Surveillance Report, Georgia, 2018 / Page 7

Number of Deaths

From 2016 to 2018, there was a 44% increase in drug deaths involving all stimulants, a 45% increase in deaths involving cocaine, and a 56% increase in deaths involving amphetamines.
From 2017 to 2018, there was an 11% increase in drug deaths involving all stimulants, an 18% increase in deaths involving cocaine, and a 10% increase in deaths involving amphetamines.
From 2016 to 2018 there was a 4% decrease in drug deaths involving all opioids. From 2017 to 2018, there was a 14% decrease in drug deaths involving all opioids.

Deaths/ 100,000 population

Stimulant-Involved Overdose Death Rates, by Age and Drug Type, Georgia, 2018

All Stimulants Cocaine Amphetamines 14

12

10

8

6

4

2

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 45-54 years died more frequently from amphetamine-involved overdose than from cocaine-involved overdose.
Persons aged 55 years or older died more frequently from cocaine-involved overdose than from amphetamine-involved overdose.
Persons aged 35-54 years had the highest rates for amphetamine-involved deaths and cocainerelated deaths.

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Deaths/ 100,000 population

Drug Overdose Death Rates, by Race and Drug Type, Georgia, 2018

16

14

12

10

9.2

8 5.7
6

4

2

0 All Stimulants

White Black 13.5

3.9 All Opioids

4.9 3.2
Cocaine Drug Type

7.0 1.3
Amphetamines

5.0 1.4
Heroin

White persons were 1.6 times more likely than black persons to die from a drug overdose involving stimulants, and 3.5 times more likely to die from a drug overdose involving opioids.
Black persons were 1.5 times more likely than white persons to die from a drug overdose involving cocaine, and white persons were 5.5 times more likely than black persons to die from an overdose involving amphetamines.

Deaths/ 100,000 population

Drug Overdose Death Rates, by Sex and Drug Type, Georgia, 2018

12

10

9.7

Male Female 11.0

8 6
3.9 4 2

5.7

5.6

4.9

4.6

2.6

1.6

1.5

0 All Stimulants

All Opioids

Cocaine Drug Type

Amphetamines

Heroin

Males were 2.5 times more likely to die from a stimulant-involved overdose than females, and 1.9 times more likely to die from an opioid-involved overdose than females.
Males were 3.1 times more likely to die from a cocaine-involved overdose than females, and 2.1 times more likely to die from an overdose involving amphetamines than females.
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Deaths/ 100,000 population

Stimulant-Involved Overdose Death Rates, by Sex and Age, Georgia, 2018
Male Female 25

20

15

10

5

0 All Ages <1

1-4

5-14

15-24 25-34 35-44 45-54 55-64 65-74 75-84

85+

Age Category (Years)

Males aged 25-64 years died more frequently from stimulant-involved overdose than males in any other age category, with males aged 35-44 years having the highest stimulant-involved death rate.
Females aged 25-64 years died more frequently from stimulant-involved overdose than females in any other age category, with females aged 45-54 years having the highest stimulant-related death rate.

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ED 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-Involved ED Visits, by Drug Type and Year, 2016-2018

6000 5000 4000 3000 2000 1000
0

2337 2522 2769 All Stimulants

2016 2017 2018

1047 1166 1241

1134 1209 1335

Cocaine

Amphetamines Drug Type

5656

5195

5014

All Opioids

ED visits involving stimulant use increased by 18.5% from 2016 to 2018, and increased by 9.8% from 2017 to 2018.
ED visits involving cocaine and amphetamine use increased by 18.5% and 17.7% respectively from 2016 to 2018, and increased by 6.4% and 10.4% from 2017 to 2018.

Number of Hospitalizations

Drug-Involved Hospitalizations, by Drug Type and Year, 2016-2018

3000 2500 2000 1500 1000
500 0

1752 1437 1520
All Stimulants

2016 2017 2018

813 888 977

627 644 764

Cocaine

Amphetamines Drug Type

2639 2622 2345
All Opioids

Hospitalizations involving stimulant use increased by 21.9% from 2016 to 2018, and increased by 15.3% from 2017 to 2018.
Hospitalizations involving cocaine and amphetamine use increased by 20.2% and 21.9% respectively from 2016 to 2018, and increased by 10.0% and 18.6% from 2017 to 2018.

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ED Visits/ 100,000 population

Stimulant-Involved ED Visit Rates, by Drug Type and Age, Georgia, 2018
Amphetamines Cocaine
35 30 25 20 15 10
5 0
Age Category (Years)

Hospitalizations/ 100,000 population

Stimulant-Involved Hospitalization Rates, by Drug Type and Age, Georgia,
2018
Amphetamines Cocaine
30 25 20 15 10
5 0
Age Category (Years)

ED Visits of Hospitalizations/ 100,000 population

Persons aged 25-34 years were more likely to visit an ED or be hospitalized because of amphetamine-involved poisoning than persons of other age categories.
Persons aged 55-64 years were more likely to visit an ED or be hospitalized because of cocaineinvolved poisoning than persons of other age categories.

Stimulant-Involved ED Visit and Hospitalization Rates, by Drug Type and Race, Georgia, 2018

White Black

30

27.2

25

22.5

20

19.3

15

10

6.7

5

4.1

11.2

3.2

2.5

0 Amphetamines ED Visit

Cocaine ED Visit

Amphetamines Hospitalization Cocaine Hospitalization

Whites were 2.9 times more likely to visit an ED and 3.5 times more likely to be hospitalized for amphetamine-involved poisonings than Blacks.
Blacks were 6.6 times more likely to visit an ED and 9.0 times more likely to be hospitalized for cocaine-involved poisonings than Whites.
Stimulant Overdose Surveillance Report, Georgia, 2018 / Page 12

Hospitalizations/ 100,000 population

ED Visits/ 100,000 population

Amphetamine-Involved ED Visit Rates, by Sex and Age, Georgia, 2018
Male Female
45 40 35 30 25 20 15 10
5 0

Amphetamine-Involved Hospitalization Rates, by Sex and Age,
Georgia, 2018
Male Female
30 25 20 15 10
5 0

Age Category (Years)

Age Category (Years)

Males aged 25-34 years visited an ED and were hospitalized for amphetamine-involved poisoning more frequently than males and females in any other age category.
Both males and females aged 25-34 years were hospitalized for amphetamine-involved poisoning most frequently.

Cocaine-Involved ED Visit Rates, by Sex and Age, Georgia, 2018
Male Female
60 50 40 30 20 10
0

Cocaine-Involved Hospitalization Rates, by Sex and Age, Georgia, 2018
Male Female
50 40 30 20 10
0

Hospitalizations/ 100,000 populatione

ED Visits/ 100,000 population

Age Category (Years)

Age Category (Years)

Males aged 45-54 years visited an ED for cocaine-involved poisoning more frequently than males and females in any other age category.
Males aged 55-64 years were hospitalized for cocaine-involved poisoning more frequently than males and females in any other age category.
Stimulant Overdose Surveillance Report, Georgia, 2018 / Page 13

Year 2018 2017 2016

Deaths involving Stimulants (Mortality) -- Georgia, 20162018

Number, and age-adjusted rate per 100,000 population Any category may include prescription and/ or illicit drugs, categories are not mutually exclusive, rates for counts under 5 may be unstable

Any Drug

No.

Rate

1,446

13.6

1,617

15.5

Any Opioid

No.

Rate

873

8.3

996

9.5

Any Stimulant

No.

Rate

703

6.7

631

6.1

Cocaine

No.

Rate

340

3.2

289

2.7

Amphetamines

No.

Rate

425

4.1

386

3.8

1,459

14.0

904

8.7

487

4.7

235

2.2

272

2.7

ED Visits and Hospitalizations involving Stimulants (Morbidity) -- Georgia, 20162018

Number, and age-adjusted rate per 100,000 population Any category may include prescription and/ or illicit drugs, categories are not mutually exclusive, rates for counts under 5 may be unstable

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

2018 23515 222.5 9379 85.6 5014 45.9 2345 20.6 2769 26.0 1752 15.9 1241 11.0

977

8.5

1335 13.1

764

7.3

2017 23856 227.6 9481 87.7 5656 52.5 2622 23.5 2522 31.9 1520 14.2 1166 10.7

888

8.1

1209 11.9

644

8.0

2016 23404 226.3 9637 91.1 5195 48.9 2639 24.3 2337 22.8 1437 13.8 1047

9.8

813

7.5

1134 11.3

627

6.2

Georgia Department of Public Health (DPH), Epidemiology Section, Drug Surveillance Unit https://dph.georgia.gov/drug- surveillance-unit
Stimulant Overdose Surveillance Report, Georgia, 2018 / Page 14

Morbidity and Mortality involving Stimulants -- Georgia, 2018

(for emergency department (ED) visits, inpatient hospitalizations, and deaths)

Number and rate 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 under 5 may be unstable

ED Visits

All Stimulants Hospitalizations

Deaths

No.

Rate

No.

Rate

No.

Rate

Total

2769

26.0

1752

15.9

703

6.7

Age group

<1 year

8

6.3

5

3.9

0

N/A

1-4 years

104

19.6

8

1.5

1

N/A

5 -14 years

98

6.9

11

0.8

1

N/A

15-24 years

335

23.2

139

9.6

34

2.4

25-34 years

633

43.0

363

24.6

151

10.2

35-44 years

501

36.5

309

22.5

182

13.3

45-54 years

479

33.9

365

25.9

178

12.6

55-64 years

486

37.8

434

33.8

128

10.0

65-74 years

114

12.7

106

11.8

25

2.8

75-84 years

8

1.9

9

2.2

0

N/A

85+ years

3

N/A

3

N/A

3

N/A

Sex (age group)

Male

1798

34.4

1174

21.9

495

9.7

<1 year

6

9.2

3

N/A

0

N/A

1-4 years

51

18.9

3

N/A

0

N/A

5-14 years

52

7.2

4

N/A

1

N/A

15-24 years

184

25.0

82

11.2

17

2.3

25-34 years

415

56.8

240

32.8

109

14.9

35-44 years

336

50.8

211

31.9

130

19.6

45-54 years

313

45.7

237

34.6

121

17.6

Stimulant Overdose Surveillance Report, Georgia, 2018 / Page 15

55-64 years

352

57.6

312

51.1

93

15.2

65-74 years

81

19.9

74

18.1

22

5.4

75-84 years

7

3.9

7

3.9

0

N/A

85+ years

1

N/A

1

N/A

2

N/A

Female

970

18.1

577

10.3

208

3.9

<1 year

2

N/A

2

N/A

0

N/A

1-4 years

53

20.4

5

1.9

1

N/A

5-14 years

46

6.6

7

1.0

0

N/A

15-24 years

151

21.3

57

8.0

17

2.4

25-34 years

218

29.4

123

16.6

42

5.7

35-44 years

165

23.2

98

13.8

52

7.3

45-54 years

166

22.9

128

17.6

57

7.9

55-64 years

134

19.9

122

18.1

35

5.2

65-74 years

33

6.8

32

6.6

3

N/A

75-84 years

1

N/A

2

N/A

0

N/A

85+ years

1

N/A

1

N/A

1

N/A

Race

White

1326

25.9

748

14.0

497

9.2

Black

1251

35.1

911

25.4

195

5.7

Georgia Department of Public Health (DPH), Epidemiology Section, Drug Surveillance Unit https://dph.georgia.gov/drug- surveillance-unit
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