Data Sources

Notes on data

All the data contained in the Opioid & Health Indicators database are compiled from reputable publicly-available databases. As such, all data are freely available for all non-commercial uses.

In order to estimate data at the level of congressional district, county-level data are aggregated by congressional district. In cases where counties are contained in multiple districts, these estimates will not be completely accurate since no effort is made to proportionately divide counties into congressional districts. For any questions about data methods or acceptable use of data, please contact us.

Indicator definitions

CURES Grant Funding

Funding from the 21st Century Cures Act is provided through the State Targeted Response to the Opioid Crisis Grants administered by the Substance Abuse and Mental Health Services Administration (SAMHSA). These grants will help address the opioid crisis by providing support to states to supplement opioid abuse prevention and treatment activities.

Data Source: Department of Health and Human Services.

Available at: https://www.hhs.gov/about/news/2017/04/19/trump-administration-awards-grants-states-combat-opioid-crisis.html

Division of HIV/AIDS Prevention Funding

The Centers for Disease Control and Prevention (CDC) provides leadership in improving public health by working with community, state, national, and international partners in surveillance, research, and prevention and evaluation activities. The Division of HIV/AIDS Prevention (DHAP) is responsible for HIV control activities.

Data Source: Centers for Disease Control and Prevention

Available at: https://www.cdc.gov/nchhstp/stateprofiles/default.htm

Division of Viral Hepatitis Funding

The Centers for Disease Control and Prevention (CDC) provides leadership in improving public health by working with community, state, national, and international partners in surveillance, research, and prevention and evaluation activities. The Division of Viral Hepatitis (DVH) is responsible for viral hepatitis control activities.

Data Source: Centers for Disease Control and Prevention

Available at: https://www.cdc.gov/nchhstp/stateprofiles/default.htm

Drug-related Deaths

The total number of deaths from drug poisoning, including both illicit and prescription drugs. Drug poisoning data are from CDC's Detailed Cause of Death data and includes ICD-10 codes X40-X44, X60-X64, X85, and Y10-Y14. This includes both opioid and non-opioid drug poisonings, since the CDC reports that due to variable levels of completeness on death certificates only 28 states have high enough quality of data to report drug-specific poisoning data. Data not available for Puerto Rico. All sub-national data representing zero to nine (0-9) deaths are suppressed. Corresponding sub-national denominator population figures are also suppressed when the population represents fewer than 10 persons. State-level estimates include suppressed values; as such, county and district estimates may not sum to state value.

Data Source: Centers for Disease Control and Prevention

Available at: https://wonder.cdc.gov

Drug-related Deaths per 100,000

The rate of death from drug poisoning, including both illicit and prescription drugs, per 100,000 population. Drug poisoning data are from CDC's Detailed Cause of Death data and includes ICD-10 codes X40-X44, X60-X64, X85, and Y10-Y14. This includes both opioid and non-opioid drug poisonings, since the CDC reports that due to variable levels of completeness on death certificates only 28 states have high enough quality of data to report drug-specific poisoning data. These values are not age-adjusted. Data not available for Puerto Rico. All sub-national data representing zero to nine (0-9) deaths are suppressed. Corresponding sub-national denominator population figures are also suppressed when the population represents fewer than 10 persons. State-level estimates include suppressed values; as such, county and district estimates may not sum to state value.

Data Source: Centers for Disease Control and Prevention

Available at: https://wonder.cdc.gov

Estimated Acute Hepatitis C Cases per 100,000

Estimated number of acute (newly diagnosed) cases of hepatitis C in one year, per 100,000 population, calculated from CDC reported cases. CDC estimates the actual number of acute cases to be 13.9 times the number of reported cases. This estimate does not capture the total number of people living with both acute and chronic hepatitis C, and therefore underrepresents the actual number of cases. According to the CDC, acute hepatitis C leads to chronic infection in 75-85% of cases. Hepatitis C has been a nationally notifiable diseases since 1994, yet not all states report usable data and no HCV data are available at the county level, undermining the ability to surveil the epidemic and identify potential outbreaks.

Data Source: Centers for Disease Control and Prevention

Available at: https://www.cdc.gov/hepatitis/statistics/

Estimated Cases of Acute Hepatitis C

Estimated number of acute (newly diagnosed) cases of hepatitis C in one year, calculated from CDC reported cases. CDC estimates the actual number of acute cases to be 13.9 times the number of reported cases. This estimate does not capture the total number of people living with both acute and chronic hepatitis C, and therefore underrepresents the actual number of cases. According to the CDC, acute hepatitis C leads to chronic infection in 75-85% of cases. Hepatitis C has been a nationally notifiable diseases since 1994, yet not all states report usable data and no HCV data are available at the county level, undermining the ability to surveil the epidemic and identify potential outbreaks.

Data Source: Centers for Disease Control and Prevention

Available at: https://www.cdc.gov/hepatitis/statistics/

Facilities Providing Mental Health Services

Number of facilities that provide mental health services. Types of care include crisis intervention teams, psychiatric emergency walk-in services, or mental health treatment. Facilities include hospital inpatient, outpatient, residential, or partial hospitalization/day treatment.

Data Source: Substance Abuse and Mental Health Services Administration.

Available at: https://www.findtreatment.samhsa.gov

Facilities Providing Substance Abuse Services

Number of facilities that provide substance abuse services. Types of care include substance abuse treatment, detoxification, transitional housing or halfway houses, prescribing of buprenorphine and/or naltrexone, or SAMHSA-certified Opioid Treatment Programs. Facilities include hospital inpatient, residential, or outpatient.

Data Source: Substance Abuse and Mental Health Services Administration.

Available at: https://www.samhsa.gov/data/substance-abuse-facilities-data-nssats

Hepatitis C Prevalence per 100,000

Estimated number of persons living with Hepatitis C antibodies, scaled by population. A positive Hepatitis C antibody test means that a person has ever been exposed to the virus, and includes the 15-20% of people infected with HCV that spontaneously clear the virus without treatment. Since this measure includes both current and historic cases of HCV, it is likely to be overestimate the current prevalence. The latest available estimates are from 2010, and therefore do not reflect the tripling in acute HCV infections from 2010-2015. Data not available for Puerto Rico.

Data Source: HepVu. Emory University, Rollins School of Public Health.

Available at: https://hepvu.org

HIV Prevalence per 100,000

Number of people living with diagnosed HIV per 100,000, among adults and adolescents 13 and older (children represent approximately 0.2% of new HIV infections in any year). All sub-national data representing zero to four (0-4) persons are suppressed.

Data Source: Centers for Disease Control and Prevention

Available at: https://gis.cdc.gov/grasp/nchhstpatlas/main.html

HOPWA Allocations and Awards

The Housing Opportunities for Persons With AIDS (HOPWA) Program is the only Federal program dedicated to the housing needs of people living with HIV/AIDS. Under the HOPWA Program, HUD makes grants to local communities, States, and nonprofit organizations for projects that benefit low-income persons living with HIV/AIDS and their families.

Data Source: Department of Housing and Urban Development

Available at: https://www.hudexchange.info/grantees/allocations-awards/?params=%7B%22limit%22%3A20%2C%22COC%22%3Afalse%2C%22sort%22%3A%22%22%2C%22min%22%3A%22%22%2C%22years%22%3A%5B%5D%2C%22dir%22%3A%22%22%2C%22grantees%22%3A%5B%5D%2C%22state%22%3A%22%22%2C%22programs%22%3A%5B8%5D%2C%22max%22%3A%22%22%7D

Inpatient Stays Resulting from Opioids per 100,000

Rate of opioid-related inpatient stays per 100,000 population. Inpatient stays are all formally-admitted hospital stays, and include those admitted through the emergency department. Data are from the Agency for Healthcare Research and Quality (AHRQ), Healthcare Cost and Utilization Project (HCUP), and the National Inpatient Sample (NIS). The NIS is based on the data collection efforts of data organizations in participating States that maintain statewide data systems and that have partnered with AHRQ. Data from non-Partner States are missing completely from the sampling frame, and data from Partner States are sometimes incomplete because of different State reporting requirements, different State restrictions, or other data omissions. The full list of ICD-10 codes included in the opioid-related stay category are described in greater detail in the data source.

Data Source: Agency for Healthcare Research and Quality.

Available at: https://www.hcup-us.ahrq.gov

Jurisdictions that have Completed a CDC Consultation

Since 2016, federal funding from the Department of Health and Human Services (DHHS) can be used to support syringe exchange programs (SEPs). Before these funds may be used for SEPs, each jurisdiction must submit a request to the Centers for Disease Control and Prevention (CDC) demonstrating that they are experiencing or at high risk of experiencing an HIV or hepatitis outbreak related to drug use.

Data Source: Centers for Disease Control and Prevention

Available at: https://www.cdc.gov/hiv/risk/ssps-jurisdictions.html

Law Enforcement Seizures of Fentanyl

The total number of drug seizures that were tested by forensic laboratories and reported to contain fentanyl to the Drug Enforcement Agency's (DEA) National Forensic Laboratory Information System (NFLIS) in a calendar year (currently only available for 2015 and 2016). The NFLIS collects drug chemistry analysis results, as well as other related information, from cases analyzed by state, local and federal forensic laboratories. These laboratories analyze substances secured in law enforcement operations across the country.

Data Source: DEA National Drug Threat Assessment (NDTA), 2016 and 2017

Available at:

New HIV Diagnoses

Number of new HIV diagnoses in one year, among adults and adolescents 13 and older (children represent approximately 0.2% of new HIV infections in any year). All sub-national data representing zero to four (0-4) diagnoses are suppressed. Corresponding sub-national denominator population figures are also suppressed when the population represents fewer than 5 persons.

Data Source: Centers for Disease Control and Prevention

Available at: https://gis.cdc.gov/grasp/nchhstpatlas/main.html

New HIV Diagnoses per 100,000

Number of new HIV diagnoses per 100,000 in one year, among adults and adolescents 13 and older (children represent approximately 0.2% of new HIV infections in any year). All sub-national data representing zero to four (0-4) diagnoses are suppressed. Corresponding sub-national denominator population figures are also suppressed when the population represents fewer than 5 persons.

Data Source: Centers for Disease Control and Prevention

Available at: https://gis.cdc.gov/grasp/nchhstpatlas/main.html

Number of 30 Days Supply of Opioids per Part D Enrollee

The number of standardized 30-day supplies of opioids reimbursed by Medicare Part D, per Medicare Part D enrollee. A standardized 30-day supply is bottom coded at 1, and top coded at 12. This means efforts to reduce the number of doses per prescription are not well captured by this measure. However, as the state-level data do not contain the actual days' supply, the 30-day supply measure was used for consistency. State data on the number of prescriptions come from the Part D Prescriber Summary table, which detail the number of standardized 30-day supplies of each drug billed to Medicare per state. County data were aggregated from the Part D Prescriber Public Use File (PUF), which contains data at the provider-drug level. Providers were matched to their ZIP code by using their unique National Provider Identifier (NPI) in the July 2015 NPPES Data Dissemination. The July 2015 NPPES Data Dissemination was accessed via archive.org, as it is not currently posted publicly but is available upon request. The standardized 30-day supply measure was also used at the county level, although days' supply, a more accurate measure of the volume prescribed, is available in the Prescriber PUF. Part D enrollment data comes from the Medicare Enrollment Dashboard.

Data Source: Centers for Medicare and Medicaid Services.

Available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/PartD2015.html

Number of People Living with Diagnosed HIV

Number of people living with diagnosed HIV, among adults and adolescents 13 and older (children represent approximately 0.2% of new HIV infections in any year). All sub-national data representing zero to four (0-4) persons are suppressed. Corresponding sub-national denominator population figures are also suppressed when the population represents fewer than 5 persons.

Data Source: Centers for Disease Control and Prevention

Available at: https://gis.cdc.gov/grasp/nchhstpatlas/main.html

Number of People with Hepatitis C

Estimated number of persons living with Hepatitis C antibodies. A positive Hepatitis C antibody test means that a person has ever been exposed to the virus, and includes the 15-25% of people infected with HCV that spontaneously clear the virus without treatment. Since this measure includes both current and historic cases of HCV, it is likely to be overestimate the current prevalence. The latest available estimates are from 2010, and therefore do not reflect the tripling in acute HCV infections from 2010-2015. Data not available for Puerto Rico.

Data Source: HepVu. Emory University, Rollins School of Public Health.

Available at: https://hepvu.org

Opioids prescribed per capita, in morphine mg equivalents (MME)

The amount of opioids prescribed, in morphine milligram equivalents (MME) per population. MME measurement allows for direct comparison of different opioids by accounting for differing potencies. The average daily MME per prescription was 48.1 in 2015, and prescriptions for 90 MME per day and up are considered to be "high-dose". This measure is from a recently published Centers for Disease Control and Prevention (CDC) report entitled "Vital Signs: Changes in Opioid Prescribing in the United States, 2006-2015" which uses retail prescription data from QuintilesIMS. County-level data were shared privately by CDC.

Data Source: Centers for Disease Control and Prevention

Available at: https://www.cdc.gov/mmwr/volumes/66/wr/mm6626a4.htm?s_cid=mm6626a4_w

Percent Needing but Not Receiving Addiction Treatment

Percent of total population aged 12 or older reporting needing but not receiving treatment for illicit drug use in the past year divided by the percent of total population aged 12 or older reporting illicit drug dependence or abuse in the past year. Data are from the National Survey on Drug Use and Health (NSDUH). Data are available at the national, state, and substate region level, with data linked to counties using the "2012-2014 National Survey on Drug Use and Health Substate Region Definitions." Sub-state data should be interpreted with caution. Data not available for Puerto Rico.

Data Source: Substance Abuse and Mental Health Services Administration.

Available at: https://www.samhsa.gov/data/population-data-nsduh

Percent of Drug Treatment Paid by Medicaid

Percentage of buprenorphine and buprenorphine/naloxone combination prescriptions covered by Medicaid. Data not available for Puerto Rico.

Data Source: IMS Institute for Healthcare Informatics.

Available at: https://www.iqvia.com/-/media/iqvia/pdfs/institute-reports/use-of-opioid-recovery-medications.pdf?la=en&hash=A0AEB9DE498D46FED720F37C41515330504F4DC3&_=1512751526251

Percent of People 12+ Reporting Drug Dependence

Percent of total population aged 12 or older reporting illicit drug dependence or abuse in the past year from the National Survey on Drug use and Health (NSDUH). Data are available at the national, state, and substate region level, with data linked to counties using the 2012-2014 National Survey on Drug Use and Health Substate Region Definitions. Data not available for Puerto Rico.

Data Source: Substance Abuse and Mental Health Services Administration.

Available at: https://www.samhsa.gov/data/population-data-nsduh

Percent of People without Health Insurance

Percent of the civilian noninstitutionalized population with no health insurance coverage. Data are from the Selected Economic Characteristics table from the American Community Survey 5-Year Estimates.

Data Source: United States Census.

Available at: https://factfinder.census.gov

Percent of Population 12 or Older Reporting Non-medical Use of Pain Relievers

Percent of total population aged 12 or older reporting nonmedical use of pain relievers in the past year from the National Survey on Drug Use and Health (NSDUH). Data are available at the national, state, and substate region level, with data linked to counties using the "2012-2014 National Survey on Drug Use and Health Substate Region Definitions." Data not available for Puerto Rico.

Data Source: Substance Abuse and Mental Health Services Administration.

Available at: https://www.samhsa.gov/data/population-data-nsduh

Physicians Licensed to Administer Buprenorphine

Number of physicians authorized to treat opioid dependency with buprenorphine by state. This includes physicians at substance abuse treatment facilities, as well as DATA-certified physicians.

Data Source: Substance Abuse and Mental Health Services Administration

Available at: https://www.samhsa.gov/medication-assisted-treatment/physician-program-data/treatment-physician-locator

Population

Population estimates are from the United States Census' Annual Estimates of the Resident Population, all ages. Data are available from American FactFinder.

Data Source: United States Census.

Available at: https://factfinder.census.gov

Prescribers Required to Check PDMP

Almost all states have a Prescription Drug Monitorning Program (PDMP), and most require dispensers to report data to the PDMP, but relatively few states require prescribers to check the PDMP before prescribing controlled substances.

Data Source: Prescription Drug Abuse Policy System.

Available at: http://pdaps.org/datasets/prescription-monitoring-program-laws-1408223416-1502818373

Ryan White Funding

The Ryan White HIV/AIDS Program provides a comprehensive system of care that includes primary medical care and essential support services for people living with HIV who are uninsured or underinsured. The Program works with cities, states, and local community-based organizations to provide HIV care and treatment services to more than half a million people each year. Part C funding totals include both Early Intervention Services and Capacity Development Program grants. Part F funding totals include only the Dental Programs. Find more information about the Ryan White HIV/AIDS Program here.

Data Source: Health Resources and Services Administration.

Available at:

Syringe Exchange Program Legality

Indicates whether states have specifically authorized syringe service programs statewide in legislation. States where local units have interpreted state laws to allow syringe access services or where no law prohibits syringe exchange are considered to permit syringe exchange programs. States with pilot programs, those where syringe exchange would require legislative action and/or supportive interpretation of local laws, or those with pending syringe exchange legislation are considered illegal. State laws were gathered from the HIV Prevention Justice Alliance, and compared against current syringe exchange program legislation on state government websites to review accuracy and up-to-date status.

Data Source: HIV Prevention Justice Alliance.

Available at: http://www.preventionjustice.org/wp-content/uploads/2017/03/TAG-IDU-HIV-and-HCV-prevention-webinar-3.20.17.pdf

Syringe Exchange Programs

Total number of syringe exchange programs. The directory of syringe exchange programs is aggregated by self-reporting to the North American Syringe Exchange Network (NASEN) and is therefore unlikely to be a comprehensive and complete list of all syringe exchange programs. Does not include programs that do not distribute syringes. Syringe exchange programs wishing to be identified in the database should contact NASEN to be added to the file.

Data Source: North American Syringe Exchange Network.

Available at: https://nasen.org/directory