1. NAPHSIS Annual Meeting 2014Slide 1 NAPHSIS ANNUAL MEETING | Seattle | June 8-11, 2014 VITAL RECORDS: A CULTURE OF QUALITY Washington State’s approach to improving data on narcotic related deaths and prevention Amy Poel, PhC & Jennifer Sabel, PhD

2. NAPHSIS Annual Meeting 2014Slide 2 Overview WA drug poisoning mortality trends Deaths by specific drugs & combos Limitations of ICD-10 coding History of WA opioid methodology WA opioid methods Resulting data Prevention strategies

3. NAPHSIS Annual Meeting 2014Slide 3 Drug Poisoning Mortality Trends WA, 1999-2012

4. NAPHSIS Annual Meeting 2014Slide 4 Specific Drugs on Death Certificates WA, 2012 Drug Overdose Deaths

5. NAPHSIS Annual Meeting 2014Slide 5 Numbers of Drugs on Death Certificates WA, 2012, Drug Overdose Deaths

6. NAPHSIS Annual Meeting 2014Slide 6 Limitations of ICD-10 Coding Drug specificity sometimes unclear – T40.6 = Other and unspecified narcotics – T50.9 = Other and unspecified drugs General drug categories Prescription vs. illicit drugs not always clear

7. NAPHSIS Annual Meeting 2014Slide 7 History of WA Opioid Methodology Participation in 2004 11-state MMWR highlighted ICD coding limitations Workers compensation program interested in opioid deaths Interest from state nosologist & injury program

8. NAPHSIS Annual Meeting 2014Slide 8 Query Program Morphine – “Was the morphine heroin or pharmaceutical?” Drug/Opiate – “Please provide the name of the drug” – “Please provide the name of the opiate” 2010 67 queries 2010 67 queries 2011 3 queries 2011 3 queries 2012 9 queries 2012 9 queries 2013 1 query 2013 1 query

9. NAPHSIS Annual Meeting 2014Slide 9 WA Opioid Methodology: Starting Point WA resident ICD-10 T400-T404, T406, F11 – Multiple cause of death fields Manner of death: natural, accident, undetermined

10. NAPHSIS Annual Meeting 2014Slide 10 WA Opioid Methodology “morphine or heroin”=>morphine “morphine” and “opiate”-manually reviewed for medication/pharmaceutical terms All deaths not coded as accidental poisonings (X40-X49) manually reviewed and assigned to accidental poisoning category if there were overdose terms

11. NAPHSIS Annual Meeting 2014Slide 11 Resulting Data

12. NAPHSIS Annual Meeting 2014Slide 12 Comparing Toxicology Results and ICD coding King County, 2012 Drug Type# of Deaths with Drug Present in Toxicology Results # of Deaths with appropriate T code Sensitivity Benzodiazepine595288.1% Cocaine434195.3% Heroin*797392.4% Methadone47 100.0% Methamphetamine333297.0% Opioid Analgesics*434297.7% * There were 9 cases where ‘pharmaceutical morphine’ is listed on the death certificate that were placed into the Opioid Analgesics category instead of Heroin.

13. NAPHSIS Annual Meeting 2014Slide 13 WA Prevention Strategies Clinical prescribing guidelines & rules Emergency department prescribing guidelines & sharing of patient data Medicaid ‘lock-in’ program Prescription drug monitoring program Good Samaritan Law & overdose education Prescription drug take back program

14. NAPHSIS Annual Meeting 2014Slide 14 NAPHSIS ANNUAL MEETING| Seattle | June 8-11, 2014 VITAL RECORDS: A CULTURE OF QUALITY Thank You Amy PoelJennifer Sabel Amy.poel@doh.wa.govJennifer.sabel@doh.wa.gov 360-236-4326360-236-2865