About Opioid-related Data in New York State

Index

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Methodology and Limitations

Types of Estimates

  1. Percentage/age-adjusted percentage:  Percentages are calculated per 100 population (e.g. Percentage of patients receiving more than an average daily dose ≥90 morphine milligram equivalents of opioid analgesics).
    The percentages were age-adjusted to the U.S. 2000 standard population using appropriate age distributions. 1 Age-adjustment is a process that is performed to allow communities with different age structures to be compared.2
  2. Rate/age-adjusted rate:  A rate is a measure of the frequency with which an event occurs in a defined population over a specified period of time. Rates used for the opioid website tracking indicators are per 1,000 or 100,000 population.
    The rates were age-adjusted to the U.S. 2000 standard population using appropriate age distributions. 1 Age-adjustment is a process that is performed to allow communities with different age structures to be compared.2

Unstable Estimates

Multiple years of data were combined to generate more stable estimates when the number of events for an indicator was small (i.e., rare conditions).

An asterisk (*) symbol is used to indicate that a percentage, or rate is unreliable/unstable. This usually occurs when there are less than 10 events in the numerator.

Data Suppression for Confidentiality

Results are not shown (i.e., suppressed) when issues of confidentiality exist. Suppression rules vary depending on the data source and the indicator.

Data Sources Suppression Criteria
PMP Numerator between 1 - 5 cases
Death Denominator population <30
SPARCS Numerator between 1 - 5 cases

PMP:  Prescription Monitoring Program
SPARCS:  Statewide Planning and Research Cooperative System

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Prescription Monitoring Program (PMP) data in New York State by region and county

Prescription Monitoring Program indicator descriptions and data sources
Indicator Definition Numerator/detailed explanation Denominator/detailed explanation Data Source
Opioid analgesic prescriptions rate per 1,000 population Number and rate of opioid analgesic prescriptions per 1,000 residents Schedule II, III and IV opioid analgesic prescriptions dispensed to state residents Midyear population for the calendar year under surveillance from US census NYS PMP registry
Crude rate of patients prescribed opioid analgesics from five or more prescribers and dispensed at five or more pharmacies per 100,000 population Crude rate of multiple provider episodes for prescription opioids (five or more prescribers and five or more pharmacies in a six-month period) per 100,000 residents Number of patients receiving prescriptions for opioid analgesics from five or more prescribers and that are dispensed at five or more pharmacies in a six-month period Midyear population for the calendar year under surveillance from US census NYS PMP registry
Buprenorphine prescribing for substance use disorder (SUD), rate per 1,000 population Buprenorphine for substance use disorder (SUD) prescribing rates per 1,000 residents Buprenorphine prescriptions dispensed to state residents for substance use disorder (SUD) within the state Midyear population for the calendar year under surveillance from US census NYS PMP registry

New York State Prescription Monitoring Program - NYSPMP

The New York State Prescription Monitoring Program Registry (PMP) is an online registry that is maintained by New York State Department of Health’s Bureau of Narcotic Enforcement. The registry collects dispensed prescription data for controlled substances in schedules II, III, IV and V that are reported by more than 5,000 separate dispensing pharmacies and practitioners registered with New York State. The data must be submitted to the Bureau of Narcotic Enforcement (BNE) within 24 hours after the prescription is dispensed. BNE closely monitors all submitted prescriptions and their associated information. The integrity of the data is achieved through a variety of system edits, and it is the responsibility of the pharmacies to provide timely and accurate data.

Implications of the New York State PMP

Effective August 27, 2013, NYS prescribers are required to consult the Prescription Monitoring Program Registry prior to writing a prescription for Schedule II, III, and IV controlled substances. The PMP provides practitioners with direct, secure access to view dispensed controlled substance prescription histories for their patients. The PMP is available 24 hours a day/7 days a week via an application on the Health Commerce System (HCS). Patient reports will include all controlled substances that were dispensed in New York State and reported by the pharmacy/dispenser for the past year. This information will allow practitioners to better evaluate their patients' treatment with controlled substances and determine whether there may be abuse or non-medical use. In addition, pharmacists can also access the registry before dispensing the prescriptions for controlled substances.

Data exclusions

For all PMP indicators, several exclusions were applied. Prescriptions for out-of-state patients or without a valid patient’s NY ZIP code were removed from the analysis. Data from veterinarians and prescription drugs administered to animals were not included in the analysis of PMP data. Prescriptions filled for opioids that have supply days greater than 90 were eliminated from the analysis. Also, opioids not typically used in outpatient settings and cold formulations including elixirs, antitussives, decongestants, antihistamines and expectorants were not included in the analyses.

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Overdose deaths related to opioids in New York State by Region and County

Overdose death indicator descriptions and data sources
Indicator Definition ICD codes/detailed explanation Data Source
Overdose deaths involving any drug All drug poisoning deaths Underlying cause of death, determined from the field designated as such, or, where missing or unknown, from the first listed multiple cause of death field: X40-X44, X60-X64, X85, Y10-Y14 Vital Statistics
Overdose deaths involving any opioid Poisoning deaths involving any opioid, all manners, using all causes of death Underlying cause of death, determined from the field designated as such, or, where missing or unknown, from the first listed multiple cause of death field: X40-X44, X60-X64, X85, Y10-Y14 AND Any opioid in all other causes of death: T40.0, T40.1, T40.2, T40.3, T40.4, T40.6 Vital Statistics
Overdose deaths involving heroin Poisoning deaths involving heroin, all manners, using all causes of death Underlying cause of death, determined from the field designated as such, or, where missing or unknown, from the first listed multiple cause of death field: X40-X44, X60-X64, X85, Y10-Y14 AND Heroin in all other causes of death: T40.1 Vital Statistics
Overdose deaths involving any opioid pain reliever Poisoning deaths involving any opioid pain reliever, all manners, using all causes of death Underlying cause of death, determined from the field designated as such, or, where missing or unknown, from the first listed multiple cause of death field: X40-X44, X60-X64, X85, Y10-Y14 AND Any opioid pain relievers in all other causes of death: T40.2, T40.3, T40.4 Vital Statistics
Overdose deaths involving methadone Poisoning deaths involving methadone, all manners, using all causes of death Underlying cause of death, determined from the field designated as such, or, where missing or unknown, from the first listed multiple cause of death field: X40-X44, X60-X64, X85, Y10-Y14 AND Methadone in all other causes of death: T40.3 Vital Statistics
Overdose deaths involving any synthetic opioid other than methadone Poisoning deaths involving any synthetic opioid other than methadone, all manners, using all causes of death Underlying cause of death, determined from the field designated as such, or, where missing or unknown, from the first listed multiple cause of death field: X40-X44, X60-X64, X85, Y10-Y14 AND Methadone in all other causes of death: T40.4 Vital Statistics

Vital Statistics

New York State consists of two registration areas, New York City (NYC) and New York State Exclusive of New York City (also referred to as Rest of State). NYC includes the five counties of Bronx, Kings (Brooklyn), New York (Manhattan), Queens and Richmond (Staten Island); the remaining 57 counties comprise New York State Exclusive of NYC. The NYSDOH’s Bureau of Vital Records processes data from live birth, death, fetal death and marriage certificates recorded in New York State Exclusive of NYC. Through a cooperative agreement, the NYSDOH receives data on live births, deaths, and fetal deaths recorded in NYC from the New York City Department of Health and Mental Hygiene (NYCDOHMH) and on live births and deaths recorded outside of New York State to residents of New York State from other states and Canada.

Vital statistics mortality data include up to 20 causes of death. The mortality indicators presented here reflect all manners and all causes of death. Frequencies are based on decedents’ county of residence, not the county where death occurred. Vital Event indicators for NYC geographical areas reported by the NYSDOH and the NYCDOHMH are different because the former includes possibly all NYC residents' events, regardless of where they took place, and the latter reports events to NYC residents that took place in NYC. The indicators may also differ due to timing and/or completeness of data.

Opioid Overdose Deaths

The data presented here are county-specific opioid overdose death crude rates, organized by regions within New York State. Data are collected from death certificates. All deaths receive an ICD-9 code (before 1999) or an ICD-10 (1999 and later) indicating the underlying cause of the death, as well as up to 20 contributing causes. The codes and definitions used for opioid overdose are listed in the indicators description table. Opioid overdose deaths are based on county of residence. The source of the data is the New York State Department of Health Bureau of Biometrics and Health Statistics.

The accuracy of indicators based on codes found in vital statistics data is limited by the completeness and quality of reporting and coding. Death investigations may require weeks or months to complete; while investigations are being conducted, deaths may be assigned a pending status on the death certificate (ICD-10-CM underlying cause code of R99, “other ill-defined and unspecified causes of mortality”). Analysis of the percentage of death certificates with an underlying cause of death of R99 by age, over time, and by jurisdiction should be conducted to determine potential impact of incomplete underlying causes of death on drug overdose death indicators. Data may change as deaths are confirmed and reported.

The percentage of death certificates with information on the specific drug(s) involved in drug overdose deaths varies substantially by state and local jurisdiction, and may vary over time. The substances tested for, the circumstances under which the tests are performed, and how information is reported on death certificates may also vary. Drug overdose deaths that lack information about the specific drugs may have involved opioids. Even after a death is ruled as caused by a drug overdose, information on the specific drug might not be subsequently added to the certificate. Therefore, estimates of fatal drug overdoses involving opioids may be underestimated from lack of drug specificity. Additionally, deaths involving heroin might be misclassified as involving morphine (a natural opioid), because morphine is a metabolite of heroin.

Please note, the indicator: “Overdose deaths involving opioid pain relievers” includes overdose deaths due to pharmaceutically and illicitly produced naturally-occurring, semi-synthetic, and synthetic opioids such as codeine, oxycodone, and fentanyl. The indicator “Overdose deaths involving synthetic opioids other than methadone” includes overdose deaths due to pharmaceutically and illicitly produced synthetic opioids other than methadone, such as fentanyl.

The death rates are calculated per 100,000 population. Population estimates used for computing the death rates were obtained by the NYSDOH Bureau of Biometrics from the U.S. Census Bureau.

Opioid overdose mortality data are presented as tables, maps and graphs at the state and county level. Tables present three years of data and include for each county, the number of opioid overdose deaths for each of the three years, the total number of opioid overdose deaths for that three-year period, the average population of the three-year period and the three-year average annual opioid overdose death rate per 100,000 population. The crude death rate was calculated by dividing the total number of opioid overdose deaths for the three-year period by three to get the average number of opioid overdose deaths per year. The average number of opioid overdose deaths was then divided by the average population of the three-year period and multiplied by 100,000.

Within the table data, each county is linked to that specific county's three-year trend data. The trend data for each county is presented by a graph and table with single year and three-year average opioid overdose death rates. Also included, for comparison, are six years of opioid overdose death rates for NYC (if that county is within NYC) or death rates for New York State excluding NYC (if that county is outside of NYC).

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Opioid outpatient emergency department visits in New York State by region and county

Emergency department visits indicator descriptions and data sources
Indicator Definition ICD codes/detailed explanation Data Source
Outpatient emergency department visits involving any drug overdose Outpatient (not being admitted) emergency department visits involving any drug poisoning ICD-9-CM: 960-979; OR First-listed External Cause of Injury E850-E858; E950.0-E950.5; E962.0; E980.0-E980.5 SPARCS
Outpatient emergency department visits involving any opioid overdose Outpatient (not being admitted) emergency department visits involving any opioid poisoning, principal diagnosis or first-listed cause of injury ICD-9-CM: Principal Diagnosis: 9650, 96500, 96501, 96502, 96509 OR First-listed External Cause of Injury: E8500, E8501, E8502 SPARCS
Outpatient emergency department visits involving heroin overdose Outpatient (not being admitted) emergency department visits involving heroin poisoning, principal diagnosis or first-listed cause of injury ICD-9-CM: Principal Diagnosis: 96501 OR First-listed External Cause of Injury: E8500 SPARCS
Outpatient emergency department visits involving any opioid excluding heroin overdose Outpatient (not being admitted) emergency department visits involving any opioid poisoning except heroin, principal diagnosis or first-listed cause of injury ICD-9-CM: Principal Diagnosis: 9650, 96500, 96502, 96509 OR First-listed External Cause of Injury: E8501, E8502 SPARCS

Statewide Planning and Research Cooperative System - SPARCS

Health Care Facilities licensed in New York State, under Article 28 of the Public Health Law, are required to submit their inpatient and/or outpatient data to SPARCS. SPARCS is a comprehensive all payer data reporting system established in 1979 as a result of cooperation between the healthcare industry and government. The system was initially created to collect information on discharges from hospitals. SPARCS currently collects patient level detail on patient characteristics, diagnoses and treatments, services, and charges for hospitals, ambulatory surgical centers, and clinics, both hospital extension and diagnosis and treatment centers.

Per NYS Rules and Regulations, Section 400.18 of Title 10, this data is required to be submitted: (1) on a monthly basis, (2) 95% within 60 days following the end of the month of patients discharge/visit, and (3) 100% are due 180 days following the end of the month of the patient discharge/visit. Failure to comply may result in the issuance of Statement of Deficiencies (SODs) and facilities may be subject to a reimbursement rate penalty.

The accuracy of indicators, which are based on diagnosis codes (ICD-9-CM codes prior to Oct. 1, 2015 and ICD-10-CM on/after Oct. 1, 2015) reported in the data by the facilities, is limited by the completeness and quality of reporting and coding by the facilities. The indicators are defined based on the principal diagnosis code or first-listed valid external cause code only. The sensitivity and specificity of these indicators may vary by year, hospital location, and drug type. Changes should be interpreted with caution due to the change in codes used for the definition. Hospitalization, and ED data may change as hospitalizations and ED visits are confirmed and reported.

Opioid overdose emergency department visits

SPARCS collects information about ED visits through the patient discharge data system. Outpatient ED visits are events that did not result in admission to the hospital. Each outpatient emergency department (ED) visit receives an ICD-9-CM code (ICD-10-CM codes beginning Oct. 1, 2015) at discharge that indicates the primary reason for the occurrence. There are also a first-listed cause, external cause of injury, and up to 24 other diagnosis codes recorded to further describe the ED visits. The codes and definitions used for opioid overdose are listed in the indicators description table.

Statistics in these tables are based on the primary diagnosis and first-listed cause of injury unless otherwise noted. An individual can have more than one ED visit. Numbers and rates are based on the number of discharges and not on the number of individuals seen. The frequencies are based on patients' county of residence, not the county where the incident occurred. The frequencies do not include instances in which New York residents visited an ED located outside of New York State. For ED visits in which patient county of residence was listed as unknown or missing, but a valid New York ZIP code was present, county of residence was assigned based on ZIP code. For indicators related to the ED data, the numbers represent ED visits for opioid overdose patients who were not subsequently admitted into the hospital.

Population estimates used for computing the opioid overdose ED visit rates were obtained by the New York State Department of Health (NYSDOH) Bureau of Biometrics from the United States (U.S.) Census Bureau. Opioid overdose ED data are presented by total population and by various age groups.

Opioid overdose ED visit data are presented as tables, maps and graphs at the state and county level. Tables display the latest available opioid overdose ED visit data for a three-year time period. Tables include, for each county, the number of ED visits for each of the three years, the total number of ED visits for the three-year period, the average population of the three-year period and the three-year average annual crude opioid overdose ED visit rates per 100,000 population. The crude opioid overdose ED visit rate was calculated by dividing the total number of opioid overdose ED visits for the three-year period by three to get the average number of opioid overdose ED visits per year. The average number of opioid overdose ED visits was then divided by the average population of the three-year period and multiplied by 100,000.

Within the table data, each county is linked to that specific county's trend data. The trend data for each county are presented by a graph and table with single year and three-year average opioid overdose ED visit rates. Also included, for comparison, are ten years of opioid overdose ED visit rates for New York City (if that county resides within New York City) or opioid overdose ED visit rates for Upstate New York (if that county resides within Upstate New York).

County three-year average opioid ED visit rates for each age group are also presented. A bar graph plots age-specific county opioid ED visit rates for eight regions and the New York State total. The New York State map displays age-specific county opioid ED visit rates by quartile.

The SPARCS data do not include visits by people who sought care from hospitals outside of New York State, which may lower numbers and rates for some counties, especially those which border other states.

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Opioid hospital discharges in New York State by region and county

Hospital discharges indicator descriptions and data sources
Indicator Definition ICD codes/detailed explanation Data Source
Hospital discharges involving any drug overdose Hospital discharges involving any drug poisoning ICD-9-CM: 960-979; OR First-listed External Cause of Injury E850-E858; E950.0-E950.5; E962.0; E980.0-E980.5 SPARCS
Hospital discharges involving any opioid overdose Hospital discharges involving any opioid poisoning, principal diagnosis or first-listed cause of injury ICD-9-CM: Principal Diagnosis: 9650, 96500, 96501, 96502, 96509 OR First-listed External Cause of Injury: E8500, E8501, E8502 SPARCS
Hospital discharges involving heroin overdose Hospital discharges involving heroin poisoning, principal diagnosis or first-listed cause of injury ICD-9-CM: Principal Diagnosis: 96501 OR First-listed External Cause of Injury: E8500 SPARCS
Hospital discharges involving any opioid excluding heroin overdose Hospital discharges involving any opioid poisoning except heroin, principal diagnosis or first-listed cause of injury ICD-9-CM: Principal Diagnosis: 9650, 96500, 96502, 96509 OR First-listed External Cause of Injury: E8501, E8502
ICD-10-CM: Principal Diagnosis: T40.0, T40.2, T40.3, T40.4, T40.6 (Excludes ‘adverse effect’ or ‘underdosing’ as indicated by the values of 5 and 6 in the 6th character; and ‘sequela’ as indicated by the value of ‘S’ in the 7th character; e.g. T400X5S, T400X6S)
SPARCS
Neonatal abstinence syndrome Newborn with withdrawal syndrome or affected by narcotics via placenta or breast milk ICD-9-CM: Principal Diagnosis: V3 AND 779.5 or 760.72 in any other diagnoses SPARCS

Statewide Planning and Research Cooperative System - SPARCS

Health Care Facilities licensed in New York State, under Article 28 of the Public Health Law, are required to submit their inpatient and/or outpatient data to SPARCS. SPARCS is a comprehensive all payer data reporting system established in 1979 as a result of cooperation between the healthcare industry and government. The system was initially created to collect information on discharges from hospitals. SPARCS currently collects patient level detail on patient characteristics, diagnoses and treatments, services, and charges for hospitals, ambulatory surgical centers, and clinics, both hospital extension and diagnosis and treatment centers.

Per NYS Rules and Regulations, Section 400.18 of Title 10, this data is required to be submitted: (1) on a monthly basis, (2) 95% within 60 days following the end of the month of patients discharge/visit, and (3) 100% are due 180 days following the end of the month of the patient discharge/visit. Failure to comply may result in the issuance of Statement of Deficiencies (SODs) and facilities may be subject to a reimbursement rate penalty.

The accuracy of indicators, which are based on diagnosis codes (ICD-9-CM codes prior to Oct. 1, 2015 and ICD-10-CM on/after Oct. 1, 2015) reported in the data by the facilities, is limited by the completeness and quality of reporting and coding by the facilities. The indicators are defined based on the principal diagnosis code or first-listed valid external cause code only. The sensitivity and specificity of these indicators may vary by year, hospital location, and drug type. Changes should be interpreted with caution due to the change in codes used for the definition. Hospitalization, and ED data may change as hospitalizations and ED visits are confirmed and reported.

Opioid overdose hospital discharges

SPARCS collects information about hospitalizations through the patient discharge data system. Each hospitalization receives an ICD-9-CM code (ICD-10-CM codes beginning Oct. 1, 2015) at discharge that indicates the primary reason for the occurrence. There are also a first-listed cause, external cause of injury, and up to 24 other diagnosis codes recorded to further describe the hospitalization. The codes and definitions used for opioid overdose are listed in the indicators description table.

Statistics in these tables are based on the primary diagnosis and first-listed cause of injury unless otherwise noted. Newborn withdrawal syndrome and neonatal abstinence syndrome are based on primary diagnosis and all other diagnosis codes. An individual can have more than one hospitalization. Numbers and rates are based on the number of discharges and not on the number of individuals seen. The frequencies are based on patients' county of residence, not the county where the incident occurred. The frequencies do not include instances in which NY residents were admitted to hospitals located outside of New York State. For hospitalizations in which patient county of residence was listed as unknown or missing, but a valid NY ZIP code was present, county of residence was assigned based on ZIP code.

Population estimates used for computing the opioid overdose hospitalization rates were obtained by the New York State Department of Health (NYSDOH) Bureau of Biometrics from the United States (U.S.) Census Bureau. Opioid overdose hospitalization data are presented by total population and by various age groups.

Opioid overdose hospitalization data are presented as tables, maps and graphs at the state and county level. Tables display the latest available opioid overdose hospitalization data for a three-year time period. Tables include, for each county, the number of hospitalizations for each of the three years, the total number of hospitalizations for the three-year period, the average population of the three-year period and the three-year average annual crude opioid overdose hospitalization rates per 100,000 population. Tables for newborn withdrawal syndrome and neonatal abstinence syndrome provide the crude rates per 1,000 population. The crude opioid overdose hospitalization rate was calculated by dividing the total number of opioid overdose hospitalizations for the three-year period by three to get the average number of opioid overdose hospitalizations per year. The average number of opioid overdose hospitalizations was then divided by the average population of the three-year period and multiplied by 100,000 (or by 1,000 for newborn withdrawal syndrome and neonatal abstinence syndrome.

Within the table data, each county is linked to that specific county's trend data. The trend data for each county is presented by a graph and table with single year and three-year average opioid overdose hospitalization rates. Also included, for comparison, are ten years of opioid overdose hospitalization rates for New York City (if that county resides within New York City) or opioid overdose hospitalization rates for Upstate New York (if that county resides within Upstate New York).

County three-year average opioid hospitalization rates for each age group are also presented. A bar graph plots age-specific county opioid hospitalization rates for eight regions and the New York State total. The New York State map displays age-specific county opioid hospitalization rates by quartile.

The SPARCS data do not include discharges by people who sought care from hospitals outside of New York State, which may lower numbers and rates for some counties, especially those which border other states.

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The Youth Risk Behavior Surveillance System (YRBSS)

YRBSS prevalence indicator descriptions and data sources
Indicator Definition ICD codes/detailed explanation Data Source
Prevalence of injection drug use among high school students Percentage of respondents indicating that they had injected an illegal drug at least once in their lifetime Survey question: “During your lifetime, how many times have you used a needle to inject any illegal drug into your body?”
Responses: “A. 0 times B. 1 time C. 2 or more times”
YRBSS
Prevalence of heroin abuse among high school students Percentage of respondents indicating that they had used heroin Survey question: “During your life, how many times have you used heroin (also called smack, junk, or China White)?”
Responses: “A. 0 times B. 1 or 2 times C. 3 to 9 times D. 10 to 19 times E. 20 to 39 times F. 40 or more times”
YRBSS
Percentage of high school students who reported being offered, sold, or given illegal drugs Percentage of respondents indicating that they had been offered, sold, or given an illegal drug on school property in the past 12 months Survey question: “During the past 12 months, has anyone offered, sold, or given you an illegal drug on school property?”
Responses: “A. Yes B. No”
YRBSS

What is the YRBSS?

The YRBSS is a national survey of youth and young adults in the U.S. It was developed to monitor priority health risk behaviors that are often established in childhood and adolescence. The YRBSS had been conducted every two years since 1991 and surveys high school students on substance use, physical activity, dietary behaviors, sexual behaviors, and behaviors related to injuries and violence. The national survey is conducted by CDC and the state, territorial, tribal government, and local surveys are administered by departments of health and education.

What is its use?

Health departments use the data for a variety of purposes. Among those are to provide information on prevalence and trends in health behaviors, identify demographic variations in health-related behaviors, provide comparable data, and measure progress toward achieving state and national health objectives.

Who is covered in the YRBSS?

The health characteristics estimated from the YRBSS pertain only to 9th through 12th grade students in public and private schools in the U.S. A three-stage cluster sample design is employed to identify a nationally representative sample of 9th through 12th grade students. Primary sample units are used, schools are samples from the primary sample units, and intact classes of required subjects are identified and samples. All students enrolled in the sample classes can participate in the survey.

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The National Survey on Drug Use and Health (NSDUH)

NSDUH prevalence indicator descriptions and data sources
Indicator Definition ICD codes/detailed explanation Data Source
Prevalence of illicit drug use Percentage of respondents reporting use of illicit drugs in the
past month
Respondent answered “yes” to at least one question in a series about use of illicit drugs in the past 30 days. Illicit Drugs include marijuana/hashish, cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics used nonmedically, including data from original methamphetamine questions but not including new methamphetamine items added in 2005 and 2006. NSDUH
Prevalence of illicit drug use other than marijuana Percentage of respondents reporting use of illicit drugs other than marijuana in the past month Respondent answered “yes” to at least one question in a series about illicit drugs in the past 30 days, excluding marijuana. Illicit drugs other than marijuana include cocaine (including crack), heroin, hallucinogens, inhalants, or prescription-type psychotherapeutics used nonmedically, including data from original methamphetamine questions but not including new methamphetamine items added in 2005 and 2006. NSDUH
Prevalence of nonmedical pain reliever use Percentage of respondents reporting taking pain relievers in the past year in a manner other than how they were prescribed Survey question: “Have you ever, even once, used any pain relievers when they were not prescribed for you or that you took only for the experience or feeling they caused?” NSDUH
Prevalence of illicit drug dependence or abuse Percentage of respondents meeting the criteria for illicit drug dependence or abuse in the past year Survey asks about symptoms consistent with the DSM-IV definition of dependence and the DSM-IV definition of abuse. Respondents meet the criteria for dependence if they meet 3 of 6 criteria for a substance. Criteria for dependence: (1) spent a lot of time engaging in activities related to substance use, (2) used the substance in greater quantities or for a longer time than intended, (3) developed tolerance (i.e., needing to use the substance more than before to get desired effects or noticing that the same amount of substance use had ess effect than before), (4) made unsuccessful attempts to cut down on use, (5) continued substance use despite physical health or emotional problems associated with substance use, (6) reduced or eliminated participation in other activities because of substance use, and (7) experienced withdrawal symptoms. Criteria for abuse: (1) problems at work, home, and school; (2) doing something physically dangerous; (3) repeated trouble with the law; and (4) problems with family or friends because of use of alcohol or illicit drugs in the past 12 months. Respondents meet the criteria for abuse if they report one or more of these for a substance, and if the criteria for dependence is not met. NSDUH
Prevalence of illicit drug dependence Percentage of respondents meeting the criteria for illicit drug dependence in the past year Survey asks about symptoms consistent with the DSM-IV definition of dependence. Criteria for dependence: (1) spent a lot of time engaging in activities related to substance use, (2) used the substance in greater quantities or for a longer time than intended, (3) developed tolerance (i.e., needing to use the substance more than before to get desired effects or noticing that the same amount of substance use had less effect than before), (4) made unsuccessful attempts to cut down on use, (5) continued substance use despite physical health or emotional problems associated with substance use, (6) reduced or eliminated participation in other activities because of substance use, and (7) experienced withdrawal symptoms. Respondents meet the criteria for dependence if they meet 3 of 6 criteria for a substance. NSDUH

What is the NSDUH?

The National Survey on Drug Use and Health (NSDUH) is sponsored by the Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration (SAMHSA). SAMHSA is a division within the U.S. Department of Health and Human Services (HHS). It is an on-going data collection plan designed to provide national and state-level statistical information on the use of alcohol, tobacco, and illicit drugs, including the non-medical use of prescription drugs, in the U.S. The survey tracks trends in substance use and identifies at-risk groups. It also collects data on mental health, co-occurring substance use and mental disorders, and treatment.

What is its use?

Organizations and agencies use the data for a variety of purposes. The data are used to provide information on prevalence of substance use and abuse, identify patterns and trends in substance use, identify demographic variations in health-related behaviors, identify risk factors, and assess potential need for services.

Who is covered in the NSDUH?

The health characteristics estimated from the NSDUH pertain only to the civilian, noninstitutionalized population age 12 years and older. Approximately 70,000 individuals are interviewed. US households are randomly selected and an interviewer visits each selected household. One or two residents from each selected household may be interviewed and the interview is administered on a laptop computer. The questions are answered in private directly on to the laptop computer; for some items, the interviewer reads the question. Each survey participant is compensated with $30.

Why are the data for New York estimates?

The NSDUH uses a small area estimation procedure to provide state-level data. Data for two consecutive years are combined with county and census block/tract-level data to produce state estimates. This is a model-based methodology used by the NSDUH that allows for more precise estimates that those based solely on the sample where sample sizes are small.

Limitations

NSDUH estimates of substance use among adolescents have generally been lower than corresponding estimates from two school-based surveys: Monitoring the Future (MTF) and the Youth Risk Behavior Surveillance System (YRBSS) In December 2012, SAMHSA released a report, "Comparing and Evaluating Youth Substance Use Estimates from the National Survey on Drug Use and Health and Other Surveys," which explored some of the reasons for this. It is important to note that, although NSDUH has consistently shown lower prevalence rates than MTF and YRBSS, the trends have usually been parallel. Unlike, MTF and YRBSS, NSDUH conducts interviews in the adolescent's home. The SAMHSA report stated, "It is possible that conducting an interview in an adolescent's home environment has an inhibitory effect on adolescent substance users' willingness to report use, even if parents or other household members are not in the same room as the adolescent and are not able to see how adolescents are answering the substance use questions."

The SAMHSA report noted that factors besides interview privacy also could contribute to lower estimates of adolescent substance use in NSDUH than in MTF or YRBSS. These other factors include the focus of the survey (e.g., primary focus on substance use or on broader health topics), how prominently substance use is mentioned when a survey is presented to parents and adolescents, procedures for obtaining parental permission for their children to be interviewed, assurances of anonymity or confidentiality, the placement and context of substance use questions in the interview, the survey mode (e.g., computer-assisted interviewing with skip patterns or paper-and-pencil questionnaires), and the question structure and wording.

For example, NSDUH asks filter questions about lifetime use before asking about the most recent use of a substance or the frequency of use. Research has shown that filter questions can depress the reporting of certain behaviors. Some NSDUH respondents also may realize early during their interview that if they answer "no" to the initial filter questions about lifetime substance use, they can avoid having to answer subsequent questions and therefore will finish the interview in less time. The YRBSS questionnaire does not have these kinds of skip patterns, and the MTF questionnaire uses skip patterns minimally. In addition, students taking a survey in a classroom administration setting may not be motivated to finish sooner if they otherwise have to stay until the end of the class period.

References

  1. Klein RJ, Schoenborn CA. Age adjustment using the 2000 projected U.S. population. Healthy People Statistical Notes, no. 20. Hyattsville, Maryland: National Center for Health Statistics. January 2001. (see: www.cdc.gov/nchs/data/statnt/statnt20.pdf)
  2. About Age Adjusted Rates, 95% Confidence Intervals and Unstable Rates (see: www.health.ny.gov/statistics/cancer/registry/age.htm)