Definition Purpose: To assist state, local, tribal, territorial, and federal public health practitioners in monitoring emergency department visits for suspected overdoses of any drug.
New or Revised Definition: Revision in CDC All Drug v2
Version Date: v2 was edited on October 25, 2022
Justification for New Version: Revisions in version 2 include addition of ICD-10-CM codes T43.651A, and T43.654A - Poisoning by methamphetamines
Development Methods: CDC scientists started developing the definition using guidance from the United States Drug Enforcement Administration (DEA), Council of State and Territorial Epidemiologists (CSTE) and the Substance Abuse and Mental Health Services Administration (SAMHSA). First, International Classification of Diseases, 10th Revision (ICD-10-CM), and 9th Revision (ICD-9-CM) Clinical Modification, and Systematized Nomenclature of Medicine (SNOMED) diagnosis codes indicating an acute drug poisoning were identified; this was followed by overdose terms in the chief complaint text. Finally, drug terms indicating that any type of drug was involved in the overdose were added. The definition was developed to be inclusive of overdoses involving all drug types, not specifically those that may be illicit versus prescription.
Definition Fields & Structure: The Chief Complaint Discharge Diagnosis (CCDD) field is used to query both the diagnosis codes and chief complaint free text with exclusions (as necessary).
• Automatic inclusion:
o The ED visit is automatically included in the syndrome definition if the ED visit includes
▪ a diagnosis code indicating an unintentional or undetermined intent drug poisoning is present,
▪ an F11 ICD-10-CM code for the non-poisoning opioid use “with intoxication,”
▪ mention of naloxone in the chief complaint text, OR
▪ mention of overdose in the chief complaint text.
• Conditional inclusion:
o If the ED visits does not include a diagnosis code for drug poisoning, an F11 ICD-10-CM code for the non-poisoning opioid use “with intoxication,” or mention of naloxone or overdose in the chief complaint text, the visit is captured only if it includes two components and no exclusion terms:
1) chief complaint text indicating poisoning, AND
2) chief complaint text indicating drug involvement OR an ICD-10-CM code for opioid use, abuse, and dependence without intoxication (i.e., F11.90).
o The list of exclusions is only applied to the chief complaint text when the automatic inclusion criteria are not met. For example, if the automatic inclusion criteria are not present, exclusions such as “no loss of consciousness”, “detox”, and “withdrawal” would be applied and therefore the visit would not be captured as a suspected all drug overdose.
For Consideration: The heroin, opioid, and stimulant definitions are nested within the all drug definition; thus everything included in those queries is included in the all drug definition. There are several poisoning codes (including ICD-9-CM, ICD-10-CM, and SNOMED) and many drug names included in this version of the definition with necessary exclusions (e.g., “PCP” is a drug but also used for “primary care physician”). The team attempted to identify most drug names including some of the popular brand names; however, it is likely that some additional drug names and slang terms will be added to a future version of the definition. This is especially true as new drugs enter the market.
Limitations: This definition is subject to limitations, although their impact on assessing trends in drug overdose ED visits should be minimal. The definition is subject to both misclassification and underreporting for several reasons, including on self-report, bystander reports, and/or clinical presentations to determine if the patient had overdosed. Also, the inclusion of Narcan and naloxone terms were considered automatically an all drug overdose regardless of whether the patient was responsive to naloxone administration. After record reviews it was determined that a large majority of these records containing Narcan and naloxone were opioid overdoses, or there was no documentation of whether the patient had responded to naloxone. Finally, some hospitals may enter all diagnosis codes from a patient’s entire medical history that were not indicative of the current visit, and thus result in overreporting.