{"id":6398,"date":"2018-07-10T17:16:01","date_gmt":"2018-07-10T17:16:01","guid":{"rendered":"https:\/\/www.vdh.virginia.gov\/surveillance-and-investigation\/?page_id=6398"},"modified":"2026-01-30T10:16:46","modified_gmt":"2026-01-30T15:16:46","slug":"drug-overdose-case-definition","status":"publish","type":"page","link":"https:\/\/www.vdh.virginia.gov\/surveillance-and-investigation\/syndromic-surveillance\/drug-overdose-case-definition\/","title":{"rendered":"Drug Overdose Case Definitions"},"content":{"rendered":"<div id=\"pl-6398\"  class=\"panel-layout\" ><div id=\"pg-6398-0\"  class=\"panel-grid panel-no-style\" ><div id=\"pgc-6398-0-0\"  class=\"panel-grid-cell\" ><div id=\"panel-6398-0-0-0\" class=\"so-panel widget widget_sow-editor panel-first-child\" data-index=\"0\" ><div\n\t\t\t\n\t\t\tclass=\"so-widget-sow-editor so-widget-sow-editor-base\"\n\t\t\t\n\t\t>\n<div class=\"siteorigin-widget-tinymce textwidget\">\n\t<p>VDH uses case definitions to identify suspected unintentional drug overdose emergency department (ED) visits. These definitions rely on discharge diagnosis codes and chief complaint (reason for visit) to classify a visit as overdose-related.<\/p>\n<ul>\n<li><strong>Discharge Diagnosis:\u00a0<\/strong>Suspected overdose-related ED visits are identified using standard medical codes for clinical diagnosis and insurance billing purposes (<a href=\"https:\/\/www.icd9data.com\/2015\/Volume1\/default.htm\">ICD-9-CM<\/a>,\u00a0<a href=\"https:\/\/www.cdc.gov\/nchs\/icd\/icd-10-cm\/\">ICD-10-CM<\/a>\u00a0and <a href=\"https:\/\/www.nlm.nih.gov\/healthit\/snomedct\/index.html\">SNOMED CT<\/a>). In syndromic surveillance data these codes may be preliminary and may not specify the substance(s) involved in the suspected overdose.<\/li>\n<li><strong>Chief Complaint<\/strong>: Chief complaint is a text field describing why the patient came to the ED. The amount of information in the chief complaint can vary. Definitions include key terms and possible misspellings.<\/li>\n<\/ul>\n<p>Additional notes:<\/p>\n<ul>\n<li><strong>Intent<\/strong>: The case definitions aim to capture suspect overdose ED visits of unintentional or undetermined intent. However, syndromic surveillance data do not include complete intent information. Some intentional overdose visits may be included.<\/li>\n<li><strong>Disposition<\/strong>: Disposition refers to the patient status at the end of the ED visit (e.g., discharged, admitted, deceased). Although ED visit data is sometimes referred to as \u201cnon-fatal\u201d data, the case definitions do not include disposition status. It is possible that some overdose ED visits result in death.<\/li>\n<\/ul>\n<\/div>\n<\/div><\/div><div id=\"panel-6398-0-0-1\" class=\"so-panel widget widget_sow-accordion panel-last-child\" data-index=\"1\" ><div\n\t\t\t\n\t\t\tclass=\"so-widget-sow-accordion so-widget-sow-accordion-default-08cd2b9d9f99-6398\"\n\t\t\t\n\t\t><div>\n\t<div class=\"sow-accordion\">\n\t\t\t<div class=\"sow-accordion-panel\n\t\t\t\t\t\"\n\t\t\t\tdata-anchor-id=\"all-drug\">\n\t\t\t\t\t<div class=\"sow-accordion-panel-header-container\" role=\"heading\" aria-level=\"2\">\n\t\t\t\t\t<div class=\"sow-accordion-panel-header\" tabindex=\"0\" role=\"button\" id=\"accordion-label-all-drug\" aria-controls=\"accordion-content-all-drug\" aria-expanded=\"false\">\n\t\t\t\t\t\t<div class=\"sow-accordion-title sow-accordion-title-icon-left\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tAll Drug\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"sow-accordion-open-close-button\">\n\t\t\t\t\t\t\t<div class=\"sow-accordion-open-button\">\n\t\t\t\t\t\t\t\t<span class=\"sow-icon-ionicons\" data-sow-icon=\"&#xf218;\"\n\t\t \n\t\taria-hidden=\"true\"><\/span>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"sow-accordion-close-button\">\n\t\t\t\t\t\t\t\t<span class=\"sow-icon-ionicons\" data-sow-icon=\"&#xf209;\"\n\t\t \n\t\taria-hidden=\"true\"><\/span>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\n\t\t\t<div\n\t\t\t\tclass=\"sow-accordion-panel-content\"\n\t\t\t\trole=\"region\"\n\t\t\t\taria-labelledby=\"accordion-label-all-drug\"\n\t\t\t\tid=\"accordion-content-all-drug\"\n\t\t\t\tstyle=\"display: none;\"\t\t\t>\n\t\t\t\t<div class=\"sow-accordion-panel-border\">\n\t\t\t\t\t<p><strong>VDH All Drug Overdose v5<\/strong><\/p>\n<p>Visits can meet this definition by automatic inclusion criteria or conditional inclusion criteria.<\/p>\n<p><strong>Automatic Inclusion Criteria<\/strong>: Must have a term or code on this list.<\/p>\n<ul>\n<li>Terms: Naloxone, narcan<\/li>\n<li>ICD-9 codes: 965.00, 965.01, 965.02, 965.09, E850.0, E850.1, E850.2<\/li>\n<li>ICD-10 codes (unintentional or undetermined poisoning, initial encounter): T36.0-T36.9, T37.0-T37.9, T38.0-T38.9, T39.0-T39.9, T40.0-T40.9, T41.0-T41.9, T42.0-T42.9, T43.0-T43.9, T44.0-T44.9, T45.0-T45.9, T46.0-T46.9, T47.0-T47.9, T48.0-T48.9, T49.0-T49.9, T50.0-T50.9, T50.A, T50.B, T50.Z, T51.0-T51.9, T52.0-T52.9, T53.0-T53.9, T54.0-T54.9, T55.0-T55.9, T56.0-T56.9, T57.0-T57.9, T58.0-T58.9, T59.0-T59.9, F11.12, F11.22, F11.92<\/li>\n<li>SNOMED CT codes: 295174006, 295175007, 295176008, 295165009, 242253008, 297199006, 295213004, 296321004, 9982009, 27956007, 296325008, 241761001, 296317006, 20260003, 296290006, 61803000, 296291005, 45775001, 45421006, 296329002, 296330007, 57005003<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Conditional Inclusion Criteria<\/strong>: Must have an overdose term and a drug-related term or code and no exclusion terms or codes.<\/p>\n<ul>\n<li style=\"list-style-type: none;\"><\/li>\n<li><strong>Overdose-related terms<\/strong>: overdose, poison, ingest, intoxication, unresponsive, loss of consciousness, syncope, altered mental status, shortness of breath<\/li>\n<li><strong>Drug-related terms and codes<\/strong>: opioid, opiate, opium, morphine, hydrocodone, oxycodone, hydromorphone, oxymorphone, codeine, buprenorphine, fentanyl, methadone, naloxone, tramadol, suboxone, or medication and drug brand names (Dilaudid, Narcan, OxyContin, Percocet, Vicodin, lisdexamfetamine, biphetamine, Adderall, dexedrine, vyvanse, concerta, methylin, ritalin), narcotics, heroin, speed ball, dope, cannabis, lysergide, psychodysleptics, barbiturates, amphetamine, cocaine, pills, benzo, cathinone, cocaine, coke, crack, meth, stimulant, crystal meth, bath salt, MDMA, ecstasy, molly, ICD-10 codes: F11.10, F11.20, F11.90, F14.12, F14.22, F14.92, F15.12, F15.22, F15.92, SNOMED CT codes: 269688005, 290222000<\/li>\n<li><strong>Exclusion terms and codes<\/strong>: withdrawal, detox, suicide, intentional, self-harm, denies drug, denies heroin, denies loss of consciousness, crack and coke references unrelated to overdose (i.e. diet coke, crack tooth, back crack), ICD-9 codes: E95-97, V62.84, 965.01,ICD-10 codes: R45.851, T40.1X1A, T40.1X4A, F14.10, F14.11, F14.13, F14.14, F14.15, F14.18, F14.19, F14.20, F14.21, F14.23, F14.24, F14.25, F14.28, F14.29, F14.90, F14.91, F14.93, F14.94, F14.95, F14.98, F14.99, F15.10, F15.11, F15.13, F15.14, F15.15, F15.18, F15.19, F15.20, F15.21, F15.23, F15.24, F15.25, F15.28, F15.29, F15.90, F15.91, F15.93, F15.94, F15.95, F15.98, F15.99<\/li>\n<\/ul>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"sow-accordion-panel\n\t\t\t\t\t\"\n\t\t\t\tdata-anchor-id=\"opioid-or-unspecified-excluding-heroin\">\n\t\t\t\t\t<div class=\"sow-accordion-panel-header-container\" role=\"heading\" aria-level=\"2\">\n\t\t\t\t\t<div class=\"sow-accordion-panel-header\" tabindex=\"0\" role=\"button\" id=\"accordion-label-opioid-or-unspecified-excluding-heroin\" aria-controls=\"accordion-content-opioid-or-unspecified-excluding-heroin\" aria-expanded=\"false\">\n\t\t\t\t\t\t<div class=\"sow-accordion-title sow-accordion-title-icon-left\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tOpioid or Unspecified (Excluding Heroin)\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"sow-accordion-open-close-button\">\n\t\t\t\t\t\t\t<div class=\"sow-accordion-open-button\">\n\t\t\t\t\t\t\t\t<span class=\"sow-icon-ionicons\" data-sow-icon=\"&#xf218;\"\n\t\t \n\t\taria-hidden=\"true\"><\/span>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"sow-accordion-close-button\">\n\t\t\t\t\t\t\t\t<span class=\"sow-icon-ionicons\" data-sow-icon=\"&#xf209;\"\n\t\t \n\t\taria-hidden=\"true\"><\/span>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\n\t\t\t<div\n\t\t\t\tclass=\"sow-accordion-panel-content\"\n\t\t\t\trole=\"region\"\n\t\t\t\taria-labelledby=\"accordion-label-opioid-or-unspecified-excluding-heroin\"\n\t\t\t\tid=\"accordion-content-opioid-or-unspecified-excluding-heroin\"\n\t\t\t\tstyle=\"display: none;\"\t\t\t>\n\t\t\t\t<div class=\"sow-accordion-panel-border\">\n\t\t\t\t\t<p><strong>VDH Opioid and Unspecified Overdose (excluding Heroin) v3<\/strong><\/p>\n<p>This definition includes visits involving illicit or prescription opioids (except heroin) and visits where the substance is not specified. A visit can meet this definition by one of three conditional inclusion criteria.<\/p>\n<p><strong>Conditional Inclusion Criteria 1:<\/strong> Must have a naloxone term, an opioid overdose code or an unspecified drug overdose code, but no exclusion terms or codes.<\/p>\n<ul>\n<li><strong>Naloxone terms:<\/strong> Naloxone, narcan<\/li>\n<li><strong>Opioid or unspecified drug overdose codes<\/strong>: ICD-9 codes: 965.00, 965.02, 965.09, E850.1, E850.2, ICD-10 codes: T40.0X1A, T40.0X4A, T40.2X1A, T40.2X4A, T40.3X1A, T40.3X4A, T40.4X1A, T40.4X4A, T40.411A, T40.414A, T40.421A, T40.424A, T40.491A, T40.494A, T40.601A, T40.604A, T40.691A, T40.694A, F11.120, F11.121, F11.122, F11.129, F11.220, F11.221, F11.222, F11.229, F11.920, F11.921, F11.922, F11.929, SNOMED CT codes: 295165009, 242253008, 297199006, 295213004<\/li>\n<li><strong>Exclusion terms and codes<\/strong>: Heroin, dope, speed ball, ICD-9 codes: E95-97, V62.84, 965.01, ICD-10 codes: R45.851, T40.1X1A, T40.1X4A, SNOMED CT code: 295174006<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Conditional Inclusion Criteria 2:<\/strong> Must have the key term \u201coverdose\u201d but no exclusion terms or codes.<\/p>\n<ul>\n<li><strong>\"Overdose\"<\/strong><\/li>\n<\/ul>\n<ul>\n<li><strong>Exclusion terms and codes<\/strong>: withdrawal, detox, suicide, intentional, self-harm, on purpose, any specified non-opioid medication or drug, denies drug, denies loss of consciousness; Heroin, dope, speed ball, ICD-9 codes: E95-97, V62.84, 965.01, ICD-10 codes: R45.851, T40.1X1A, T40.1X4A, SNOMED CT code: 295174006<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><strong>Conditional Inclusion Criteria 3:<\/strong> Must have an overdose-related term and a drug-related term or code but no exclusion terms or codes.<\/p>\n<ul>\n<li><strong>Overdose-related term<\/strong>: poison, ingest, intoxication, unresponsive, loss of consciousness, syncope, altered mental status<\/li>\n<li><strong>Drug-related terms and codes<\/strong>: opioid, opiate, opium, morphine, hydrocodone, oxycodone, hydromorphone, oxymorphone, codeine, buprenorphine, fentanyl, methadone, naloxone, tramadol, suboxone, or medication and drug brand names (Dilaudid, Narcan, OxyContin, Percocet, Vicodin), F11.10, F11.20, F11.90<\/li>\n<li><strong>Exclusion terms and codes: <\/strong>withdrawal, detox, suicide, intentional, self-harm, on purpose, any specified non-opioid medication or drug, denies drug, denies loss of consciousness; Heroin, dope, speed ball, ICD-9 codes: E95-97, V62.84, 965.01, ICD-10 codes: R45.851, T40.1X1A, T40.1X4A, SNOMED CT code: 295174006<\/li>\n<\/ul>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"sow-accordion-panel\n\t\t\t\t\t\"\n\t\t\t\tdata-anchor-id=\"heroin\">\n\t\t\t\t\t<div class=\"sow-accordion-panel-header-container\" role=\"heading\" aria-level=\"2\">\n\t\t\t\t\t<div class=\"sow-accordion-panel-header\" tabindex=\"0\" role=\"button\" id=\"accordion-label-heroin\" aria-controls=\"accordion-content-heroin\" aria-expanded=\"false\">\n\t\t\t\t\t\t<div class=\"sow-accordion-title sow-accordion-title-icon-left\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tHeroin\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"sow-accordion-open-close-button\">\n\t\t\t\t\t\t\t<div class=\"sow-accordion-open-button\">\n\t\t\t\t\t\t\t\t<span class=\"sow-icon-ionicons\" data-sow-icon=\"&#xf218;\"\n\t\t \n\t\taria-hidden=\"true\"><\/span>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"sow-accordion-close-button\">\n\t\t\t\t\t\t\t\t<span class=\"sow-icon-ionicons\" data-sow-icon=\"&#xf209;\"\n\t\t \n\t\taria-hidden=\"true\"><\/span>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\n\t\t\t<div\n\t\t\t\tclass=\"sow-accordion-panel-content\"\n\t\t\t\trole=\"region\"\n\t\t\t\taria-labelledby=\"accordion-label-heroin\"\n\t\t\t\tid=\"accordion-content-heroin\"\n\t\t\t\tstyle=\"display: none;\"\t\t\t>\n\t\t\t\t<div class=\"sow-accordion-panel-border\">\n\t\t\t\t\t<p><strong>VDH Heroin Overdose v1<\/strong><\/p>\n<p>Visits can meet this definition by automatic inclusion criteria or conditional inclusion criteria.<\/p>\n<p><strong>Automatic Inclusion Criteria<\/strong>: Must have a code on this list.<\/p>\n<ul>\n<li>ICD-9 codes: 965.01, E850.0<\/li>\n<li>ICD-10 codes: T40.1X1A, T40.1X4A<\/li>\n<li>SNOMED CT codes: 295174006, 295175007, 295176008<\/li>\n<\/ul>\n<p><strong>Conditional Inclusion Criteria: <\/strong>Must have an overdose term and a heroin term but no exclusion terms or codes.<\/p>\n<ul>\n<li><strong>Overdose terms:<\/strong> Narcan, naloxone, overdose, poison, ingest, intoxication, unresponsive, loss of consciousness, syncope, altered mental status, unconscious<\/li>\n<li><strong>Heroin terms:<\/strong> heroin, speedball, dope<\/li>\n<li><strong>Exclusion terms and codes:<\/strong> withdrawal, detox, suicide, intentional, self-harm, denies drug, denies heroin, no loss of consciousness, ICD-9 codes: E95-97, V62.84, ICD-10 codes: R45.851<\/li>\n<\/ul>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"sow-accordion-panel\n\t\t\t\t\t\"\n\t\t\t\tdata-anchor-id=\"stimulant\">\n\t\t\t\t\t<div class=\"sow-accordion-panel-header-container\" role=\"heading\" aria-level=\"2\">\n\t\t\t\t\t<div class=\"sow-accordion-panel-header\" tabindex=\"0\" role=\"button\" id=\"accordion-label-stimulant\" aria-controls=\"accordion-content-stimulant\" aria-expanded=\"false\">\n\t\t\t\t\t\t<div class=\"sow-accordion-title sow-accordion-title-icon-left\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tStimulant\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"sow-accordion-open-close-button\">\n\t\t\t\t\t\t\t<div class=\"sow-accordion-open-button\">\n\t\t\t\t\t\t\t\t<span class=\"sow-icon-ionicons\" data-sow-icon=\"&#xf218;\"\n\t\t \n\t\taria-hidden=\"true\"><\/span>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"sow-accordion-close-button\">\n\t\t\t\t\t\t\t\t<span class=\"sow-icon-ionicons\" data-sow-icon=\"&#xf209;\"\n\t\t \n\t\taria-hidden=\"true\"><\/span>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\n\t\t\t<div\n\t\t\t\tclass=\"sow-accordion-panel-content\"\n\t\t\t\trole=\"region\"\n\t\t\t\taria-labelledby=\"accordion-label-stimulant\"\n\t\t\t\tid=\"accordion-content-stimulant\"\n\t\t\t\tstyle=\"display: none;\"\t\t\t>\n\t\t\t\t<div class=\"sow-accordion-panel-border\">\n\t\t\t\t\t<p><strong>VDH Stimulant Overdose v1<\/strong><\/p>\n<p>Visits can meet this definition by automatic inclusion criteria or conditional inclusion criteria.<\/p>\n<p><strong>Automatic Inclusion Criteria:<\/strong> Must have a code on this list.<\/p>\n<ul>\n<li>ICD-9 codes: 969.70, 969.71, 969.72, 969.73, 969.79, 970.0, 970.9, E854.2, E854.3<\/li>\n<li>ICD-10 codes: T40.5X1A, T40.5X4A, T43.601A, T43.604A, T43.611A, T43.614A, T43.621A, T43.624A, T43.631A, T43.634A, T43.641A, T43.644A, T43.691A, T43.694A<\/li>\n<li>SNOMED CT codes: 296321004, 9982009, 27956007, 296325008, 241761001, 296317006, 20260003, 296290006, 61803000, 296291005, 45775001, 45421006, 296329002, 296330007, 57005003<\/li>\n<\/ul>\n<p><strong>Conditional Inclusion Criteria<\/strong>. Must have an overdose term and a stimulant term or code but no exclusion terms or codes.<\/p>\n<ul>\n<li><strong>Overdose terms<\/strong>: overdose, poison, ingest, intoxication, unresponsive, loss of consciousness, syncope, altered mental status, shortness of breath, snort, nod\/nodding off<\/li>\n<li><strong>Stimulant terms and codes<\/strong>: amphetamine, medication and drug brand names (lisdexamfetamine, biphetamine, Adderall, dexedrine, vyvanse, concerta, methylin, ritalin), cathinone, speed ball, cocaine, coke, crack, meth, stimulant, crystal meth, bath salt, MDMA, ecstasy, molly, F14.12, F14.22, F14.92, F15.12, F15.22, F15.92<\/li>\n<li><strong>Exclusion terms and codes:<\/strong> denies drug, withdrawal, detoxification, cardiac stimulant, suicide, intentional, self-harm, denies loss of consciousness, crack and coke references unrelated to overdose (i.e. diet coke, crack tooth, back crack), alcohol intoxication, ICD-9 codes: E95-97, V62.84, ICD-10 codes: R45.851, T47.2X1A, F14.10, F14.11, F14.13, F14.14, F14.15, F14.18, F14.19, F14.20, F14.21, F14.23, F14.24, F14.25, F14.28, F14.29, F14.90, F14.91, F14.93, F14.94, F14.95, F14.98, F14.99, F15.10, F15.11, F15.13, F15.14, F15.15, F15.18, F15.19, F15.20, F15.21, F15.23, F15.24, F15.25, F15.28, F15.29, F15.90, F15.91, F15.93, F15.94, F15.95, F15.98, F15.99<\/li>\n<\/ul>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t<div class=\"sow-accordion-panel\n\t\t\t\t\t\"\n\t\t\t\tdata-anchor-id=\"history-of-case-definition-changes\">\n\t\t\t\t\t<div class=\"sow-accordion-panel-header-container\" role=\"heading\" aria-level=\"2\">\n\t\t\t\t\t<div class=\"sow-accordion-panel-header\" tabindex=\"0\" role=\"button\" id=\"accordion-label-history-of-case-definition-changes\" aria-controls=\"accordion-content-history-of-case-definition-changes\" aria-expanded=\"false\">\n\t\t\t\t\t\t<div class=\"sow-accordion-title sow-accordion-title-icon-left\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t\tHistory of Case Definition Changes\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<div class=\"sow-accordion-open-close-button\">\n\t\t\t\t\t\t\t<div class=\"sow-accordion-open-button\">\n\t\t\t\t\t\t\t\t<span class=\"sow-icon-ionicons\" data-sow-icon=\"&#xf218;\"\n\t\t \n\t\taria-hidden=\"true\"><\/span>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t\t<div class=\"sow-accordion-close-button\">\n\t\t\t\t\t\t\t\t<span class=\"sow-icon-ionicons\" data-sow-icon=\"&#xf209;\"\n\t\t \n\t\taria-hidden=\"true\"><\/span>\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t\t\t<\/div>\n\n\t\t\t<div\n\t\t\t\tclass=\"sow-accordion-panel-content\"\n\t\t\t\trole=\"region\"\n\t\t\t\taria-labelledby=\"accordion-label-history-of-case-definition-changes\"\n\t\t\t\tid=\"accordion-content-history-of-case-definition-changes\"\n\t\t\t\tstyle=\"display: none;\"\t\t\t>\n\t\t\t\t<div class=\"sow-accordion-panel-border\">\n\t\t\t\t\t<p><strong>The table below provides a summary of changes made to the drug overdose case definitions by VDH since September 2016.<\/strong><\/p>\n<table style=\"height: 462px;\" border=\"2\" width=\"893\">\n<tbody>\n<tr>\n<td width=\"145\">\n<p style=\"text-align: center;\"><strong>Month<\/strong><\/p>\n<\/td>\n<td width=\"510\">\n<p style=\"text-align: center;\"><strong>Description<\/strong><\/p>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: center;\" width=\"145\"><strong>September 2016<\/strong><\/td>\n<td width=\"510\">The \"Monthly Emergency Department Visits for Overdose by Opioid, Unspecified Substance and Heroin among Virginia Residents\" report was first published in September 2016.<\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: center;\" width=\"145\"><strong>July 2017<\/strong><\/td>\n<td width=\"510\">Three new exclusion terms were added to the Unintentional Overdose by Opioid or Unspecified Substance definition to improve specificity and make it mutually exclusive from the Unintentional Overdose by Heroin definition beginning in the July 2017 report. The exclusion revisions include: \u201cheron\u201d (misspelling of heroin), International Classification of Diseases 9<sup>th<\/sup>\u00a0Revision (ICD-9) code \u201c965.01\u201d and ICD 10<sup>th<\/sup>\u00a0Revision (ICD-10) code \u201cT40.1\u201d referencing heroin overdose. This change resulted in a small decrease in the number of ED visits for unintentional overdose by opioid or unspecified substance than previously reported.<\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: center;\" width=\"145\"><strong>May 2018<\/strong><\/td>\n<td width=\"510\">Case definition revisions were required beginning in the May 2018 report because of submission of SNOMED Clinical Terms (CT) codes by EDs for discharge diagnosis.\u00a0Reporting of SNOMED CT codes to VDH began in March 2018. One new exclusion term was added to the Unintentional Overdose by Opioid or Unspecified Substance definition to make it mutually exclusive from the Unintentional Overdose by Heroin definition: SNOMED CT code \u201c295174006\u201d for heroin overdose.<\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: center;\" width=\"145\"><strong>June 2018<\/strong><\/td>\n<td width=\"510\">VDH revised the case definitions based on guidance from the Centers for Disease Control and Prevention (CDC) as well as findings from a data quality evaluation conducted by VDH. \u00a0While the revised case definitions have increased the sensitivity of capturing valid unintentional overdoses among ED visits reported to VDH, the\u00a0interpretation of the overdose trends and data found in this report are not impacted.\n<ul>\n<li>Unintentional Overdose by Opioid or Unspecified Substance definition revisions: Inclusion of F11 category ICD-10 codes for opioid use, abuse and dependence, SNOMED CT codes for opioid and opiate overdose, as well as medication and drug brand names referencing opioid analgesics. Exclusion of terms referencing heroin or denial of drug use. The following exclusion terms used in previous versions of the case definition were removed: alcohol, mental health and addiction.<\/li>\n<li>Unintentional Overdose by Heroin definition revisions: Inclusion of common street names referencing heroin and SNOMED CT codes for heroin overdose.\u00a0Exclusion of discharge diagnosis codes and terms referencing suicide ideation and self-harm to match the Opioid and Unspecified Substance case definition. The following exclusion terms used in previous versions of the case definition were removed: alcohol, mental health and addiction.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: center;\" width=\"145\"><strong>August 2018<\/strong><\/td>\n<td width=\"510\">\n<ul>\n<li>Three exclusion terms were added to the Unintentional Overdose by Opioid or Unspecified Substance definition to improve specificity and make it mutually exclusive from the Unintentional Overdose by Heroin definition beginning in the August 2018 report. The exclusion revisions were: International Classification of Diseases 9<sup>th<\/sup>\u00a0Revision (ICD-9) code \u201c965.01\u201d and ICD 10<sup>th<\/sup>\u00a0Revision (ICD-10) code \u201cT40.1X1A\u201d and \"T40.1X4A\" referencing heroin overdose.\u00a0This change resulted in a very small decrease in the number of ED visits for Unintentional Overdose by Opioid or Unspecified Substance for historic data in 2015 and 2016.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: center;\" width=\"145\"><strong>November 2018<\/strong><\/td>\n<td width=\"510\">\n<ul>\n<li>Three exclusion terms were added to the Unintentional Overdose by Opioid or Unspecified Substance definition to improve specificity and make it mutually exclusive from the Unintentional Overdose by Heroin definition. The exclusions were: \"dope\", \"speed ball\", and \"speedball\".\u00a0This change resulted in a very small decrease (N=3 visits) in the number of ED visits for Unintentional Overdose by Opioid or Unspecified Substance in historic data.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: center;\" width=\"145\"><strong>January 2019<\/strong><\/td>\n<td width=\"510\">\n<ul>\n<li>A new case definition was added for All Drug overdose. This case definition includes opioids, heroin, stimulants and other narcotics as well as unspecified overdose where no substance is mentioned.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: center;\" width=\"145\"><strong>February 2021<\/strong><\/td>\n<td width=\"510\">\n<ul>\n<li>Unintentional Overdose by Opioid or Unspecified Substance case definition updates: Addition of new ICD-10 codes released October 2020 for poisoning by fentanyl or fentanyl analogs, tramadol, and other synthetic narcotics.<\/li>\n<li>All Drug Overdose case definition updates: Inclusion of T50.A\/B\/Z ICD-10 codes for poisoning by bacterial vaccines, viral vaccines, or other vaccines and biological substances. Addition of new ICD-10 codes released October 2020 for poisoning by fentanyl or fentanyl analogs, tramadol, and other synthetic narcotics.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: center;\" width=\"145\"><strong>February 2022<\/strong><\/td>\n<td width=\"510\">A new case definition was added for Stimulant overdose. This case definition includes cocaine (including crack), methamphetamine, ecstasy (MDMA), caffeine, or unspecified stimulants. Stimulant overdoses co-occurring with other substances (e.g., opioids and stimulants) are included.<\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: center;\" width=\"145\"><strong>June 2022<\/strong><\/td>\n<td width=\"510\">\n<ul>\n<li style=\"list-style-type: none;\">\n<ul>\n<li>All Drug Overdose case definition updates: Addition of SNOMED codes, drug terms, medication and drug brand names referencing stimulant overdose missing from previous versions along with exclusions for crack and coke references unrelated to overdose. ICD-10 and SNOMED codes for poisonings by anterior pituitary hormones, aspirin or propionic acid derivatives were also added.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: center;\" width=\"145\"><strong>October 2025<\/strong><\/td>\n<td width=\"510\">Edits on this date were to the wording and layout of the webpage. No changes were made to the case definitions.<\/td>\n<\/tr>\n<tr>\n<td style=\"text-align: center;\" width=\"145\"><strong>January 2026<\/strong><\/td>\n<td width=\"510\">Changed wording and layout of case definition descriptions for clarity. No changes were made to case definition syntax.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>&nbsp;<\/p>\n\t\t\t\t<\/div>\n\t\t\t<\/div>\n\t\t<\/div>\n\t\t<\/div>\n<\/div>\n<\/div><\/div><\/div><\/div><\/div>","protected":false},"excerpt":{"rendered":"<p>VDH uses case definitions to identify suspected unintentional drug overdose emergency department (ED) visits. These definitions rely on discharge diagnosis codes and chief complaint (reason for visit) to classify a visit as overdose-related. Discharge Diagnosis:\u00a0Suspected overdose-related ED visits are identified using standard medical codes for clinical diagnosis and insurance billing purposes (ICD-9-CM,\u00a0ICD-10-CM\u00a0and SNOMED CT). In [&hellip;]<\/p>\n","protected":false},"author":324,"featured_media":0,"parent":3724,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_lmt_disableupdate":"no","_lmt_disable":"","footnotes":""},"tags":[],"class_list":["post-6398","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Drug Overdose Case Definitions - Surveillance and Investigation<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.vdh.virginia.gov\/surveillance-and-investigation\/syndromic-surveillance\/drug-overdose-case-definition\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Drug Overdose Case Definitions - Surveillance and Investigation\" \/>\n<meta property=\"og:description\" content=\"VDH uses case definitions to identify suspected unintentional drug overdose emergency department (ED) visits. These definitions rely on discharge diagnosis codes and chief complaint (reason for visit) to classify a visit as overdose-related. Discharge Diagnosis:\u00a0Suspected overdose-related ED visits are identified using standard medical codes for clinical diagnosis and insurance billing purposes (ICD-9-CM,\u00a0ICD-10-CM\u00a0and SNOMED CT). In [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/www.vdh.virginia.gov\/surveillance-and-investigation\/syndromic-surveillance\/drug-overdose-case-definition\/\" \/>\n<meta property=\"og:site_name\" content=\"Surveillance and Investigation\" \/>\n<meta property=\"article:modified_time\" content=\"2026-01-30T15:16:46+00:00\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"9 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/surveillance-and-investigation\\\/syndromic-surveillance\\\/drug-overdose-case-definition\\\/\",\"url\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/surveillance-and-investigation\\\/syndromic-surveillance\\\/drug-overdose-case-definition\\\/\",\"name\":\"Drug Overdose Case Definitions - Surveillance and Investigation\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/surveillance-and-investigation\\\/#website\"},\"datePublished\":\"2018-07-10T17:16:01+00:00\",\"dateModified\":\"2026-01-30T15:16:46+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/surveillance-and-investigation\\\/syndromic-surveillance\\\/drug-overdose-case-definition\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/www.vdh.virginia.gov\\\/surveillance-and-investigation\\\/syndromic-surveillance\\\/drug-overdose-case-definition\\\/\"]}]},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/surveillance-and-investigation\\\/syndromic-surveillance\\\/drug-overdose-case-definition\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/surveillance-and-investigation\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Syndromic Surveillance\",\"item\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/surveillance-and-investigation\\\/syndromic-surveillance\\\/\"},{\"@type\":\"ListItem\",\"position\":3,\"name\":\"Drug Overdose Case Definitions\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/surveillance-and-investigation\\\/#website\",\"url\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/surveillance-and-investigation\\\/\",\"name\":\"Surveillance and Investigation\",\"description\":\"To promote and protect the health of all Virginians\",\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/www.vdh.virginia.gov\\\/surveillance-and-investigation\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Drug Overdose Case Definitions - Surveillance and Investigation","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/www.vdh.virginia.gov\/surveillance-and-investigation\/syndromic-surveillance\/drug-overdose-case-definition\/","og_locale":"en_US","og_type":"article","og_title":"Drug Overdose Case Definitions - Surveillance and Investigation","og_description":"VDH uses case definitions to identify suspected unintentional drug overdose emergency department (ED) visits. These definitions rely on discharge diagnosis codes and chief complaint (reason for visit) to classify a visit as overdose-related. Discharge Diagnosis:\u00a0Suspected overdose-related ED visits are identified using standard medical codes for clinical diagnosis and insurance billing purposes (ICD-9-CM,\u00a0ICD-10-CM\u00a0and SNOMED CT). 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