scholarly journals Going Beyond Chief Complaints to Identify Opioid-Related Emergency Department Visits

2017 ◽  
Vol 9 (1) ◽  
Author(s):  
Andrew Walsh
Keyword(s):  
Public Health ◽  
Emergency Department ◽  
Public Health Intervention ◽  
The United States ◽  
Emergency Department Visits ◽  
Opioid Use ◽  
Syndromic Surveillance System ◽  
Discharge Disposition ◽  
Chief Complaints ◽  
Ed Visits

ObjectiveTo identify heroin- and opioid-related emergency department visitsusing pre-diagnositc data. To demonstrate the value of clinical notesto public health surveillance and situational awareness.IntroductionOverdoses of heroin and prescription opioids are a growingcause of mortality in the United States. Deaths from opioids havecontributed to a rise in the overall mortality rate of middle-aged whitemales during an era when other demographics are experiencing lifeexpectancy gains.1 A successful public health intervention to reversethis mortality trend requires a detailed understanding of whichpopulations are most affected and where those populations live. Whilemortality is the most relevant metric for this emerging challenge,increased burden on laboratory facilities can create significantdelays in obtaining confirmation of which patients died from opioidoverdoses.Emergency department visits for opioid overdoses can provide amore timely proxy measure of overall opioid use. Unfortunately, chiefcomplaints do not always contain an indication of opioid involvement.Overdose patients are not always conscious at registration whichlimits the amount of information they can provide. Menu-drivenregistration systems can lump all overdoses together regardless ofsubstance. A more complete record of the emergency departmentinteraction, such as that provided by triage notes, could provide theinformation necessary to differentiate opioid-related visits from otheroverdoses.MethodsEmergency department registration data was collected fromhospitals via the EpiCenter syndromic surveillance system. Thisdata included chief complaints, triage notes, discharge disposition,and preliminary diagnosis codes. Data elements were linked across agiven visit using patient identifiers and visit numbers as appropriate.Heroin- and opioid-related indicators were identified in chiefcomplaints and triage notes using regular expressions. These wereseparated into three categories: visits with an indication of overdose,visits for withdrawal symptoms, and visits where opioids werementioned in some other context such as history of use. Thesecategories were designed to be mutually exclusive.Regular expression classification results were compared toclassifications based on opioid-related diagnosis codes.ResultsA total of 2,934,610 ED registrations with triage notes and diagnosiscodes were collected from 82 hospitals between January 1, 2015 andAugust 21, 2016. Of these encounters, 24,012 referenced opioid usein some way; 16,718 mentioned heroin specifically; 3,663 mentionedfentanyl specifically; and 5,350 mentioned opioids generically.Table 1 shows the distribution of heroin-related ED visits acrosscategories and source of the indicator. Column totals are not the sumof individual row amounts; they have been adjusted so that a givenregistration is only counted once.Table 2 shows the overlap of heroin-related ED visits betweensources of indicators. Triage notes showed the least overlap with theother two sources, while chief complaints showed the most.ConclusionsWhile it is possible to find indicators of opioid use or overdosein chief complaint data, that field alone does not provide totalinformation about which ED visits are related to opioids. Triagenotes in particular indicate opioid involvement in a large numberof visits not identified by other data sources. While many of theseare simply mentions of opioids, possibly indicating past history ofuse or even in some cases just that questions about opioid use wereasked, a substantial number of visits with overdose indicators werealso detected solely from triage note data. These results suggest thattriage notes can be a valuable additional data source for more complexhealth concerns such as opioid drug use.Table 1: Heroin-Related ED Visits By Indicator Source and CategoryTable 2: Overlap of Heroin-Related ED Visits between Indicators

scholarly journals Assessing Prior Pain Visits and Medical History Risk Factors for Opioid Overdose

2018 ◽  
Vol 10 (1) ◽  
Author(s):  
Andrew Walsh
Keyword(s):  
Emergency Department ◽  
Logistic Regression ◽  
Odds Ratio ◽  
The United States ◽  
Emergency Department Visits ◽  
Specific Patient ◽  
Syndromic Surveillance System ◽  
Chief Complaints ◽  
History Of ◽  
Ed Visits

Objective: Identifying text features of emergency department visits associated with risk of future drug overdose.Introduction: Opioid overdoses are a growing cause of mortality in the United States.1 Medical prescriptions for opioids are a risk factor for overdose2. This observation raises concerns that patients may seek multiple opioid prescriptions, possibly increasing their overdose risk. One route for obtaining those prescriptions is visiting the emergency department (ED) for pain-related complaints. Here, two hypotheses related to prescription seeking and overdoses are tested. (1) Overdose patients have a larger number of prior ED visits than matched controls. (2) Overdose patients have distinct patterns of pain-related complaints compared to matched controls.Methods: ED registrations were collected via the EpiCenter syndromic surveillance system. Regular expression searches on chief complaints identified overdose visits. Overdose visits were matched with control visits from the same facility with maximal similarity of gender, age, home location and arrival time.A year of prior ED visits for cases and controls were matched using facility-specific patient identifiers or birthdate, gender and home location.Patient history chief complaints were sanitized to standardize spelling, expand abbreviations and consolidate phrases. Word frequency comparisons between groups identified candidate terms for modeling.Odds ratios of patient history terms were calculated with univariate logistic regression. Multivariate lasso logistic regression selected covariates for prediction. These models were fit to data from one quarter and cutoffs for covariate inclusion were validated on the following quarter’s data. Model predictions were validated on a 1% sample of ED registrations from the next quarter.Results: Quarter three of 2016 yielded 23,769 overdose ED visits and matching controls; quarter four yielded 21,957 pairs; and 15,824 ED visits were sampled from the first quarter of 2017 including 130 overdose visits.Contrary to expectations, patients in the control group averaged 0.7 additional ED visits in the prior year relative to controls; this pattern was consistent across quarters and regardless of how prior visits were matched (Fig 1).Prior visits for various pain categories were also more common among control patients than overdose patients (e.g. odds ratio for “back pain”: 0.78). Terms associated with drug use (e.g. “detox” odds ratio: 2.66) and mental health concerns (e.g. “psychological” odds ratio: 4.28) were most consistently overrepresented in the history of overdose patients (Table 1). Terms associated with chronic disease were most overrepresented in the history of control patients (Table 2).The best predictive model achieved a sensitivity of 57% and a specificity of 86% on test data (Fig 2).Conclusions: While a history of more overall ED visits and more ED visits related to pain were not associated with overdose ED visits, vocabulary of prior ED visits did predict future overdose ED visits. Performance of predictive models exceeded expectations, given the relative scarcity of overdoses among ED visits and the simplicity of chief complaints used for prediction. The correlation between past and future overdose visits highlights the need for targeted intervention to break addiction cycles.

scholarly journals Emergency Department Visits and Trends Related to Cocaine, Psychostimulants, and Opioids in the United States, 2008-2018

2021 ◽  
Author(s):  
Leslie W. Suen ◽  
Thibaut Davy-Mendez ◽  
Kathy T. LeSaint ◽  
Elise D. Riley ◽  
Phillip Coffin
Keyword(s):  
Emergency Department ◽  
Drug Toxicity ◽  
The United States ◽  
Emergency Department Visits ◽  
Opioid Use ◽  
Stimulant Use ◽  
Care Survey ◽  
Ed Visits ◽  
Nationally Representative ◽  
Psychiatric Complications

Abstract Background Drug-related emergency department (ED) visits are escalating, especially for stimulant use (i.e., cocaine and psychostimulants such as methamphetamine). We sought to characterize rates, presentation, and management of US ED visits related to cocaine and psychostimulant use, compared to opioid use. Methods We used 2008–2018 National Hospital Ambulatory Medical Care Survey data to identify a nationally representative sample of ED visits related to cocaine and psychostimulant use, with opioids as the comparator. We excluded visits related to ≥2 of the three possible drug categories. We estimated annual rate trends using unadjusted Poisson regression; described demographics, presenting concerns, and management; and determined associations between drug-type and presenting concerns (categorized as psychiatric, neurologic, cardiopulmonary, and drug toxicity/withdrawal) using logistic regression, adjusting for age, sex, race/ethnicity, and homelessness. Results Cocaine-related ED visits did not significantly increase, while psychostimulant-related ED visits increased from 2008 to 2018 (2.2 visits per 10,000 population to 12.9 visits per 10,000 population; p < 0.001). Cocaine-related ED visits had higher usage of cardiac testing, while psychostimulant-related ED visits had higher usage of chemical restraints than opioid-related ED visits. Cocaine- and psychostimulant-related ED visits had greater odds of presenting with cardiopulmonary concerns (cocaine adjusted odds ratio [aOR] 2.95, 95% CI 1.70–5.13; psychostimulant aOR 2.46, 95% CI 1.42–4.26), while psychostimulant-related visits had greater odds of presenting with psychiatric concerns (aOR 2.69; 95% CI 1.83–3.95) and lower odds of presenting with drug toxicity/withdrawal concerns (aOR 0.47, 95%CI 0.30–0.73) compared to opioid-related ED visits. Conclusion Presentations for stimulant-related ED visits differ from opioid-related ED visits: compared to opioids, ED presentations related to cocaine and psychostimulants are less often identified as related to drug toxicity/withdrawal and more often require interventions to address acute cardiopulmonary and psychiatric complications.

scholarly journals Characterizing and Forecasting Emergency Department Visits Related to COVID-19 Using Chief Complaints and Discharge Diagnoses

2020 ◽  
Author(s):  
Phillip Koshute ◽  
Rekha Holtry ◽  
Richard Wojcik ◽  
Wayne Loschen ◽  
Sheri Lewis
Keyword(s):  
Public Health ◽  
Emergency Department ◽  
The United States ◽  
Emergency Department Visits ◽  
Logistic Growth ◽  
National Capital Region ◽  
Local Public Health ◽  
Health Authorities ◽  
Public Health Authorities ◽  
Ed Visits

AbstractIn response to the unprecedented public health challenge posed by the SARS CoV-2 virus (COVID-19) in the United States, we and our colleagues at the Johns Hopkins University Applied Physics Laboratory (JHU/APL) have developed a model of COVID-19 progression using emergency department (ED) visit data from the National Capital Region (NCR). We obtained ED visits counts through targeted queries of the NCR Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE). To focus on ED visits by COVID-19 patients, we adjusted the query results for typical ED visit volumes and for reductions in ED volumes due to COVID-19 precautions. With these ED visit data, we fitted a logistic growth model to characterize and forecast the increase in cumulative COVID-19 ED visits. Our model achieves the best fit when we assume that the first NCR visit occurred in early January. We estimate that approximately 15,000 COVID-19 ED visits occurred prior to May 2020 and that approximately 17,000 more visits will occur in subsequent months. We plan to deploy an operational pilot of this model in the NCR ESSENCE environment, assisting local public health authorities as they brace for a second wave of COVID-19. Additionally, we will iteratively assess potential model refinements, aiming to maximize our model’s relevance for local public health authorities’ situational awareness and decision-making.

scholarly journals Interrupted time series design to evaluate ICD-9-CM to ICD-10-CM coding changes on trends in Colorado emergency department visits related to traumatic brain injury

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Lauren Alexis De Crescenzo ◽  
Barbara Alison Gabella ◽  
Jewell Johnson
Keyword(s):  
Public Health ◽  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Interrupted Time Series ◽  
Emergency Department Visits ◽  
Control And Prevention ◽  
Icd 10 ◽  
Ed Visits ◽  
The Impact

Abstract Background The transition in 2015 to the Tenth Revision of the International Classification of Disease, Clinical Modification (ICD-10-CM) in the US led the Centers for Disease Control and Prevention (CDC) to propose a surveillance definition of traumatic brain injury (TBI) utilizing ICD-10-CM codes. The CDC’s proposed surveillance definition excludes “unspecified injury of the head,” previously included in the ICD-9-CM TBI surveillance definition. The study purpose was to evaluate the impact of the TBI surveillance definition change on monthly rates of TBI-related emergency department (ED) visits in Colorado from 2012 to 2017. Results The monthly rate of TBI-related ED visits was 55.6 visits per 100,000 persons in January 2012. This rate in the transition month to ICD-10-CM (October 2015) decreased by 41 visits per 100,000 persons (p-value < 0.0001), compared to September 2015, and remained low through December 2017, due to the exclusion of “unspecified injury of head” (ICD-10-CM code S09.90) in the proposed TBI definition. The average increase in the rate was 0.33 visits per month (p < 0.01) prior to October 2015, and 0.04 visits after. When S09.90 was included in the model, the monthly TBI rate in Colorado remained smooth from ICD-9-CM to ICD-10-CM and the transition was no longer significant (p = 0.97). Conclusion The reduction in the monthly TBI-related ED visit rate resulted from the CDC TBI surveillance definition excluding unspecified head injury, not necessarily the coding transition itself. Public health practitioners should be aware that the definition change could lead to a drastic reduction in the magnitude and trend of TBI-related ED visits, which could affect decisions regarding the allocation of TBI resources. This study highlights a challenge in creating a standardized set of TBI ICD-10-CM codes for public health surveillance that provides comparable yet clinically relevant estimates that span the ICD transition.

scholarly journals Use of Emergency Department Data to Monitor and Respond to an Increase in Opioid Overdoses in New Hampshire, 2011-2015

2017 ◽  
Vol 132 (1_suppl) ◽  
pp. 73S-79S ◽  
Author(s):  
Elizabeth R. Daly ◽  
Kenneth Dufault ◽  
David J. Swenson ◽  
Paul Lakevicius ◽  
Erin Metcalf ◽  
...  
Keyword(s):  
Public Health ◽  
Emergency Department ◽  
New Hampshire ◽  
Syndromic Surveillance ◽  
Situational Awareness ◽  
The United States ◽  
Chief Complaint ◽  
Public Health Response ◽  
Syndromic Surveillance System ◽  
Icd Codes

Objectives: Opioid-related overdoses and deaths in New Hampshire have increased substantially in recent years, similar to increases observed across the United States. We queried emergency department (ED) data in New Hampshire to monitor opioid-related ED encounters as part of the public health response to this health problem. Methods: We obtained data on opioid-related ED encounters for the period January 1, 2011, through December 31, 2015, from New Hampshire’s syndromic surveillance ED data system by querying for (1) chief complaint text related to the words “fentanyl,” “heroin,” “opiate,” and “opioid” and (2) opioid-related International Classification of Diseases ( ICD) codes. We then analyzed the data to calculate frequencies of opioid-related ED encounters by age, sex, residence, chief complaint text values, and ICD codes. Results: Opioid-related ED encounters increased by 70% during the study period, from 3300 in 2011 to 5603 in 2015; the largest increases occurred in adults aged 18-29 and in males. Of 20 994 total opioid-related ED visits, we identified 18 554 (88%) using ICD code alone, 690 (3%) using chief complaint text alone, and 1750 (8%) using both chief complaint text and ICD code. For those encounters identified by ICD code only, the corresponding chief complaint text included varied and nonspecific words, with the most common being “pain” (n = 3335, 18%), “overdose” (n = 1555, 8%), “suicidal” (n = 816, 4%), “drug” (n = 803, 4%), and “detox” (n = 750, 4%). Heroin-specific encounters increased by 827%, from 4% of opioid-related encounters in 2011 to 24% of encounters in 2015. Conclusions: Opioid-related ED encounters in New Hampshire increased substantially from 2011 to 2015. Data from New Hampshire’s ED syndromic surveillance system provided timely situational awareness to public health partners to support the overall response to the opioid epidemic.

Emergency Department Visits due to Scabies in the United States: A Retrospective Analysis of a Nationally Representative Emergency Department Sample

2019 ◽  
Author(s):  
Raghav Tripathi ◽  
Konrad D Knusel ◽  
Harib H Ezaldein ◽  
Jeremy S Bordeaux ◽  
Jeffrey F Scott
Keyword(s):  
United States ◽  
Emergency Department ◽  
Retrospective Analysis ◽  
The United States ◽  
Cost Of Care ◽  
Emergency Department Visits ◽  
Limited Information ◽  
Targeted Interventions ◽  
Ed Visits ◽  
Nationally Representative

Abstract Background Limited information exists regarding the burden of emergency department (ED) visits due to scabies in the United States. The goal of this study was to provide population-level estimates regarding scabies visits to American EDs. Methods This study was a retrospective analysis of the nationally representative National Emergency Department Sample from 2013 to 2015. Outcomes included adjusted odds for scabies ED visits, adjusted odds for inpatient admission due to scabies in the ED scabies population, predictors for cost of care, and seasonal/regional variation in cost and prevalence of scabies ED visits. Results Our patient population included 416 017 218 ED visits from 2013 to 2015, of which 356 267 were due to scabies (prevalence = 85.7 per 100 000 ED visits). The average annual expenditure for scabies ED visits was $67 125 780.36. The average cost of care for a scabies ED visit was $750.91 (±17.41). Patients visiting the ED for scabies were most likely to be male children from lower income quartiles and were most likely to present to the ED on weekdays in the fall, controlling for all other factors. Scabies ED patients that were male, older, insured by Medicare, from the highest income quartile, and from the Midwest/West were most likely to be admitted as inpatients. Older, higher income, Medicare patients in large Northeastern metropolitan cities had the greatest cost of care. Conclusion This study provides comprehensive nationally representative estimates of the burden of scabies ED visits on the American healthcare system. These findings are important for developing targeted interventions to decrease the incidence and burden of scabies in American EDs.

scholarly journals Emergency Department Visits for Opioid Overdoses Among Patients With Cancer

2019 ◽  
Vol 112 (9) ◽  
pp. 938-943 ◽  
Author(s):  
Vikram Jairam ◽  
Daniel X Yang ◽  
James B Yu ◽  
Henry S Park
Keyword(s):  
At Risk ◽  
Emergency Department ◽  
Statistical Tests ◽  
Temporal Trends ◽  
The United States ◽  
Emergency Department Visits ◽  
Multivariable Logistic Regression Analysis ◽  
Opioid Overdose ◽  
Patients With Cancer ◽  
Ed Visits

Abstract Background Patients with cancer may be at risk of high opioid use due to physical and psychosocial factors, although little data exist to inform providers and policymakers. Our aim is to examine overdoses from opioids leading to emergency department (ED) visits among patients with cancer in the United States. Methods The Healthcare Cost and Utilization Project Nationwide Emergency Department Sample was queried for all adult cancer-related patient visits with a primary diagnosis of opioid overdose between 2006 and 2015. Temporal trends and baseline differences between patients with and without opioid-related ED visits were evaluated. Multivariable logistic regression analysis was used to identify risk factors associated with opioid overdose. All statistical tests were two-sided. Results Between 2006 and 2015, there were a weighted total of 35 339 opioid-related ED visits among patients with cancer. During this time frame, the incidence of opioid-related ED visits for overdose increased twofold (P &lt; .001). On multivariable regression (P &lt; .001), comorbid diagnoses of chronic pain (odds ratio [OR] 4.51, 95% confidence interval [CI] = 4.13 to 4.93), substance use disorder (OR = 3.54, 95% CI = 3.28 to 3.82), and mood disorder (OR = 3.40, 95% CI = 3.16 to 3.65) were strongly associated with an opioid-related visit. Patients with head and neck cancer (OR = 2.04, 95% CI = 1.82 to 2.28) and multiple myeloma (OR = 1.73, 95% CI = 1.32 to 2.26) were also at risk for overdose. Conclusions Over the study period, the incidence of opioid-related ED visits in patients with cancer increased approximately twofold. Comorbid diagnoses and primary disease site may predict risk for opioid overdose.

scholarly journals Rising Trends in Emergency Department Visits Associated With Hepatitis C Virus Infection in the United States, 2006-2014

2019 ◽  
Vol 134 (6) ◽  
pp. 685-694
Author(s):  
Shaoman Yin ◽  
Laurie Barker ◽  
Eyasu H. Teshale ◽  
Ruth B. Jiles
Keyword(s):  
United States ◽  
Emergency Department ◽  
Hepatitis C ◽  
Baby Boomers ◽  
The United States ◽  
Emergency Department Visits ◽  
Medicare Beneficiaries ◽  
Compensated Cirrhosis ◽  
Ed Visits ◽  
Medicaid Beneficiaries

Objective: Emergency departments (EDs) are critical settings for hepatitis C care in the United States. We assessed trends and characteristics of hepatitis C–associated ED visits during 2006-2014. Methods: We used data from the 2006-2014 Nationwide Emergency Department Sample to estimate numbers, rates, and costs of hepatitis C–associated ED visits, defined by either first-listed diagnosis of hepatitis C or all-listed diagnosis of hepatitis C. We assessed trends by demographic characteristics, liver disease severity, and patients’ disposition by using joinpoint analysis, and we calculated the average annual percentage change (AAPC) from 2006 to 2014. Results: During 2006-2014, the rate per 100 000 visits of first-listed and all-listed hepatitis C–associated ED visits increased significantly from 10.1 to 25.4 (AAPC = 13.0%; P < .001) and from 484.4 to 631.6 (AAPC = 3.4%; P < .001), respectively. Approximately 70% of these visits were made by persons born during 1945-1965 (baby boomers); 30% of visits were made by Medicare beneficiaries and 40% by Medicaid beneficiaries. Significant rate increases were among visits by baby boomers (first-listed: AAPC = 13.8%; all-listed: AAPC = 2.6%), persons born after 1965 (first-listed: AAPC = 14.3%; all-listed: AAPC = 9.2%), Medicare beneficiaries (first-listed: AAPC = 18.0%; all-listed: AAPC = 3.9%), and persons hospitalized after ED visits (first-listed: AAPC = 20.0%; all-listed: AAPC = 2.3%; all P < .001). Increasing proportions of compensated cirrhosis were among visits by baby boomers (first-listed: AAPC = 11.5%; all-listed: AAPC = 6.3%). Annual hepatitis C–associated total ED costs increased by 400.0% (first-listed) and 192.0% (all-listed) during 2006-2014. Conclusion: Public health efforts are needed to address the growing burden of hepatitis C care in the ED.

scholarly journals A Descriptive Analysis of Location of Older Adult Falls That Resulted in Emergency Department Visits in the United States, 2015

2020 ◽  
pp. 155982762094218
Author(s):  
Briana L. Moreland ◽  
Ramakrishna Kakara ◽  
Yara K. Haddad ◽  
Iju Shakya ◽  
Gwen Bergen
Keyword(s):  
United States ◽  
Older Adults ◽  
Emergency Department ◽  
The United States ◽  
Emergency Department Visits ◽  
Targeted Prevention ◽  
Injury Surveillance System ◽  
Injurious Falls ◽  
Ed Visits ◽  
At Home

Introduction. Falls among older adults (age ≥65) are a common and costly health issue. Knowing where falls occur and whether this location differs by sex and age can inform prevention strategies. Objective. To determine where injurious falls that result in emergency department (ED) visits commonly occur among older adults in the United States, and whether these locations differ by sex and age. Methods. Using 2015 National Electronic Injury Surveillance System-All Injury Program data we reviewed narratives for ED patients aged ≥65 who had an unintentional fall as the primary cause of injury. Results. More fall-related ED visits (71.6%) resulted from falls that occurred indoors. A higher percentage of men’s falls occurred outside (38.3%) compared to women’s (28.4%). More fall-related ED visits were due to falls at home (79.2%) compared to falls not at home (20.8%). The most common locations for a fall at home were the bedroom, bathroom, and stairs. Conclusion. The majority of falls resulting in ED visits among older adults occurred indoors and varied by sex and age. Knowing common locations of injurious falls can help older adults and caregivers prioritize home modifications. Understanding sex and age differences related to fall location can be used to develop targeted prevention messages.

Emergency department visits for prescription and synthetic opioid overdoses among patients with cancer.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 6579-6579
Author(s):  
Vikram Jairam ◽  
Daniel X. Yang ◽  
James B. Yu ◽  
Henry S. Park
Keyword(s):  
Cervical Cancer ◽  
Emergency Department ◽  
Cancer Patients ◽  
The United States ◽  
Emergency Department Visits ◽  
Cancer Site ◽  
Opioid Overdose ◽  
Patients With Cancer ◽  
Rate Of Increase ◽  
Ed Visits

6579 Background: Patients with cancer may be at high risk of opioid dependence due to physical and psychosocial factors, although little data exists to inform providers and policymakers. Our aim is to examine overdoses from prescription and synthetic opiates leading to emergency department (ED) visits among patients with cancer in the United States. Methods: The Healthcare Cost and Utilization Project Nationwide Emergency Department Sample (HCUP-NEDS) was queried for all patient visits with a primary diagnosis of prescription or synthetic opioid overdose between 2006 and 2015. Baseline differences between patients with and without cancer were assessed using chi-square and ANOVA testing. Overdose rates by primary cancer site were normalized using prevalence data from the Surveillance, Epidemiology, and End Results (SEER) Program. Weighted frequencies were used to create national estimates for all data analyses. Results: There were 682,820 weighted ED visits for synthetic opioid overdose, among which 34,547 (5.1%) visits were also associated with a diagnosis of cancer. During this timeframe, ED visits for opioid overdose among patients with cancer increased 2.5-fold, compared to 1.7-fold among those without cancer. 16.5% of patients with cancer had metastatic disease. Patients with cancer presenting for opioid overdose had higher risk of hospital admission (74.8% vs 49.6%), respiratory intubation (13.2% vs 12.2%), mortality (2.1% vs 1.1%), and cost-of-hospital-stay ($32,665 vs $31,824) compared to their non-cancer counterparts (all P < 0.05). Primary cancers with the highest normalized overdose rates (ED visits per 10,000 patients) were esophagus (134), liver & intrahepatic bile duct (124), and cervical cancer (124). Other common cancers had the following normalized overdose rates: lung (105), head and neck (70), and breast (26). Conclusions: Approximately 5% of all ED visits due to prescription and synthetic opioid overdose are among patients with cancer. The rate of increase in ED visits due to opioid overdose from cancer patients was nearly 50% higher than that from non-cancer patients over the 10-year study period. Patients with esophageal, liver, and cervical cancer may be at highest risk.

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