Deaths from drug overdoses have risen steadily over the past two decades and have become the leading cause of injury death in the United States. Prescription drugs, especially opioids, have been increasingly implicated in drug overdose deaths over the last decade. In response to recent increases in opioid-related morbidity and mortality, the U.S. Department of Health and Human Services (HHS) has made addressing the opioid abuse problem a high priority. HHS is focused on implementing evidence-based approaches to reduce opioid overdoses and overdose-related mortality and the prevalence of opioid use disorder.
HHS's initiative focuses on three priority areas to combat opioid abuse:
AHRQ is increasing the evidence base on this topic with data and research and provides a forum where communities can share their tools for combating the issue of opioid misuse.
Our interactive map allows users to explore State-specific information about opioid-related hospital stays, including trends in hospitalization rates broken down by sex, income and geographic area. For example:
The map, which includes information about 44 States and the District of Columbia, highlights data from AHRQ's Fast Stats, an online tool that offers national and state-specific data on hospital stays and emergency department visits, including data by age, gender, community-level income and urban versus rural residency.
While opioid-related hospitalizations have increased in many communities, the trend is particularly striking in low-income communities and in small metropolitan geographical areas, according to a new AHRQ Healthcare Cost and Utilization Project Statistical Brief #226: Patient Residence Characteristics of Opioid-Related Inpatient Stays and Emergency Department Visits Nationally and by State, 2014. Hospitalizations increased 65 percent in the lowest-income areas and more than 70 percent in the second lowest-income areas, and the increase was more than 120 percent for small metropolitan areas (counties with 50,000 to 249,000 people). The data highlight the rates of opioid-related hospitalizations and emergency department visits according to patient location and community-level income from 2005 to 2014.
Hospitalizations involving opioid pain relievers and heroin increased 75 percent for women between 2005 and 2014, a jump that significantly outpaced the 55-percent increase among men, according to Statistical Brief #224, Patient Characteristics of Opioid-Related Inpatient Stays and Emergency Department Visits Nationally and by State, 2014, an AHRQ report that provides the most current national rates on opioid-related hospitalizations and emergency department visits, also includes data that illustrate wide variation by State. Because of the accelerated rates among women during that 10-year period, women and men were hospitalized at virtually the same rate nationwide in 2014 – about 225 hospitalizations per 100,000 people, according to AHRQ's analysis.
Related AHRQ Views Blog: Shining a Spotlight on the Opioid Crisis Through the Power of Data
Related infographic: Women Have Higher Rates of Opioid-Related Hospitalizations In Most States
Opioid-related hospital stays involving prescription opioids or illicit opioids such as heroin increased nationwide by 64 percent between 2005 and 2014, according to Statistical Brief #219, Opioid-Related Hospital Stays and Emergency Department Visits by State, 2009–2014, an AHRQ report that provides insights into the Nation's costly opioid epidemic. The report summarizes State-specific data, provides trends over time, and identifies the States with the highest and lowest rates of opioid-related hospital stays in 2014, the most current year available. For example, in 2014, the District of Columbia, Maryland, Massachusetts, New York, Rhode Island and West Virginia each reported rates exceeding 350 per 100,000 people—far above the national average of 225 per 100,000.
Related AHRQ Views Blog: AHRQ Data Prove What Every Hospital Knows: Opioid Stays Are Going Up
Related infographic: Opioids’ Burden on Hospital Care: A State-by-State Comparison
The rate of hospitalizations for overuse of pain medications has increased more than 150 percent since 1993, according to Statistical Brief #177, Hospital Inpatient Utilization Related to Opioid Overuse Among Adults, 1993–2012, an AHRQ report from the Healthcare Cost and Utilization Project that found that the rate of hospital stays involving opioid overuse among adults increased from 116.7 to 295.6 stays per 100,000 population from 1993 to 2012.
The authors found that hospitalization rates were climbing among every adult age group and in every region of the country, making the problem more uniformly widespread than has previously been observed. The most significant increases in rates were among women, people living in the Midwest, and people 45 and older. The data also show that in 1993, Medicaid was billed for more than twice as many hospitalizations involving opioid overuse as any other payer, but by 2012 these differences diminished, and the largest increase was seen for discharges billed to Medicare.
Related AHRQ Views Blog: AHRQ Data Reveal Wider Impact of Opioid Overuse.
Trends in Prescribed Outpatient Opioid Use and Expenses in the U.S. Civilian Noninstitutionalized Population, 2002–2012, a statistical brief from AHRQ's Medical Expenditure Panel Survey, examines trends in the number of persons purchasing at least one outpatient prescription opioid, and total expenses and total number of prescriptions, as well as average annual cost per person and total and average out-of-pocket costs for the U.S. civilian noninstitutionalized population from 2002 through 2012. The brief finds that:
Research Needed To Determine Best Medication-Assisted Treatment Models of Care for Opioid Use Disorder in Primary Care Settings
"Medication-Assisted Treatment Models of Care for Opioid Use Disorder in Primary Care Settings," a Technical Brief in AHRQ's Effective Health Care Program, examined 12 promising and innovative medication-assisted treatment (MAT) models of care in primary care settings, described barriers to MAT implementation, summarized the evidence available on MAT models of care in primary care settings, identified gaps in the evidence base, and provided guidance for future research. The models of care presented may help inform the individualized implementation of MAT models of care in different primary care settings.
Innovations include the use of designated non-physician staff for the key integration/coordination role; centralized intake and stabilization of patients with ongoing management in community settings; screening and induction performed in alternate settings (emergency department, prenatal setting) with subsequent referral to community settings; community-based stakeholder engagement to develop practice standards and improve quality of care; and use of Internet-based learning networks. Key barriers to implementation of MAT models of care include stigma, lack of institutional support, lack of prescribing physicians, lack of expertise, and inadequate reimbursement.
AHRQ is investing about $12 million over 3 years in a series of grants to discover how to best support primary care practices and rural communities in delivering MAT for opioid abuse in rural primary care practices. AHRQ-funded projects will explore and test solutions aimed at overcoming barriers to the use of MAT in rural primary care settings, such as limited continuing training opportunities for prescribing physicians, negative perceptions about people with substance abuse disorders, negative expectations about the effectiveness of treatment, and lack of social support services in rural communities.
Practices involved in the initiative will provide access to MAT to more than 20,000 individuals struggling with opioid addiction using innovative technology, including patient-controlled smart phone apps and remote training and expert consultation using Project ECHO—a telehealth program started with AHRQ support that links specialists at an academic hub to primary care providers working on the frontlines in rural communities.
AHRQ has awarded grants to:
AHRQ's Innovations Exchange features several innovations aimed at reducing opioid misuse and associated health and safety consequences. The initiatives include an opioid overdose education and naloxone distribution program targeting high-risk communities, a mayoral task force in New York City that developed a series of strategies to combat the problem, an emergency department that implemented a protocol on the use of controlled substances, and a program to promote appropriate prescribing and monitoring of opioid therapy for patients with chronic pain not caused by cancer.
AHRQ's Innovations Exchange also offers a toolkit with resources for first responders, prescribers, patients, family members, and those who are recovering from opioid overdose; guidelines to help clinicians make treatment decisions for patients who may be abusing opioids; a manual on the development of overdose prevention programs; and a guide that supports implementation of overdose prevention and response strategies.