The Virginia Department of Health (VDH)'s drug overdose-related mortality table and dashboard provides timely and accurate counts of deaths of Virginia residents by utilizing both the underlying cause of death as well as the contributory/multiple causes of death codes. The processes in deriving drug overdose-related death counts follows the guidelines set forth by the Centers for Disease Control and Prevention’s (CDC) Opioid Overdose Indicator Support Toolkit, Version 3.0 (March 2018). These aggregate Drug Overdose Mortality Indicator counts can be used for surveillance, reporting, evaluation, and communication purposes1.
- The following types of deaths are excluded from these indicators:
- Deaths related to chronic use of drugs (e.g., damage to organs from long-term drug use)
- Deaths due to alcohol and tobacco
- Deaths from adverse effects of drugs
- Deaths that occur under the influence of drugs, but do not involve acute poisoning (e.g., a car crash that occurred because the driver was drowsy from taking a prescription drug).
- The percentage of fatal drug overdoses lacking information on the death certificate about the specific drug(s) causing the death varies substantially over time and by state and local jurisdiction (e.g., some states have almost no missing data while others lack specific information on over 50% of their drug overdose deaths). State epidemiologists should understand the completeness of reporting of the specific drug(s) involved in their jurisdiction in order to understand the quality and limitations of the indicators for reporting and interpretation purposes.
- Death investigators may require weeks or months to complete their investigation (e.g., complete toxicology testing) and classify a death as a drug overdose. While the investigation is being conducted, deaths may be assigned a pending status on the death certificate. That status should be updated when the investigation is complete. State epidemiologists should have an understanding of the death investigation process in their jurisdiction in order to determine the quality of the indicators for reporting and interpretation purposes.
- Because many drug overdose deaths involve more than one drug, the same death may be counted in more than one indicator. For example, rates for the individual indicator “Drug Overdose Deaths Involving Natural and Semi-Synthetic Opioids” (Indicator 5) and “Drug Overdose Deaths Involving Methadone” (Indicator 7) will not sum to the rate for “Drug Overdose Deaths Involving Prescription Opioid Pain Relievers: Natural and Semi-Synthetic Opioids and Methadone” (Indicator 4) because some deaths could involve both methadone and a natural or semi-synthetic opioid.
- It is anticipated that complete drug overdose death data files will be available within nine (9) months after the end of a calendar year.
- Rate Calculations: Overdose deaths are presented as a rate per 100,000 population.
- Suppression: Suppression is applied to death counts of 1 to 4 and rates with numerators of 1 to 4 to maintain confidentiality and accurate rate calculations. Suppressed statistics are indicated with an asterisk (*).
- Data is produced and processed from sources believed to be reliable and accurate at that point of time. No warranty expressed or implied is made regarding accuracy, adequacy, completeness, legality, reliability or usefulness of any information. Additionally, not all data elements are reported at the source. Please see Virginia Code §32.1 for information on data mandated to be conveyed by the patient and/or facility. This disclaimer applies to both isolated and aggregate uses of the data.
- While VDH strives to report data both accurately and timely, delays can occur in awaiting finalized data for both Out-of-State Records and/or National Center for Health Statistics (NCHS) edits.
- Deaths attributed to ICD-10 Code R99 “Other ill-defined and unspecified cause of mortality” could potentially be cases of opioid-related deaths. Deaths classified as R99 are reviewed and updated monthly by VDH to ascertain potential opioid-related deaths.
- Aggregate statewide and locality counts for the Commonwealth of Virginia may differ from the reported counts from the VDH Office of the Chief Medical Examiner (OCME). Some possible causes of these potential discrepancies are:
- Virginia Department of Health's Vital Event Statistics Program reports deaths based on the decedent's residence, whereas OCME reports deaths based on where the event (i.e., opioid overdose) occurred. OCME investigates deaths that occur in Virginia, whereas Vital Event Statistics Program data presented here only reports deaths of Virginia residents
- Vital Event Statistics Program utilizes ICD-10 medical coding to report underlying and contributing cause(s) of death. OCME utilizes a unique coding scheme that also incorporates toxicology and cause of death statements for overdose coding
- There is no unique ICD-10 code for fentanyl; fentanyl deaths are currently captured within the ICD-10 code of T40.4 (synthetic opioids, other than methadone) in the Vital Statistics data. OCME is able to code for fentanyl due to toxicology reporting and investigation.
Centers for Disease Control and Prevention's Opioid Overdose Indicator Support Toolkit. Version 3.0. Page 14
Suppression: Suppression is applied to overdose death counts of 1 to 4 and rates with numerators of 1 to 4 to maintain confidentiality and accurate rate calculations. Suppressed statistics are indicated with an asterisk (*).
- Centers for Disease Control and Prevention Opioid Overdose Indicator Support Toolkit. Version 3.0. Guidance for building and reporting on opioid-related mortality, morbidity, and PDMP indicators. Data-Driven Prevention Initiative (DDPI), National Center for Injury Prevention and Control. 3/23/2018.
- Hedegaard H, Miniño AM, Warner M. Drug overdose deaths in the United States, 1999–2017. NCHS Data Brief, no 329. Hyattsville, MD: National Center for Health Statistics. 2018.
- Ahmad FB, Escobedo LA, Rossen LM, Spencer MR, Warner M, Sutton P. Provisional drug overdose death counts. National Center for Health Statistics. (2019). Retrieved September 6, 2019. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
- Centers for Disease Control and Prevention ICD-10 Mortality Manual 2a -2017. (2017). Retrieved September 6, 2019. https://www.cdc.gov/nchs/data/dvs/2a_2017.pdf