Drug Overdose Case Definitions

Summary of Case Definitions Inclusion and Exclusion Terms and Revisions

Unintentional overdose by opioid or unspecified substance (excluding heroin) includes medical and non-medical use of a prescription opioid or where the substance is not specified.

  • Automatic Inclusion criteria (Chief Complaint or Discharge Diagnosis):
    • Terms: Narcan, naloxone
    • ICD-9 codes: 965.00, 965.02, 965.09, E850.1, E850.2
    • ICD-10 codes: T40.0X1A, T40.0X4A, T40.2X1A, T40.2X4A, T40.3X1A, T40.3X4A, T40.4X1A, T40.4X4A, T40.411A, T40.414A, T40.421A, T40.424A, T40.491A, T40.494A, T40.601A, T40.604A, T40.691A, T40.694A, F11.120, F11.121, F11.122, F11.129, F11.220, F11.221, F11.222, F11.229, F11.920, F11.921, F11.922, F11.929
    • SNOMED CT codes: 295165009, 242253008, 297199006, 295213004

  • Conditional Inclusion criteria (Chief Complaint or Discharge Diagnosis). Must have one overdose term and one drug-related term or code.
    • At least one overdose related term: overdose, poison, ingest, intoxication, unresponsive, loss of consciousness, syncope, altered mental status

              AND

    • At least one drug-related term or ICD-10 code: opioid, opiate, opium, morphine, hydrocodone, oxycodone, hydromorphone, oxymorphone, codeine, buprenorphine, fentanyl, methadone, naloxone, tramadol, suboxone, or medication and drug brand names (Dilaudid, Narcan, OxyContin, Percocet, Vicodin), F11.10, F11.20, F11.90

  • Exclusion criteria (Chief Complaint or Discharge Diagnosis):
    • Terms: withdrawal, detox, suicide, intentional, self-harm, on purpose, any specified non-opioid medication or drug, heroin, dope, speed ball, denies drug, denies loss of consciousness
    • ICD-9 codes: E95-97, V62.84, 965.01
    • ICD-10 codes: R45.851, T40.1X1A, T40.1X4A
    • SNOMED CT code: 295174006

 

Unintentional overdose by heroin

  • Automatic Inclusion criteria (Chief Complaint or Discharge Diagnosis):
    • ICD-9 codes: 965.01, E850.0
    • ICD-10 codes: T40.1X1A, T40.1X4A
    • SNOMED CT codes: 295174006, 295175007, 295176008

  • Conditional Inclusion criteria (Chief Complaint or Discharge Diagnosis). Must have one overdose term and one drug-related term or code.
    • At least one overdose related term: narcan, naloxone, overdose, poison, ingest, intoxication, unresponsive, loss of consciousness, syncope, altered mental status

              AND

    • At least one drug-related term or ICD-10 code: heroin, speedball, dope

  • Exclusion criteria (Chief Complaint or Discharge Diagnosis):
    • Terms: withdrawal, detox, suicide, intentional, self-harm, denies drug, denies heroin, denies loss of consciousness
    • ICD-9 codes: E95-97, V62.84
    • ICD-10 codes: R45.851

 

Unintentional overdose by all drug

  • Automatic Inclusion criteria (Chief Complaint or Discharge Diagnosis):
    • Terms: Narcan, naloxone
    • ICD-9 codes: 965.00, 965.01, 965.02, 965.09, E850.0, E850.1, E850.2
    • The following ICD-10 codes only include visits for unintentional or undetermined poisoning in the initial encounter: T36.0-T36.9, T37.0-T37.9, T38.0-T38.9, T39.0-T39.9, T40.0-T40.9, T41.0-T41.9, T42.0-T42.9, T43.0-T43.9, T44.0-T44.9, T45.0-T45.9, T46.0-T46.9, T47.0-T47.9, T48.0-T48.9, T49.0-T49.9, T50.0-T50.9, T50.A, T50.B, T50.Z, T51.0-T51.9, T52.0-T52.9, T53.0-T53.9, T54.0-T54.9, T55.0-T55.9, T56.0-T56.9, T57.0-T57.9, T58.0-T58.9, T59.0-T59.9, F11.12, F11.22, F11.92
    • SNOMED CT codes: 295174006, 295175007, 295176008, 295165009, 242253008, 297199006, 295213004, 296321004, 9982009, 27956007, 296325008, 241761001, 296317006, 20260003, 296290006, 61803000, 296291005, 45775001, 45421006, 296329002, 296330007, 57005003

  • Conditional Inclusion criteria (Chief Complaint or Discharge Diagnosis). Must have one overdose term and one drug-related term or code.
    • At least one overdose related term: overdose, poison, ingest, intoxication, unresponsive, loss of consciousness, syncope, altered mental status, shortness of breath

              AND

    • At least one drug-related term or ICD-10 code: opioid, opiate, opium, morphine, hydrocodone, oxycodone, hydromorphone, oxymorphone, codeine, buprenorphine, fentanyl, methadone, naloxone, tramadol, suboxone, or medication and drug brand names (Dilaudid, Narcan, OxyContin, Percocet, Vicodin, lisdexamfetamine, biphetamine, Adderall, dexedrine, vyvanse, concerta, methylin, ritalin), narcotics, heroin, speed ball, dope, cannabis, lysergide, psychodysleptics, barbiturates, amphetamine, cocaine, pills, benzo, cathinone, cocaine, coke, crack, meth, stimulant, crystal meth, bath salt, MDMA, ecstasy, molly, F11.10, F11.20, F11.90, F14.12, F14.22, F14.92, F15.12, F15.22, F15.92, 269688005, 290222000

  • Exclusion criteria (Chief Complaint or Discharge Diagnosis):
    • Terms: withdrawal, detox, suicide, intentional, self-harm, denies drug, denies heroin, denies loss of consciousness, crack and coke references unrelated to overdose (i.e. diet coke, crack tooth, back crack)
    • ICD-9 codes: E95-97, V62.84, 965.01
    • ICD-10 codes: R45.851, T40.1X1A, T40.1X4A, F14.10, F14.11, F14.13, F14.14, F14.15, F14.18, F14.19, F14.20, F14.21, F14.23, F14.24, F14.25, F14.28, F14.29, F14.90, F14.91, F14.93, F14.94, F14.95, F14.98, F14.99, F15.10, F15.11, F15.13, F15.14, F15.15, F15.18, F15.19, F15.20, F15.21, F15.23, F15.24, F15.25, F15.28, F15.29, F15.90, F15.91, F15.93, F15.94, F15.95, F15.98, F15.99

 

Unintentional overdose by stimulant

  • Automatic Inclusion criteria (Chief Complaint or Discharge Diagnosis):
    • ICD-9 codes: 969.70, 969.71, 969.72, 969.73, 969.79, 970.0, 970.9, E854.2, E854.3
    • The following ICD-10 codes only include visits for unintentional or undetermined poisoning in the initial encounter: T40.5X1A, T40.5X4A, T43.601A, T43.604A, T43.611A, T43.614A, T43.621A, T43.624A, T43.631A, T43.634A, T43.641A, T43.644A, T43.691A, T43.694A
    • SNOMED CT codes: 296321004, 9982009, 27956007, 296325008, 241761001, 296317006, 20260003, 296290006, 61803000, 296291005,  45775001,  45421006,  296329002, 296330007, 57005003

  • Conditional Inclusion criteria (Chief Complaint or Discharge Diagnosis). Must have one overdose term and one drug-related term or code.
    • At least one overdose related term: overdose, poison, ingest, intoxication, unresponsive, loss of consciousness, syncope, altered mental status, shortness of breath, snort, nod/nodding off

              AND

    • At least one drug-related term or ICD-10 code: amphetamine, medication and drug brand names (lisdexamfetamine, biphetamine, Adderall, dexedrine, vyvanse, concerta, methylin, ritalin), cathinone, speed ball, cocaine, coke, crack, meth, stimulant, crystal meth, bath salt, MDMA, ecstasy, molly, F14.12, F14.22, F14.92, F15.12, F15.22, F15.92

  • Exclusion criteria (Chief Complaint or Discharge Diagnosis):
    • Terms: withdrawal, detoxification, suicide, intentional, self-harm, denies drug, denies loss of consciousness , cardiac stimulant, crack and coke references unrelated to overdose (i.e. diet coke, crack tooth, back crack), alcohol intoxication
    • ICD-9 codes: E95-97, V62.84
    • ICD-10 codes: R45.851, T47.2X1A, F14.10, F14.11, F14.13, F14.14, F14.15, F14.18, F14.19, F14.20, F14.21, F14.23, F14.24, F14.25, F14.28, F14.29, F14.90, F14.91, F14.93, F14.94, F14.95, F14.98, F14.99, F15.10, F15.11, F15.13, F15.14, F15.15, F15.18, F15.19, F15.20, F15.21, F15.23, F15.24, F15.25, F15.28, F15.29, F15.90, F15.91, F15.93, F15.94, F15.95, F15.98, F15.99

 

The table below provides a summary of changes made to the drug overdose case definitions by VDH since September 2016.

Month

Description
September 2016 The "Monthly Emergency Department Visits for Overdose by Opioid, Unspecified Substance and Heroin among Virginia Residents" report was first published in September 2016.
July 2017 Three new exclusion terms were added to the Unintentional Overdose by Opioid or Unspecified Substance definition to improve specificity and make it mutually exclusive from the Unintentional Overdose by Heroin definition beginning in the July 2017 report. The exclusion revisions include: “heron” (misspelling of heroin), International Classification of Diseases 9th Revision (ICD-9) code “965.01” and ICD 10th Revision (ICD-10) code “T40.1” referencing heroin overdose. This change resulted in a small decrease in the number of ED visits for unintentional overdose by opioid or unspecified substance than previously reported.
May 2018 Case definition revisions were required beginning in the May 2018 report because of submission of SNOMED Clinical Terms (CT) codes by EDs for discharge diagnosis. Reporting of SNOMED CT codes to VDH began in March 2018. One new exclusion term was added to the Unintentional Overdose by Opioid or Unspecified Substance definition to make it mutually exclusive from the Unintentional Overdose by Heroin definition: SNOMED CT code “295174006” for heroin overdose.
June 2018 VDH revised the case definitions based on guidance from the Centers for Disease Control and Prevention (CDC) as well as findings from a data quality evaluation conducted by VDH.  While the revised case definitions have increased the sensitivity of capturing valid unintentional overdoses among ED visits reported to VDH, the interpretation of the overdose trends and data found in this report are not impacted.

  • Unintentional Overdose by Opioid or Unspecified Substance definition revisions: Inclusion of F11 category ICD-10 codes for opioid use, abuse and dependence, SNOMED CT codes for opioid and opiate overdose, as well as medication and drug brand names referencing opioid analgesics. Exclusion of terms referencing heroin or denial of drug use. The following exclusion terms used in previous versions of the case definition were removed: alcohol, mental health and addiction.
  • Unintentional Overdose by Heroin definition revisions: Inclusion of common street names referencing heroin and SNOMED CT codes for heroin overdose. Exclusion of discharge diagnosis codes and terms referencing suicide ideation and self-harm to match the Opioid and Unspecified Substance case definition. The following exclusion terms used in previous versions of the case definition were removed: alcohol, mental health and addiction.
August 2018
  • Three exclusion terms were added to the Unintentional Overdose by Opioid or Unspecified Substance definition to improve specificity and make it mutually exclusive from the Unintentional Overdose by Heroin definition beginning in the August 2018 report. The exclusion revisions were: International Classification of Diseases 9th Revision (ICD-9) code “965.01” and ICD 10th Revision (ICD-10) code “T40.1X1A” and "T40.1X4A" referencing heroin overdose. This change resulted in a very small decrease in the number of ED visits for Unintentional Overdose by Opioid or Unspecified Substance for historic data in 2015 and 2016.
November 2018
  • Three exclusion terms were added to the Unintentional Overdose by Opioid or Unspecified Substance definition to improve specificity and make it mutually exclusive from the Unintentional Overdose by Heroin definition. The exclusions were: "dope", "speed ball", and "speedball". This change resulted in a very small decrease (N=3 visits) in the number of ED visits for Unintentional Overdose by Opioid or Unspecified Substance in historic data.
January 2019
  • A new case definition was added for All Drug overdose. This case definition includes opioids, heroin, stimulants and other narcotics as well as unspecified overdose where no substance is mentioned.
February 2021
  • Unintentional Overdose by Opioid or Unspecified Substance case definition updates: Addition of new ICD-10 codes released October 2020 for poisoning by fentanyl or fentanyl analogs, tramadol, and other synthetic narcotics.
  • All Drug Overdose case definition updates: Inclusion of T50.A/B/Z ICD-10 codes for poisoning by bacterial vaccines, viral vaccines, or other vaccines and biological substances. Addition of new ICD-10 codes released October 2020 for poisoning by fentanyl or fentanyl analogs, tramadol, and other synthetic narcotics.
February 2022
  • A new case definition was added for Stimulant overdose. This case definition includes cocaine (including crack), methamphetamine, ecstasy (MDMA), caffeine, or unspecified stimulants. Stimulant overdoses co-occurring with other substances (e.g., opioids and stimulants) are included.
June 2022
  • All Drug Overdose case definition updates: Addition of SNOMED codes, drug terms, medication and drug brand names referencing stimulant overdose missing from previous versions along with exclusions for crack and coke references unrelated to overdose. ICD-10 and SNOMED codes for poisonings by anterior pituitary hormones, aspirin or propionic acid derivatives were also added.

 

 

Last Updated: June 16, 2022