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Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use (2017)

Chapter: Appendix C: Existing Data Sources on Opioid Use, Misuse, Overdose, and Other Harms

« Previous: Appendix B: Biographical Sketches of Committee Members and Consultants
Suggested Citation:"Appendix C: Existing Data Sources on Opioid Use, Misuse, Overdose, and Other Harms." National Academies of Sciences, Engineering, and Medicine. 2017. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. Washington, DC: The National Academies Press. doi: 10.17226/24781.
×
Suggested Citation:"Appendix C: Existing Data Sources on Opioid Use, Misuse, Overdose, and Other Harms." National Academies of Sciences, Engineering, and Medicine. 2017. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. Washington, DC: The National Academies Press. doi: 10.17226/24781.
×
Data Source Numerators Description
National Forensic Laboratory Information System (NFLIS) U.S. Drug Enforcement Administration (DEA) Drug cases investigated by the DEA at compound level (diversion) Chemistry on drugs seized by law enforcement is analyzed by state, county, and volunteer forensic labs. Available for states, participating localities, and nationally.
Poison control calls State poison control centers, National Poison Data System (NPDS) Poison control calls related to “intentional exposures” (includes abuse, misuse, and suspected suicidal) or “intentional abuse exposures” Number of exposure calls by drug/substance at state and national levels.
Drug treatment admissions (e.g., Treatment Episode Data Set [TEDS]) State and local drug treatment agencies Lifetime nonmedical opioid, heroin users; past-year and past-month heroin use, any nonmedical opioid use (not product-specific) Admissions to publicly funded treatment programs and opioid substitution programs by primary, secondary, and tertiary drug, route of administration, demographics. Available at local, state, and national levels.
Arrestee Drug Abuse Monitoring (ADAM) Program Office of National Drug Control Policy Survey/urine screen of recently arrested individuals (diversion) Urinalysis results (marijuana, cocaine, opiates, methamphetamine) and self-reported drug use.
System to Retrieve Information from Drug Evidence (STRIDE) DEA Street drug price by geographic area; street drug purity by geographic area Drug exhibits sent to the DEA laboratories. Provides national data on purity and weight of each sample by month seized. Totals annual seizure weights by drug.
Suggested Citation:"Appendix C: Existing Data Sources on Opioid Use, Misuse, Overdose, and Other Harms." National Academies of Sciences, Engineering, and Medicine. 2017. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. Washington, DC: The National Academies Press. doi: 10.17226/24781.
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Timing Strengths Limitations
Monthly Uniform data collection across sites and over time. Detects new/emerging drugs. Captures only mentions, not quantity seized. Not an appropriate surrogate for misuse. Decisions regarding enforcement and prosecution may influence which drugs are seized/tested. Significant lag in identifying new synthetic drugs because reference standards may not exist.
Monthly Ability to detect new/ emerging drugs in real time. Product- and drug-specific information. NPDS analyses must be requested and purchased; available 12 months after year ends; specific poison center data may be available in real time (depends on center). Possible misclassification of drug involved and reason for exposure. May underrepresent most severe cases of misuse.
Annual, semiannual, or monthly depending on source Data collection is relatively uniform across states. May be influenced by funding streams and referral sources (e.g., criminal justice diversion or emphasis on certain drugs). Publicly available TEDS data lag 1–2 years. Limited differentiation of opioid products. Not nationally representative.
Annual Uniform data collection across sites; sample includes individuals generally not captured in other datasets (e.g., drug treatment). Male arrestees only, limited to five sites in 2012. No longer fully operational. Not an appropriate surrogate for misuse.
Annual Only source of data on illicit drug purity and price. Complete datasets can be obtained via Freedom of Information Act (FOIA) request and analyzed. Strongly influenced by enforcement activities; not representative.
Suggested Citation:"Appendix C: Existing Data Sources on Opioid Use, Misuse, Overdose, and Other Harms." National Academies of Sciences, Engineering, and Medicine. 2017. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. Washington, DC: The National Academies Press. doi: 10.17226/24781.
×
Data Source Numerators Description
Uniform Crime Report (UCR) Federal Bureau of Investigation Arrests due to possession or trafficking of heroin and other opiates UCR Part II contains annual summary of drug-related arrests (possession, sale). Reported by each law enforcement unit at the local level.
National Survey on Drug Use and Health (NSDUH) Substance Abuse and Mental Health Services Administration (SAMHSA) Lifetime nonmedical opioid, heroin users; first-time nonmedical opioid use, heroin initiates; past-year and past-month heroin use, nonmedical opioid use by therapeutic drug class; Diagnostic and Statistical Manual of Mental Disorders, fourth edition, diagnosed abuse or dependence Self-reported drug use and abuse/dependence among respondents aged *12. Results available at national level and for some metropolitan statistical areas (MSAs) and substate areas.
Youth Risk Behavior Surveillance System (YRBSS) U.S. Centers for Disease Control and Prevention (CDC) Youth rates of nonmedical use of prescription opioids National school-based survey of self-reported drug use. Includes results at state (n = 47) and local (n = 22) levels.
Monitoring the Future (MTF) University of Michigan Misuse rates among middle school, high school, college students and young adults Nationally representative survey of self-reported drug use among 8th, 10th, 12th graders.
Automation of Reports and Consolidated Orders System (ARCOS) DEA Amount of manufactured controlled substance circulating through legal means, by compound Measure of prescription drug supply based on mandatory reporting for Schedule I and II controlled substances and selected Schedule III and IV substances from manufacture to sale. Data for each substance reported by quantity (e.g., mg, dosage unit) and 3-digit zip code.
Suggested Citation:"Appendix C: Existing Data Sources on Opioid Use, Misuse, Overdose, and Other Harms." National Academies of Sciences, Engineering, and Medicine. 2017. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. Washington, DC: The National Academies Press. doi: 10.17226/24781.
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Timing Strengths Limitations
Annual System has been in operation more than 30 years; is being updated to allow online analysis. Strongly influenced by enforcement priorities. Only four categories of drugs. No ability to do any data analysis other than summaries.
Annual Longitudinal data collection supports analysis of changes over time. Data can be analyzed online. Household survey excludes institutionalized and unhoused individuals.
Every 2 years Representative/weighted sample for United States and some states/localities. Longitudinal data collection supports analysis of changes over time. Limited to youth attending school.
Annual Longitudinal data collection supports analysis of changes over time. Limited to youth attending school. Not site-specific. Asks about only two prescription opioid products; the rest are considered “narcotics other than heroin.”
Annual Comprehensive inventory of all legal drug sources. Can be analyzed longitudinally down to zip code level by individual substance, formula (e.g., extended-release). Cannot discern between licit and illicit drug use. Data must be procured through FOIA request.
Suggested Citation:"Appendix C: Existing Data Sources on Opioid Use, Misuse, Overdose, and Other Harms." National Academies of Sciences, Engineering, and Medicine. 2017. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. Washington, DC: The National Academies Press. doi: 10.17226/24781.
×
Data Source Numerators Description
Drug mortality Local medical examiners/coroners, state vital records, National Center for Health Statistics nationwide data; SAMHSA’s Drug Abuse Warning Network (DAWN-ME) (ended 2011) Counts of drug-related mortality by compound, some by International Classification of Diseases (ICD) code; for DAWN-ME: mortality data (only for 13 states) Cause of death and toxicology, drug poisoning deaths, and drug-induced deaths. DAWN-ME captured agent-level data.
Emergency department (ED) visits and/or hospital discharges for drug-related causes CDC (SAMHSA’s Drug Abuse Warning Network [DAWN-ED] ended 2011; also the Nationwide Emergency Department Sample [NEDS], which conducted a 20 percent sample of EDs, was discontinued) Unclear, but documentation suggests these will be ICD code–defined ED visits (e.g., unintentional poisoning); for DAWN-ED: misuse/ abuse-related ED visits National Hospital Care Survey is a new survey that will provide data on health care delivery in inpatient, outpatient, and EDs, as well as other ambulatory settings. Will include data on drug-related care episodes. Previously, DAWN-ED collected data using retrospective records review at EDs selected through longitudinal probability sampling. DAWN-ED captured agent-level data on exposures and clinical drug-involved consequences.
HIV/hepatitis C virus (HCV) data State and local health departments New cases of HIV related to injection drug use (IDU); new cases of HCV related to IDU New infections attributed to IDU, IDU by men who have sex with men (MSM), and heterosexual modes of transmission.
Trends in trafficking reports DEA Field Divisions Street price of drugs; availability and sources of drug Each Field Division reports price data, availability, sources, and trafficking by drug.
Suggested Citation:"Appendix C: Existing Data Sources on Opioid Use, Misuse, Overdose, and Other Harms." National Academies of Sciences, Engineering, and Medicine. 2017. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. Washington, DC: The National Academies Press. doi: 10.17226/24781.
×
Timing Strengths Limitations
Annual, although preliminary reports are available at local level sooner Data can be analyzed online through CDC WONDER. Data available by state. Local medical examiner data may not include deaths where private physician was in attendance. Drug use may or may not be based on autopsy reports—depends on state law. State data have 1–2 year time lag; national NCHS is complete in 2–3 years. Cause of death determined by ICD category.
New system is not functional One of few measures of drug-related morbidity. Unclear at what level of geographic specificity these data will be reported. New system is not yet operational. Longitudinal data from DAWN will not be compatible with new system. Unclear if agent-level data will be available, as this is a function of hospital toxicological testing procedures.
HIV reports usually annual, sometime semiannual or monthly; HCV reports less frequent Comprehensive record of individuals who test positive for HIV and risk factors. Reported at county, state, and national levels. Risk group (e.g., IDU, MSM-IDU, heterosexual) is self-reported. Levels of HIV—and especially HCV—testing vary across sites.
Semiannual Extensive data on supply side. Unclear geographic specificity. Unclear whether product- and/or compound-specific. DEA redacts sensitive data prior to release. Possible sampling biases, possible selection biases.
Suggested Citation:"Appendix C: Existing Data Sources on Opioid Use, Misuse, Overdose, and Other Harms." National Academies of Sciences, Engineering, and Medicine. 2017. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. Washington, DC: The National Academies Press. doi: 10.17226/24781.
×
Data Source Numerators Description
Proprietary surveillance system Researched Abuse, Diversion and Addiction-Related Surveillance System (RADARS) Lifetime nonmedical opioid, heroin use; first-time nonmedical opioid use, heroin initiates; past-year and past-month heroin use, nonmedical opioid use by product; measures of diversion; street price of opioid products Drug diversion, poison center, opioid treatment, impaired health care worker, Survey of Key Informants, college survey, StreetRx (streetrx.com for street drug price) programs.
Proprietary surveillance system National Addictions Vigilance Intervention and Prevention Program (NAVIPPRO) Lifetime nonmedical opioid, heroin use; first-time nonmedical opioid use, heroin initiates; past-year and past-month heroin use; nonmedical opioid use by product; route of administration; lifetime and past-year nonfatal opioid overdose; source of opioids Addiction Severity Index-Multimedia Version (ASI-MV) Connect includes assessments of adults on drug use and for treatment need (intake, criminal justice, drug courts, Temporary Assistance for Needy Families) at 3-digit zip code level. Web Informed Services (WIS) quantifies endorsement of drugs among drug-use forums and discussion boards. Comprehensive Health Assessment for Teens assesses teenagers and young adults on drug use and for treatment need at 3-digit zip code level.
Suggested Citation:"Appendix C: Existing Data Sources on Opioid Use, Misuse, Overdose, and Other Harms." National Academies of Sciences, Engineering, and Medicine. 2017. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. Washington, DC: The National Academies Press. doi: 10.17226/24781.
×
Timing Strengths Limitations
Near real time Product and substance with composition- and formulation-specific differentiation. Exposure among certain high-risk groups can be identified (e.g., impaired health care workers). Multifaceted data collection effort. Geographically identified data. Must be requested and purchased. Possible sampling biases, possible information biases. Not nationally representative.
Near real time Product and substance with composition- and formulation-specific differentiation. Multifaceted data collection effort. Geographically identified data. Exposure among important high-risk groups can be identified (e.g., pregnant women, sexual minorities). Geographically identified data. Must be requested and purchased. Sampling bias possible; not a probability sample. Recall bias possible. Not nationally representative.
Suggested Citation:"Appendix C: Existing Data Sources on Opioid Use, Misuse, Overdose, and Other Harms." National Academies of Sciences, Engineering, and Medicine. 2017. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. Washington, DC: The National Academies Press. doi: 10.17226/24781.
×

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Suggested Citation:"Appendix C: Existing Data Sources on Opioid Use, Misuse, Overdose, and Other Harms." National Academies of Sciences, Engineering, and Medicine. 2017. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. Washington, DC: The National Academies Press. doi: 10.17226/24781.
×
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Suggested Citation:"Appendix C: Existing Data Sources on Opioid Use, Misuse, Overdose, and Other Harms." National Academies of Sciences, Engineering, and Medicine. 2017. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. Washington, DC: The National Academies Press. doi: 10.17226/24781.
×
Page 448
Suggested Citation:"Appendix C: Existing Data Sources on Opioid Use, Misuse, Overdose, and Other Harms." National Academies of Sciences, Engineering, and Medicine. 2017. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. Washington, DC: The National Academies Press. doi: 10.17226/24781.
×
Page 449
Suggested Citation:"Appendix C: Existing Data Sources on Opioid Use, Misuse, Overdose, and Other Harms." National Academies of Sciences, Engineering, and Medicine. 2017. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. Washington, DC: The National Academies Press. doi: 10.17226/24781.
×
Page 450
Suggested Citation:"Appendix C: Existing Data Sources on Opioid Use, Misuse, Overdose, and Other Harms." National Academies of Sciences, Engineering, and Medicine. 2017. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. Washington, DC: The National Academies Press. doi: 10.17226/24781.
×
Page 451
Suggested Citation:"Appendix C: Existing Data Sources on Opioid Use, Misuse, Overdose, and Other Harms." National Academies of Sciences, Engineering, and Medicine. 2017. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. Washington, DC: The National Academies Press. doi: 10.17226/24781.
×
Page 452
Suggested Citation:"Appendix C: Existing Data Sources on Opioid Use, Misuse, Overdose, and Other Harms." National Academies of Sciences, Engineering, and Medicine. 2017. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. Washington, DC: The National Academies Press. doi: 10.17226/24781.
×
Page 453
Suggested Citation:"Appendix C: Existing Data Sources on Opioid Use, Misuse, Overdose, and Other Harms." National Academies of Sciences, Engineering, and Medicine. 2017. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. Washington, DC: The National Academies Press. doi: 10.17226/24781.
×
Page 454
Suggested Citation:"Appendix C: Existing Data Sources on Opioid Use, Misuse, Overdose, and Other Harms." National Academies of Sciences, Engineering, and Medicine. 2017. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. Washington, DC: The National Academies Press. doi: 10.17226/24781.
×
Page 455
Suggested Citation:"Appendix C: Existing Data Sources on Opioid Use, Misuse, Overdose, and Other Harms." National Academies of Sciences, Engineering, and Medicine. 2017. Pain Management and the Opioid Epidemic: Balancing Societal and Individual Benefits and Risks of Prescription Opioid Use. Washington, DC: The National Academies Press. doi: 10.17226/24781.
×
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Drug overdose, driven largely by overdose related to the use of opioids, is now the leading cause of unintentional injury death in the United States. The ongoing opioid crisis lies at the intersection of two public health challenges: reducing the burden of suffering from pain and containing the rising toll of the harms that can arise from the use of opioid medications. Chronic pain and opioid use disorder both represent complex human conditions affecting millions of Americans and causing untold disability and loss of function. In the context of the growing opioid problem, the U.S. Food and Drug Administration (FDA) launched an Opioids Action Plan in early 2016. As part of this plan, the FDA asked the National Academies of Sciences, Engineering, and Medicine to convene a committee to update the state of the science on pain research, care, and education and to identify actions the FDA and others can take to respond to the opioid epidemic, with a particular focus on informing FDA's development of a formal method for incorporating individual and societal considerations into its risk-benefit framework for opioid approval and monitoring.

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