Drug Overdose Data Sources
Minnesota Department of Health Data Sources
Description: Drug overdose fatality data come from Minnesota death certificates. After a death occurs, a death investigation is completed, along with an autopsy (89% of drug overdose deaths had an autopsy completed in 2021), and a medical examiner or coroner determines the cause and manner of death. Both are added to the corresponding sections of the death certificate. Once the medical examiner certifies a death certificate, the Office of Vital Records (OVR) at the Minnesota Department of Health (MDH) performs data quality checks to ensure the death certificate was completed properly and accurately. After death certificates are sent to MDH's OVR, they are then sent to the National Center for Health Statistics (NCHS) where the literal text on the death certificate in the cause of death fields is converted from text to the International Classification of Diseases and Related Health Problems, 10th revision (ICD-10) codes. The NCHS uses a specially made computer program to code the literal text on the death certificate into ICD-10 codes according to the information listed on the death certificate. This program allows for one underlying cause of death and up to 20 contributing causes of death. Once this program is run and the data are assigned ICD-10 codes, the data are returned to the OVR in the MDH and made available for analysis.
ICD-10 Codes Used in Identifying Overdose Deaths
To identify drug overdose deaths and the specific drugs involved from the entire death certificate file, a two-step analysis is completed. First, only death certificates with an ICD-10 underlying cause of death ICD-10 code in the ranges of X40-X44, X60-X64, X85, or Y10-Y14 are selected. From there specific ICD-10 drug codes in the contributing cause of death fields are searched to identify all drug overdose deaths that involved each drug category of interest (ICD-10 drug codes: T36-T50). The drug categories are not mutually exclusive, meaning a death with heroin (T40.1) and cocaine (T40.5) will be counted in both drug categories. Data are then summarized by demographic and geographic variables of interest.
Strengths and Limitations
Strengths: All deaths in the state are reported to OVR, as well as Minnesota resident deaths that occurred in other states. There is a consistency of reporting across states, which aids analysis. Additionally, data can be easily grouped by some drug categories based on ICD-10 codes to allow for examination of trends over time.
Limitations: The limitations of the death certificate data include timeliness in completing the death certificates. The death investigation, autopsy process, and toxicology testing take time to complete. Due to Minnesota’s current medical examiner and coroner system, there is also variability in how drug overdose deaths are reported. This includes variation in the details and specificity listed on a death certificate in terms of the specific drugs involved in a death. Annual preliminary data become available in the second quarter of the following year and is not finalized for a full calendar year. Finally, death certificates cannot be used to quickly identify new drug trends because of the time it takes to complete toxicology and for death certificates to be finalized and made available for analysis.
Perform your own analysis:
- CDC WONDER The CDC WONDER online mortality databases utilize a rich online query system for the analysis of public health data. Analyses of death certificates can be conducted for the U.S., as well as for any state, including Minnesota.
- CDC WISQARS CDC’s WISQARS (Web-based Injury Statistics Query and Reporting System) is an interactive, online database that provides fatal and nonfatal injury, violent death, and cost of injury data from a variety of trusted sources. Researchers, the media, public health professionals, and the public can use WISQARS data to learn more about the public health and economic burden associated with unintentional and violence-related injury in the United States.
Description: Developed by the Centers for Disease Control and Prevention (CDC), the State Unintentional Drug Overdose Reporting System (SUDORS) collects detailed information on overdose deaths occurring in Minnesota. The Minnesota Department of Health (MDH) currently partners with all Minnesota medical examiners and coroners to collect data on unintentional and undetermined overdose deaths. The data are used to better understand circumstances surrounding the incident as well as the type and origin of drugs involved. Starting in 2019, more than 97% of all overdose deaths occurring in Minnesota have been reported in SUDORS. More information can be found here: State Unintentional Drug Overdose Reporting System (SUDORS).
The data includes:
- All deaths due to an overdose that occurred in Minnesota
- Coverage: 2019 - ongoing
- Fatal drug overdoses of unintentional (i.e., accidental) or undetermined intent
Strengths and Limitations
Strengths: Comprehensive toxicology information is available, including all substances present at the time of death. Furthermore, detailed circumstances about the events leading up to and at the time of death are abstracted from medical examiner and coroner files. For example, data are available on people experiencing homeless and/or housing instability, as well as detailed mental health, past medical history, and overdose-specific circumstances.
Limitations: Only cases that meet the SUDORS case definition are included; therefore, it is possible that not all unintentional or undetermined overdose or substance-related deaths are present in the analysis. SUDORS attempts to collect 600+ decedent, injury, and circumstance variables, but only data present in the medical examiner or coroner records at the time of abstraction are included. Due to this, many circumstance variables can be assumed undercounted or are reported as missing/unknown.
Description: Data for nonfatal hospital-treated overdose come from hospital discharge data. The Minnesota Department of Health (MDH) receives approximately 95% of hospital discharge data every three months from our partners at the Minnesota Hospital Association. The data covers all 87 counties and can include reports from all 123 acute care hospitals in the state, as well as additional hospitals located in North Dakota.
ICD-10-CM Codes Used to Identify Nonfatal Drug Overdose
MDH uses the Centers for Disease Control and Prevention (CDC) Drug Overdose Surveillance and Epidemiology case definition to identify hospital visits related to a nonfatal drug overdose. To do this, International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes are used. ICD-10-CM codes are what medical professionals use for clinical diagnosis and insurance billing purposes. There are many ICD-10-CM codes for drug overdose. For a full list of the ICD-10-CM codes currently used to identify nonfatal overdose data, please review Appendix I in the Nonfatal Drug Overdose Dashboard Guidance.
Strengths and Limitations
- The data includes:
- Minnesota residents who were treated at Minnesota and North Dakota hospitals
- All emergency department visits and inpatient hospitalizations
- The data represent most hospital visits for drug overdose in Minnesota, regardless of the patient’s insurance carrier or payer.
- The data are de-duplicated prior to analysis, which means that a hospital visit is only counted once.
- The data does not include:
- Nonfatal drug overdoses occurring out in the community
- Nonfatal drug overdoses treated by Emergency Medical Services (EMS) and not transported to a hospital
- Nonfatal drug overdoses treated at federally funded facilities (like Veteran’s Affairs or Indian Health Service), tribally operated facilities, stand-alone psychiatric facilities, and other out-of-state facilities
- Hospital discharge data are primarily used for billing purposes, not for public health purposes.
- ICD-10-CM diagnosis codes sometimes lack detail. For example, using a code for ‘unspecified opioids’ does not help us understand what type of opioid was involved in an overdose.
- All drug overdoses are suspected overdoses. Drugs that are suspected to be involved in hospital visits are often self-reported by the patient or determined by presenting symptoms at the hospital. Toxicology tests are not typically run to determine the specific drug types involved. It is important to interpret drug-specific trends with caution.
- The transition to ICD-10-CM in the final quarter of 2015 (October – December 2015) makes comparisons inaccurate, if not impossible, to previous years. Because of this, data is provided from 2016 onward.
Other Data Considerations
- Most often, the data shared by MDH will include nonfatal drug overdoses of unintentional (i.e., accidental) and undetermined intent. Nonfatal drug overdoses determined to be intentional (i.e., related to self-harm) are not usually included, unless otherwise noted. For access to data on nonfatal intentional drug overdoses, please visit the Hospital-Treated Suicidal and Self-Harm Injury Dashboard.
- Drug categories are non-exclusive. For example, a nonfatal overdose involving a synthetic opioid would be counted as an ‘All opioid’ overdose and an ‘All drug’ overdose.
- In the hospital discharge data, the collection of race and ethnicity information has not always been consistent. However, it has been improving over the past several years. In 2016, 23% of hospital-treated nonfatal drug overdoses had missing race and ethnicity data. By 2021, the proportion of visits with missing race and ethnicity data had decreased to 2%. This context is important to keep in mind when looking at historical trends by race or ethnicity of the patient.
Perform your own analysis:
- The Nonfatal Drug Overdose Dashboard is a tool that provides the public with data to better understand which people are experiencing nonfatal drug overdoses, where they are happening, and the impacts on communities. The one-page dashboard includes three sections (trends over time, demographics, geography), allowing the user to examine data by suspected drug type, hospital setting (emergency department, hospitalization), population groups (county of residence, five-year age groups, gender, race/ethnicity), and various epidemiologic measures (counts, rate, proportion). The dashboard also features dynamic narratives to aid the user in data interpretation and provides helpful tips for navigation.
Description: The Minnesota Drug Overdose and Substance Use Surveillance Activity (MNDOSA) tracks cases of substance misuse that result in emergency department visits or hospitalization in near-real time. Toxicology testing is rarely performed for overdoses that are treated in hospitals. The MNDOSA program fills this information gap by identifying substances used in severe and unusual cases and collects data on the circumstances and risk factors involved in these cases.
Participating sites report cases treated in emergency departments where the principal diagnosis is attributable to substance misuse, to the MNDOSA program. An overview of MNDOSA data, including the substances commonly detected and substance trends over time, can be found at Minnesota Drug Overdose and Substance Use Surveillance Activity.
Strengths and Limitations
Strengths of MNDOSA data are the availability of enhanced toxicology data, which are rarely available for nonfatal overdoses. These data show trends in substance use over time and help detect emerging and novel substances. Circumstance data provide important context that informs prevention among high-risk populations.
MNDOSA currently operates at select hospitals in Northeast Minnesota and the Twin Cities Metro Area; these data do not represent substance use trends seen at all hospitals across the state, or in all regions of Minnesota. Cases are reported through MNDOSA if they are being treated in a hospital for a reason primarily due to substance use; this often includes drug overdoses but may include other acute problems related to substance use. Finally, data collected from electronic health records vary in completeness, so MNDOSA findings must be interpreted with caution.
Description: Syndromic surveillance emphasizes the use of near real-time data with statistical tools to detect and characterize unusual activity for further public health investigation.
Syndromic surveillance systems may be utilized for situational awareness, to further characterize an outbreak beyond initial detection and notification, to monitor the spread of an outbreak, and/or to monitor the effectiveness of outbreak response and interventions. These data help public health officials detect, monitor, and respond quickly to local public health threats and events of public health importance. Please access the MDH Syndromic Surveillance website to learn more about how the data is currently used at MDH. Additional examples of the data can be found on the Situational Awareness page of the MDH COVID-19 Situation Update website.
Strengths and Limitations
Strengths: Syndromic surveillance differs from other data sources, such as case or electronic case reports, All Payer Claims Database (APCD), and Electronic Health Record (EHR) Consortium data, in the breadth of data collected resulting in the ability to monitor and identify emerging public health concerns in near-real time. Syndromic surveillance includes data on all visits treated at hospitals, regardless of condition. Analysis of these data based on signs and symptoms before a confirmed diagnosis or lab test significantly improves the timeliness of analysis and allows identification of concerns across a broad range of conditions. Other data sources mentioned above are focused on a specific diagnosis or lab test, resulting in an inability to examine other relevant conditions or identify new health issues.
Limitations: Because the syndromic surveillance data are based on presenting signs and symptoms when a patient first walks through the door, conditions are considered suspected and are not confirmed. Subsequently, these data are not exact measures and should not be used to understand trends, rather than to count exact cases. in addition, recent data are not final and are subject to change. To account for the variability during this time, the syndromic data will typically include on-week "lag period" bars.
Other Drug Overdose and Substance Use Data Sources
The following data sources are available through partners outside MDH. The MDH Drug Overdose Dashboard includes some drug overdose and substance use-related data from these sources. For access to additional data from the below data sources, please reach out to the respective organizations.
Description: The Minnesota Student Survey (MSS) is a statewide school-based survey that is conducted every three years to gain insights into the world of students and their experiences. The survey asks questions about activities, experiences, and behaviors. Examples of topics covered include:
- tobacco, alcohol, and drug use
- school climate
- physical activity
- violence and safety
- connections with school and family
The survey is anonymous and voluntary, but all schools are invited to participate. This includes public, nonpublic, charter, and tribal schools. It also includes alternative learning centers and juvenile correctional facilities.
The survey is administered jointly by the Minnesota Departments of Education (MDE), Health (MDH), Human Services (DHS), and Public Safety (DPS). For more information, please visit the DHS Minnesota Student Survey webpage.
Strengths and Limitations
Strengths: The MSS is a major source of information about the thoughts and experiences of Minnesota’s youth. Seventy percent (70%) of Minnesota school districts and more than 135,000 students participated in the 2022 survey. The MSS allows for sub-state analysis and the ability to track behaviors over time.
Limitations: The survey asks questions about behaviors or beliefs that are sensitive in nature, which may result in the underreporting of these behaviors or beliefs. Analyses are also limited by small sample sizes in certain geographic or demographic subgroups. Since the survey is administered in school, students not in or absent from school do not have the opportunity to participate in the MSS. Trend analyses can also be limited as the survey is updated and questions are added or removed.
- MDE Minnesota Student Survey Data Reports and Analytics webpage provides a tool to generate MSS Tables. Data files are available by geographic level (county, district, state), school name, and year (2013-2022).
- MDH Minnesota Student Survey webpage provides data tables and reports of MSS results by various demographic characteristics.
- Substance Use in Minnesota (SUMN) provides data on over 100 indicators of alcohol, tobacco, and other drug consumption patterns, consequences, and contributing factors in Minnesota. Data are provided at the county level, regional, and state level, and by demographic group when possible.
Description: DAANES is designed to provide policymakers, planners, service providers and others in Minnesota with access to current information about chemical dependency treatment activities across the continuum of care. The Department of Human Services is required by statute to collect sufficient information to evaluate the efficiency and effectiveness of treatment for chemical dependency. In addition, the federal Substance Abuse and Mental Health Services Administration (SAMHSA) of the Department of Health and Human Services has mandatory reporting requirements through the National Outcomes Measurements (NOMs) monitoring system. SAMHSA requires that all treatment providers who receive any state or federal funds report on this system for all treatment admissions regardless of funding source. In Minnesota, DAANES is used to meet both state and federal reporting requirements.
Strengths and Limitations
Strengths: DAANES provides information on the primary substance at admission to substance use disorder treatment services for adults and adolescents. This allows for the tracking of trends in admissions for certain categories of drugs, as well as the primary route of administration. When paired with complementary data sources, DAANES can help to provide a more comprehensive picture of substance use in Minnesota.
Limitations: Relying on the primary substance at admission to substance use disorder treatment services does not capture the complete picture of substance use, as oftentimes people are using more than one substance at a time or have used a different substance in the past. Additionally, it does not put into perspective treatment capacity and how the need is or is not being met in Minnesota. DAANES does not allow for quick identification of emerging drug trends.
- Substance Use in Minnesota(SUMN) provides data on over 100 indicators of alcohol, tobacco, and other drug consumption patterns, consequences, and contributing factors in Minnesota. Data are provided at the county level, regional, and state level, and by demographic group when possible.
Description: In 2009, Minnesota Statute 151.126 required the Board of Pharmacy to develop and maintain a database of dispensed controlled substance prescriptions, including opioids, for promoting public health. The goal of the PMP database is to assist with safe prescribing and dispensing as well as reduce the misuse of controlled substance prescriptions. PMPs have proven to be effective in reducing prescription drug misuse and diversion, assisting prescriber and pharmacists in managing their patient’s care, and identifying potential high-risk behavior.
Note: Minnesota's Prescription Monitoring Program (PMP) is often referred to as a Prescription Drug Monitoring Program or PDMP.
Strengths and Limitations
The PMP collects information on all dispensations of schedule II-V, butalbital, and gabapentin dispensed in Minnesota. It also actively exchanges PMP history data with authorized account holders in 43 other states and jurisdictions to eliminate unknown prescription activity across borders. The PMP uses Controlled Substance Insight Alerts (CSIAs) to notify prescribers and pharmacies when a patient in their care has met or exceeded a set threshold that may indicate the patient is at risk for an overdose.
Limitations: Prescription data in the PMP are only as accurate as the records submitted by the dispensers. Beginning on July 1, 2017, a law went into effect mandating that all prescribers and pharmacists practicing in Minnesota must create and maintain a PMP account. Beginning on January 1, 2021, the Legislature mandated prescribers use the PMP database before issuing an initial prescription for an opioid, at least once every three months for patients receiving an opioid prescription for the treatment of chronic pain, and at least once every three months for patients participating in medically assisted treatment (MAT) for opioid use disorder. Tracking PMP compliance is difficult to assess – access to protected health information, which is not publicly available, would be needed to evaluate the clinical decision making of the prescriber to measure compliance. Additionally, statutory restrictions on the privacy of PMP data make it difficult to track the impact of PMP utilization on public health.
- The Minnesota Board of Pharmacy Prescription Monitoring Program (PMP) releases an annual report with prescription dispensation data. Monthly PMP utilization reports are also available.
- The Minnesota Board of Pharmacy manages a PMP Analytics Dashboard with dispensation data that can be filtered by county, payment type, prescription type, drug schedules, and quarters. The data dashboard began in 2022 and is updated quarterly
Description: Drug arrests and seizures that are completed by the Violent Crime Enforcement Teams are submitted to the Minnesota Department of Public Safety. Information includes the number of arrests for sale or possession of drugs, the type of drug involved in the arrest, the type of drug seized, as well as prevention and training activities.
Strengths and Limitations
Strengths: These data provide a picture of the drug activity that has been observed through arrests and seizures by the Minnesota Department of Public Safety. The data are updated quarterly and shared with the Minnesota Department of Health in a timely manner. These data provide another layer of information regarding the type of drug arrests that are occurring, and the type of drugs involved.
Limitations: These data are limited in their ability to identify emerging drug trends and may not accurately represent drug use patterns. The decrease in arrests and seizures in the first quarter of 2017 likely reflects two fewer grants to Violent Crime Enforcement Teams, which makes trends in these data difficult to interpret as funding changes.
- The Department of Public Safety (DPS) Violence Crime Enforcement Teams (VCET) provides statistical and narrative reports on their program activities and outcomes, including number of drug arrests and amounts seized.
Social Services Information System (SSIS)
Description: SSIS, administered by the Minnesota Department of Human Services (DHS), is Minnesota’s Statewide Automated Child Welfare Information System (SACWIS) that collects federally mandated child welfare data and provides support for the delivery and management of child welfare services. Throughout the years, SSIS has expanded and now includes adult programs and child programs.
- DHS published releases an ‘Out-of-home care and Permanency Report’ on an annual basis. The annual report provides information on children placed in out-of-home care in Minnesota, highlighting work across the state to ensure and promote safety, permanency, and well-being of children who experience out-of-home care.