| 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 Any opioid
pain relievers 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’ as indicated by the value of ‘S’ in the 7th character; e.g. T400X5S, T400X6S) | 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’ as indicated by the value of ‘S’ in the 7th character; e.g. T401X5S, T401X6S) | 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’ as indicated by the value of ‘S’ in the 7th character; e.g. T400X5S, T400X6S) | 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’ as indicated by the value of ‘S’ in the 7th character; e.g. T400X5S, T400X6S) | 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’ as indicated by the value of ‘S’ in the 7th character; e.g. T401X5S, T401X6S) | 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’ as indicated by the value of ‘S’ in the 7th character; e.g. T400X5S, T400X6S) | SPARCS |
| Admissions for heroin | Admissions to OASAS-certified substance use disorder treatment programs with heroin reported as the primary, secondary, or tertiary substance of use at admission, aggregated by client county of residence. | Clients may also have another opioid or any other substance as the primary, secondary, or tertiary substance of use at admission. | OASAS Client Data System |
| Admissions for any opioid (including heroin) | Admissions to OASAS-certified substance use disorder treatment programs with heroin or any other synthetic or semi-synthetic opioid reported as the primary, secondary, or tertiary substance of use at admission, aggregated by client county of residence. | Other opioid includes synthetic and semi-synthetic opioids. The OASAS Client Data System (CDS) collects specific data on methadone, buprenorphine, oxycodone, as well as “other synthetic opioids.” Other
synthetic opioids also include drugs such as hydrocodone, pharmaceutical and/or non-pharmaceutical fentanyl. Clients may also have heroin or any other substance as the primary, secondary or tertiary substance of use at admission. |
OASAS 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 e-PCR 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 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 |
| Suspected opioid overdoses by EMS agencies | 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 rule out term) 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 e-PCR 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 cases |
| OASAS Client Data System (CDS) – Admissions | Numerator 1-5 admissions |
| 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. |
| OASAS Client Data System (CDS) | The CDS includes data for individuals served in the OASAS-certified treatment system. These data do not
include patients treated for Substance Use Disorder (SUD) by the U.S. Department of Veterans Affairs
(VA), treated for SUD in programs located outside of New York State, treated in hospitals for care not
related to SUD, or transferred to other systems of care not related to treatment of SUD. The guidance for
SUD treatment programs to submit admissions data to the CDS should be no later than 30 days following
the clinical admission transaction. Admissions data are substantially complete three months after the due
date but may be updated indefinitely. The accuracy of measures is affected by the timeliness, completeness, consistency, and quality of data reported by programs. Additionally, the sensitivity and specificity of these measures may vary by provider, program and substances reported. Opioid admissions data are not measures for the prevalence of opioid use. The availability of opioid treatment services within a county may affect the number of admissions reported for county residents to programs offering these services. Admissions are not unique counts of people as a person can be admitted into treatment more than once during a time-period. |
| 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 99% of all EMS data statewide, from 60%-65% of all certified EMS agencies. 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. The County Opioid Quarterly Reports now capture electronic PCR data from both NEMSIS version 2 and NEMSIS version 3 agencies. Now that NEMSIS version 3 data are being captured by New York State, the receipt of historical data has increased the number of naloxone administration reports counted for several counties. Additional increases may occur as more EMS agencies begin to submit NEMSIS version 3 data, which will be reflected in future quarterly reports as the data become available. |
| 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. |
Office of Science
Bureau of Vital Records
AIDS Institute
State Vital Statistics Program
Bureau of Emergency Medical Services and Trauma Systems
Bureau of Narcotic Enforcement
If you have questions about the reports, please contact:
Public Health Information Group at: opioidprevention@health.ny.gov