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U.S. Department of Health and Human Services
Opioid Stewardship in the Indian Health Service

Opioid Crisis Data: Understanding the Epidemic

According to the most recent Centers for Disease Control and Prevention (CDC) data, American Indian and Alaska Native (AI/AN) populations had the second highest overdose rates from all opioids in 2017 (15.7 deaths/100,000 population) among racial/ethnic groups in the US. AI/AN populations also had the second highest overdose death rates from heroin (5.2) and third highest from synthetic opioids (6.5). Read the full Data Overview Exit Disclaimer: You Are Leaving www.ihs.gov report from the CDC.

Waves of Opioid Overdose Deaths

Three Waves of Opioid Overdose Deaths

Understanding the Opioid Overdose Epidemic: CDC's Response to the Opioid Overdose Epidemic

The graph above shows overdose death rates by opioid type during three waves during the rise in opioid overdose deaths. The first wave, in 1999, was due to prescription opioid overdoses. The second wave began in 2010 and was due to the rise in heroin overdose deaths. The third wave started in 2013 and involves deaths from synthetic opioids including fentanyl. The DEA now estimates that tests of four out of every 10 counterfeit pills with fentanyl contain a potentially lethal dose. Learn more about the risks of counterfeit pills. [PDF - 5.6 MB]

Check on state reported drug-related overdose and death trends [PDF - 1.2 MB] tracked by The American Medical Association.

Other emerging potent synthetic opioids are surfacing on the illicit drug market. These include fentanyl analogs, such as acetylfentanyl, furanylfentanyl, and carfentanil*. These are similar in chemical structure to fentanyl, but not routinely detected because specialized toxicology testing is required*. Another class of synthetic opioids, nitazenes, are the latest hazard to public safety. Read the full background brief on nitazenes [PDF - 681 KB], part of the benzimidazole class of synthetic opioids.

*Reference
Synthetic Opioid Overdose Data:Drug Overdose - CDC Injury Center Exit Disclaimer: You Are Leaving www.ihs.gov 

Local Data Approaches

Multi-disciplinary, collaborative approaches to opioid related data are necessary to understand the opioid epidemic and to plan an effective public health response. The IHS has developed and released the RPMS Report and Information Processor (RRIP) program as a tool for sites to monitor opioid prescribing within their local health systems, to identify patients with prescriptions for opioids at risk for opioid overdose, and to create regional comparisons between sites of similar size or demographics. The IHS seeks to expand utilization of these tools to create a responsive opioid surveillance strategy to monitor local opioid prescribing and leverage utilization of timely, actionable data to inform professional peer evaluation strategies and interventions. Secondary outcomes include increasing the capacity of health care providers and systems of care to integrate evidence based opioid prescribing strategies into practice to leverage a standard of care across the health system. Opioid stewardship is the responsibility of local, regional, and national health system leadership.

RPMS Report and Information Processor (RRIP)

RRIP allows users to import RPMS reports into Excel. This allows for more efficient use of data by adding sorting and filtering functions to these reports. The RRIP has been built in an Excel spreadsheet using macros, and is available via email by request.

To request a copy of the RRIP, please email the RRIP technical assistance team.

Additional resources for using RRIP in practice:

Per IHS Chapter 32, prescribers and pharmacists shall access the appropriate state PDMP at specified times throughout the course of caring for a patient receiving a controlled substance prescription.

It is recommended to document PDMP monitoring through the use of a patient education code. With this method, the patient will need to be provided with education following these proposed standards: PDMP Check Documentation in RPMS EHR with Education Codes [PDF - 402 KB]

Examples of FileMan reports that may be run to retrieve the documentation of any PDMP education codes from RPMS: PDMP Check Documentation in RPMS EHR with FM Reports [PDF - 477 KB]

Opioid Response Data

The U.S. Department of Agriculture (USDA) launched an interactive data tool to help rural communities address the opioid crisis. This new community assessment tool empowers rural leaders to make data-driven decisions to build resilient communities. The tool enables users to overlay substance misuse data against socioeconomic, census and other public information. This data will help leaders, researchers and policymakers assess what actions will be most effective in addressing the opioid crisis at the local level. The Opioid Misuse Community Assessment Tool Exit Disclaimer: You Are Leaving www.ihs.gov  is free and available to the public. It can be also be accessed from USDA’s Rural Opioid Misuse web page.

ITCA TEC Opioid Report 2018

The Opioid Epidemic in Indian Country, What Tribal Leaders in Arizona Need To Know Exit Disclaimer: You Are Leaving www.ihs.gov  [PDF - 1.77 MB]. The report, prepared in response to Tribal leadership prioritizing behavioral health and substance abuse, including opioids, in the IHS Phoenix and Tucson Service Areas, offers information to the Tribes ITAC provides epidemiologic services for.

Resources