# Presentation: 235035

**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

## 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)

- 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**

## 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

## ICD mortality coding by country

|  | ICD-9-UCOD | ICD-10-UCOD | Substance-specific |
| --- | --- | --- | --- |
| England and Wales | 1990-2000 | 2001-2002 | Literals from text files |
| Canada | 1990-1999 | 2000-2002 | From under-lying cause |
| United States | 1990- 1998 | 1999-2002 | Multiple cause coding |

## ICD ‘definitions’ of drug poisoning

|  |  | ICD-10 |
| --- | --- | --- |
| Nondependent abuse of drugs | 
305.2-.9 | F11-16, 18-19 (not .2) |
| Dependent abuse | 304 | F11-16,18-19(.2) |
| Unintentional | E850-E858 | X40-X44 |
| Suicide | E950(.0-5) | X60-X64 |
| Undetermined | E980(.0-.5) | Y10-Y14 |
| Homicide | E962.0 | X85 |
| [Alcohol intoxication | 305.0 | F10.0] |

_**ICD-9**_

## Drug poisoning death rates: US, 2002

## Drug poisoning deaths, ages 35-54

## Drug poisoning death rates,males 35-54 years

## Drug poisoning death rates, males, 25-34 years

## Drug poisoning death rates,  females, 35-54 years

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

## Canada: Leading substance categories based on underlying cause of death: No further specificity available

- Opiates and related narcotics
- Tranquilizers and other psychotropic agents
- Local anaesthetics (includes cocaine)

## England & Wales: Leading specified substances mentioned in drug deaths for those 35-54 years:  [not  ICD coded]: 1993-2002

- _Antidepressants_ (23%)
- Paracetamol (22%)
- _Heroin/morphine _(17%)
- _Methadone _(9%)
- _Benzodiazepines _(7%)

## US: Leading specified substances mentioned in drug deaths for those 35-54 years: 2002

- Cocaine T40.5:  25%
- Other specified opioids T40.2: 21%
- _Antidepressants T43.0-T43.2:  _ 11%
- Alcohol T51: 11%
- Carbon Monoxide T58:  8%
- _Heroin T40.1:  _10%
- _Benzodiazepines T42.4:_   9%
- _Methadone T40.3_  10%

## 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....

## 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