Trends in Opiate-Related Overdose Admissions in a Nationally Representative Sample of US Hospitals: 1993-2007

Background: Local and anecdotal data suggest increasing opiate overdoses beginning in the mid-1990s in the US, but few studies have examined trends or demographic changes in opiate-related overdose hospital admissions in a nationally representative sample.

Method: Using the Nationwide Inpatient Survey (NIS), we estimated the number of hospital admissions with opiate overdose ICD-9 codes (which include both illicit and prescription opiates) between 1993 and 2007 and the overdose rates by ethnicity, gender and age.

Results: In 1993 there were 8,889 (34.5 per million US population) opiate overdose admissions, which increased dramatically by 2007 to 40,655 (135 per million) – a 291% increase. Admissions for White patients saw the largest increase from 23.5 to 119.4 per million, a 408% increase in overdoses. This was much higher than the increases in admissions seen for African-American patients (105% to 80.7 per million in 2007), or Hispanic patients (48% to 44.9 per million). The increase in overdose admissions for female patients - 414% - exceeded that for males, 214%. All 5-year age categories between 16 and 64 saw increased overdose admission rates.

Conclusions: There was a substantial increase in the rate of heroin and prescription opiate overdose-related hospital admissions between 1993 and 2007 in the US. We found evidence that the heroin/opiate overdose epidemic has shifted, becoming more White and female. We will further explore sociodemographic (e.g., urban vs. rural, changes in economic circumstances) and drug market factors (e.g., heroin price and purity trends) associated with the increase in opiate overdose and regional/state variation.