1. Drug Poisoning: Trends and Current Status US, England & Wales, Canada Lois A. Fingerhut US, National Center for Health Statistics Clare Griffiths UK, Office of National Statistics Kathryn Wilkins Canada, Statistics Canada

2. ICD-9 vs ICD-10 Underlying cause: external cause codes (X & Y codes) Multiple cause: T codes for substances Mental health “F” codes Nondependent abuse Dependent abuse Alcohol intoxication (not included here) Adverse effects codes (not included here) Definitional issues: Drug poisoning mortality

3. ICD-9 vs ICD-10 Substance selection ICD-9 underlying cause codes for poisoning more specific than ICD-10 codes ICD-10, to get specific substances Literals from the death certificate Code the multiple cause data

4. ICD mortality coding by country ICD-9- UCOD ICD-10- UCOD Substance- specific England and Wales 1990-20002001-2002Literals from text files Canada1990-19992000-2002From under- lying cause United States 1990- 1998 1999-2002Multiple cause coding

5. ICD ‘definitions’ of drug poisoning ICD-10 Nondependent abuse of drugs305.2-.9F11-16, 18-19 (not.2) Dependent abuse304F11-16,18-19(.2) UnintentionalE850-E858X40-X44 SuicideE950(.0-5)X60-X64 UndeterminedE980(.0-.5)Y10-Y14 HomicideE962.0X85 [Alcohol intoxication305.0F10.0] ICD-9

6. Drug poisoning death rates: US, 2002

7. Drug poisoning deaths, ages 35-54

8. Drug poisoning death rates, males 35-54 years

9. Drug poisoning death rates, males, 25-34 years

10. Drug poisoning death rates, females, 35-54 years

11. Abuse-related (mental health codes) death rates, males 35-54 years

12. Canada: Leading substance categories based on underlying cause of death: No further specificity available 1) Opiates and related narcotics 2) Tranquilizers and other psychotropic agents 3) Local anaesthetics (includes cocaine)

13. England & Wales: Leading specified substances mentioned in drug deaths for those 35-54 years: [not ICD coded]: 1993-2002 1) Antidepressants (23%) 2) Paracetamol (22%) 3) Heroin/morphine (17%) 4) Methadone (9%) 5) Benzodiazepines (7%)

14. US: Leading specified substances mentioned in drug deaths for those 35-54 years: 2002 1. Cocaine T40.5: 25% 2. Other specified opioids T40.2: 21% 3. Antidepressants T43.0-T43.2: 11% 4. Alcohol T51: 11% 5. Carbon Monoxide T58: 8% 6. Heroin T40.1: 10% 7. Benzodiazepines T42.4: 9% 8. Methadone T40.3 10%

15. Next Steps Recommend adding certain ICD codes from Mental and Behavioral Disorders (F10-F19) to classification of poisoning deaths Nondependent abuse? Dependent abuse? Alcohol intoxication? Drug status- legal/illegal use International variation- a topic to be researched….

16. Questions… Lois A Fingerhut: US NCHS LFingerhut@cdc.gov Clare Griffiths UK ONS Clare.Griffiths@ons.gsi.gov.uk Kathryn Wilkins Canada Statistics Canada Kathryn.Wilkins@statcan.ca