| Measures | |||
|---|---|---|---|
| Indicator | Definition | ICD codes/Detailed Explanation | Data Source |
| All overdose deaths involving opioids | All poisoning deaths involving opioids, all manners, using all causes of death | Underlying cause of death, determined from the field designated as such, or, where missing or unknown, from the first-listed multiple cause of
death field: X40-X44, X60-X64, X85, Y10-Y14 AND Any opioid in all other causes of death: T40.0, T40.1, T40.2, T40.3, T40.4, T40.6 (Data for New York State exclusive of New York City are provided by NYSDOH Bureau of Vital Records. Data for the five boroughs in New York City are accessed via CDC WONDER.) |
Vital Statistics CDC WONDER |
| Overdose deaths involving heroin | Poisoning deaths involving heroin, all manners, using all causes of death | Underlying cause of death, determined from the field designated as such, or, where missing or unknown, from the first-listed multiple cause of death field: X40- X44, X60-X64, X85, Y10-Y14 AND Heroin in all
other causes of death: T40.1 (Data for New York State exclusive of New York City are provided by NYSDOH Bureau of Vital Records. Data for the five boroughs in New York City are accessed via CDC WONDER.) |
Vital Statistics CDC WONDER |
| Overdose deaths involving synthetic opioids other than methadone (incl. illicitly produced opioids such as fentanyl) | Poisoning deaths involving synthetic opioids other than methadone (incl. illicitly produced opioids such as fentanyl), all manners, using all causes of death | Underlying cause of death, determined from the field designated as such, or, where missing or unknown, from the first-listed multiple cause of death field: X40- X44, X60-X64, X85, Y10-Y14 AND synthetic opioids
other than methadone (incl. illicitly produced opioids such as fentanyl) in all other causes of death: T40.4 (Data for New York State exclusive of New York City are provided by NYSDOH Bureau of Vital Records. Data for the five boroughs in New York City are accessed via CDC WONDER.) |
Vital Statistics CDC WONDER |
| All emergency department visits involving opioid overdose | All outpatient (not being admitted) emergency department visits involving opioid poisonings, all manners, principal diagnosis, or first-listed cause of injury | ICD-10-CM: Principal Diagnosis: T40.0, T40.1, T40.2, T40.3, T40.4, T40.6 (Excludes ‘adverse effect’ or ‘underdosing’ as indicated by the values of 5 and 6 in the 6th character; and ‘sequela’ and ‘subsequent encounter’ as indicated by the values ‘S’ and ‘D’ in the 7th character, respectively; e.g. T400X5S, T400X6S, T400X5D, T400X6D) | SPARCS |
| Emergency department visits involving heroin overdose | Outpatient (not being admitted) emergency department visits involving heroin poisoning, all manners, principal diagnosis, or firstlisted cause of injury | ICD-10-CM: Principal Diagnosis: T40.1 (Excludes ‘adverse effect’ or ‘underdosing’ as indicated by the values of 5 and 6 in the 6th character; and ‘sequela’ and ‘subsequent encounter’ as indicated by the values ‘S’ and ‘D’ in the 7th character, respectively; e.g. T401X5S, T401X6S, T401X5D, T401X6D) | SPARCS |
| Emergency department visits involving opioid overdose excluding heroin | Outpatient (not being admitted) emergency department visits involving opioid poisonings except heroin, all manners, principal diagnosis, or firstlisted cause of injury | ICD-10-CM: Principal Diagnosis: T40.0, T40.2, T40.3, T40.4, T40.6 (Excludes ‘adverse effect’ or ‘underdosing’ as indicated by the values of 5 and 6 in the 6th character; and ‘sequela’ and ‘subsequent encounter’ as indicated by the values ‘S’ and ‘D’ in the 7th character, respectively; e.g. T400X5S, T400X6S, T400X5D, T400X6D) | SPARCS |
| All hospitalizations involving opioid overdose | All hospitalizations involving opioid poisonings, all manners, principal diagnosis or first-listed cause of injury | ICD-10-CM: Principal Diagnosis: T40.0, T40.1, T40.2, T40.3, T40.4, T40.6 (Excludes ‘adverse effect’ or ‘underdosing’ as indicated by the values of 5 and 6 in the 6th character; and ‘sequela’ and ‘subsequent encounter’ as indicated by the values ‘S’ and ‘D’ in the 7th character, respectively; e.g. T400X5S, T400X6S, T400X5D, T400X6D) | SPARCS |
| Hospitalizations involving heroin overdose | Hospitalizations involving heroin poisonings, all manners, principal diagnosis or first-listed cause of injury | ICD-10-CM: Principal Diagnosis: T40.1 (Excludes ‘adverse effect’ or ‘underdosing’ as indicated by the values of 5 and 6 in the 6th character; and ‘sequela’ and ‘subsequent encounter’ as indicated by the values ‘S’ and ‘D’ in the 7th character, respectively; e.g. T401X5S, T401X6S, T401X5D, T401X6D) | SPARCS |
| Hospitalizations involving opioid overdose excluding heroin | Hospitalizations involving opioid poisonings except heroin, all manners, principal diagnosis or first-listed cause of injury | ICD-10-CM: Principal Diagnosis: T40.0, T40.2, T40.3, T40.4, T40.6 (Excludes ‘adverse effect’ or ‘underdosing’ as indicated by the values of 5 and 6 in the 6th character; and ‘sequela’ and ‘subsequent encounter’ as indicated by the values ‘S’ and ‘D’ in the 7th character, respectively; e.g. T400X5S, T400X6S, T400X5D, T400X6D) | SPARCS |
| Unique individuals enrolled in substance use disorder treatment programs who reported heroin as the primary substance use at admission | A person is counted once if they were in treatment (received one or more services) during a time-period. A unique person may receive multiple services or be in treatment many years and therefore, may be counted uniquely across one or more time periods. The person’s most recent county of residence for each time period is reported. | Persons entering treatment for Substance Use Disorders who reported a primary substance use at admission with heroin.
Examples: Primary Substance=heroin. |
NYS OASAS Data Warehouse, Client Data System |
| Unique individuals enrolled in substance use disorder treatment programs who reported any opioid, including heroin, as the primary substance use at admission | A person is counted once if they were in treatment (received one or more services) during a time-period. A unique person may receive multiple services or be in treatment many years and therefore, may be counted uniquely across one or more time periods. The person’s most recent county of residence for each time period is reported. | Persons entering treatment for Substance Use Disorders who reported a primary substance use at admission with with any opioid, including heroin.
Example: Primary Substance=heroin, methadone, buprenorphine, or oxycodone |
NYS OASAS Data Warehouse, Client Data System |
| Naloxone administration report by Emergency Medical Services (EMS) | Each naloxone administration report represents an EMS encounter when the administration of naloxone was given during patient care. Often, administrations of naloxone were given for patients presenting with similar signs and symptoms of a potential opioid overdose; final diagnosis of an opioid overdose is completed during definitive care or final evaluation. | Medication administered is equal to naloxone. | NYS ePCR data, and other regional EMS Program data collection methods |
| Naloxone administration report by law enforcement | Each naloxone administration report represents a naloxone administration instance in which a trained law enforcement officer administered one or more doses of naloxone to a person suspected of an opioid overdose. | Not applicable | NYS Law Enforcement Naloxone Administration Database |
| Naloxone administration report by registered Community Opioid Overdose Prevention (COOP) program | Each naloxone administration report represents a naloxone administration instance in which a trained responder administered one or more doses of naloxone to a person suspected of an opioid overdose. Naloxone administration instances that are not reported to the AIDS Institute by the registered COOP programs are excluded from the county report. | Not applicable | NYS Community Opioid Overdose Prevention Naloxone Administration Database |
| Emergency Medical Services (EMS) suspected opioid overdose | If any one of the following conditions are met: 1) naloxone is administered with positive response, 2) provider impressions indicate poisoning by opioids, 3) provider impressions indicate opioid related disorder and naloxone is administered, 4) provider impressions indicate unspecified drug overdose and opioid term is mentioned in narrative and response to naloxone is not worse and no narcotics are administered by EMS, 5) provider impressions indicate unspecified drug overdose, cardiac arrest, apnea, or respiratory failure and opioid term is mentioned in narrative and naloxone is administered and patient fatality is indicated, 6) opioid term and overdose term mentioned in narrative with no terms that indicated contradiction with an opioid overdose (e.g., “not an opioid”, “not an overdose”) and at least two additional terms indicating an opioid overdose mentioned in narrative and no narcotics are administered by EMS |
Please see Appendix for detailed methodology | NYS ePCR data, and other regional EMS Program data collection methods |
| Suppression Rules | |
|---|---|
| Data Source | Suppression Criteria |
| Vital Statistics - Death Records | Denominator population fewer than 50 |
| Statewide Planning and Research Cooperative System (SPARCS) - ED and hospital records | Numerator 1-5 cases |
| CDC WONDER | Numerator 1-9 deaths |
| NYS OASAS Data Warehouse, Client Data System – Enrollment | Numerator 1-9 unique individuals enrolled |
| Prehospital Care Reports | Numerator 1-10 administrations and suspected overdoses |
| NYS Law Enforcement Naloxone Administration Dataset | None |
| NYS Community Opioid Overdose Prevention Program (COOP) Dataset | None |
| Data Limitations | |
|---|---|
| Data Source | Limitations |
| Vital Records CDC WONDER |
The accuracy of indicators based on codes found in vital statistics data is limited by the completeness and
quality of reporting and coding. Death investigations may require weeks or months to complete; while
investigations are being conducted, deaths may be assigned a pending status on the death certificate (ICD-10-
CM underlying cause code of R99, “other ill-defined and unspecified causes of mortality”). Analysis of the
percentage of death certificates with an underlying cause of death of R99 by age, over time, and by jurisdiction
should be conducted to determine potential impact of incomplete underlying causes of death on drug overdose
death indicators. The percentage of death certificates with information on the specific drug(s) involved in drug overdose deaths varies substantially by state and local jurisdiction and may vary over time. The substances tested for, the circumstances under which the tests are performed, and how information is reported on death certificates may also vary. Drug overdose deaths that lack information about the specific drugs may have involved opioids. Even after a death is ruled as caused by a drug overdose, information on the specific drug might not be subsequently added to the certificate. Therefore, estimates of fatal drug overdoses involving opioids may be underestimated from lack of drug specificity. Additionally, deaths involving heroin might be misclassified as involving morphine (a natural opioid), because morphine is a metabolite of heroin. The indicator “Overdose deaths involving opioid pain relievers” includes overdose deaths due to pharmaceutically and illicitly produced opioids such as fentanyl. |
| SPARCS | The recent data may be incomplete and should be interpreted with caution. Health Care Facilities licensed in
New York State, under Article 28 of the Public Health Law, are required to submit their in-patient and/or
outpatient data to SPARCS. SPARCS is a comprehensive all-payer data reporting system established in 1979
in cooperation between the healthcare industry and government. Created to collect information on discharges
from hospitals, SPARCS now collects patient level detail on patient characteristics, diagnoses and
treatments, services, and charges for hospitals, ambulatory surgical centers, and clinics, both hospital extension
and diagnosis and treatment centers. Per NYS Rules and Regulations, Section 400.18 of Title 10, data are required to be submitted:(1) monthly, (2) 95% within 60 days following the end of the month of patient’s discharge/visit, and (3) 100% are due 180 days following the end of the month of the patient discharge/visit. Failure to comply may result in the issuance of Statement of Deficiencies (SODs) and facilities may be subject to a reimbursement rate penalty. The accuracy of indicators, which are based on diagnosis codes (ICD-9-CM codes before Oct. 1, 2015 and ICD-10-CM on or after Oct. 1, 2015) reported by the facilities, is limited by the completeness and quality of reporting and coding by the facilities. The indicators are defined based on the principal diagnosis code or firstlisted valid external cause code only. The sensitivity and specificity of these indicators may vary by year, hospital location, and drug type. Changes should be interpreted with caution due to the change in codes used for the definition. The SPARCS data do not include discharges by people who sought care from hospitals outside of New York State, which may lower numbers and rates for some counties, especially those which border other states. |
| NYS OASAS Data Warehouse, Client Data System | The CDS includes data for individuals enrolled in the OASAS-certified treatment system. These data do not include
individuals who do not enter treatment, get treated by the U.S. Department of Veterans Affairs (VA), go outside of New
York State for treatment, are admitted to hospitals but not to Substance Use Disorder (SUD) treatment, get diverted to
other systems, or receive an addictions medication from a physician outside of the OASAS system of care. Data are
considered to be substantially complete three months after the due date but are able to be updated indefinitely. The
accuracy of data depends on the completeness, consistency and quality of reporting and coding by the programs. The
availability of substance use disorder treatment services within a county may affect the number of unique people
enrolled who reside in that county. |
| EMS Patient Care Reports | Documentation data entry errors can occur and may result in ‘naloxone administered’ being recorded when a
different medication had been administered. Patients who present as unresponsive or with an altered mental status with unknown etiology may be administered naloxone, as part of the treatment protocol, while attempts are being made to determine the cause of the patient’s current unresponsive state or altered mental status. Electronic PCR data currently capture approximately 100% of all EMS data statewide. The remaining data are reported via paper PCR, from which extracting opioid/heroin overdoses and naloxone administrations is impractical. The Suffolk County Medical Control data do not include patients recorded as ‘unresponsive/unknown’ who received a treatment protocol that includes naloxone. The National Emergency Medical Services Information System (NEMSIS) is a universal standard for how EMS patient care data are collected. Prior to 2019, most EMS agencies in New York State adhered to the NEMSIS version 2.2.1 standard that was released in 2005. As of January 1, 2020, most have transitioned to the updated NEMSIS version 3.4.0 standard, which has improved the quality of EMS data. Further improvements have occurred with NEMSIS version 3.5.0 beginning in July 2024. The County Opioid Quarterly Reports now capture electronic PCR data only from NEMSIS version 3.5.0. |
| NYS Law Enforcement Naloxone Administration Dataset | All data are self-reported by the responding officer at the scene. Not all data fields are completed by the
responding officer. There is often a lag in data reporting. All data should be interpreted with caution. It is possible that not all naloxone administrations reported are for an opioid overdose. There are not toxicology reports to confirm suspected substances used. Increase may represent expansion of program and may or may not indicate an increase in overdose events. On November 1, 2022, an online electronic form was launched for law enforcement officers statewide to directly enter their naloxone administration reports. Data suggest this resulted in an increased number of reports being submitted. Data for New York City on naloxone administration reports by law enforcement are not included in this report. Data displayed for Nassau County on naloxone administration reports by law enforcement are not complete due to the use of an alternate reporting system. |
| NYS Community Opioid Overdose Prevention (COOP) Program Dataset | All data are self-reported by the responder on the scene. Not all data fields are completed by the responder.
There is often a lag in data reporting. All data should be interpreted with caution. Increase may represent expansion of program and may or may not indicate an increase in overdose events. Reporting administrations of naloxone to the NYSDOH is one of the mandated responsibilities of registered COOP program directors. The community naloxone database is updated continually, and the dataset is never “closed.” Duplicate reports may be identified and removed in later quarters. Due to the transition in May 2018 from paper-based reporting to an online reporting system, a different ZIP Code file was used that may result in small shifts in the number of reports per county from past quarters. The actual number of incidents of naloxone administrations in the community may be higher than the number reported to the NYSDOH due to the delay in reporting. The actual number of naloxone administrations is likely to substantially exceed the number reported to the NYSDOH. |
Bureau of Vital Records
AIDS Institute
State Vital Statistics Program
Division of State Emergency Medical Services
Bureau of Narcotic Enforcement
If you have questions about the reports, please contact:
Public Health Information Group at: opioidprevention@health.ny.gov