[Test-ED Visits] Understanding Overdose Data

Use the monthly overdose reports for the most up-to-date data on fatal and nonfatal overdoses in your county and across the state.

Monthly Overdose Reports use provisional data to monitor overdose trends in NC before final data are available. These reports can be used to:

• Monitor changes in the number of overdoses happening statewide or at the county level to know when to respond or act.
• Know where overdoses are happening in the state and which groups are experiencing overdoses.
• Focus prevention and response activities to groups that are most impacted by overdose.

For more information on using provisional data to monitor overdoses in NC, visit Using Provisional Overdose Data.

Monthly Overdose Reports are shared through a Google Drive folder.

• Open the folder in the Google Drive for the report you are interested in.
• Select the “Download” button on the far right of the screen to download the report.

Four reports are updated monthly with the most recent data.

Separate reports include data on overdose deaths, the most severe outcome of the overdose epidemic, and non-fatal overdoses. Use the reports together for a more complete picture of overdoses across the state.

There are additional overdoses that may not be captured in these reports, for example, if someone does not seek medical treatment after an overdose. But these reports can provide important context to support planning and response.

Use the interactive overdose data tool to access overdose data if you are comfortable using data dashboards to query and filter data.

The interactive overdose data can be used to:

• Filter data for metrics by place, statewide or by county.
• Monitor changes in the number and rate of overdose metrics to help know when to respond or act in your community.
  • Compare the change in the selected metric from year to year.
  • Compare the rates for the selected metric to the statewide rate and across counties.
  • Monitor whether rates for a selected place (state/county) are high, low, or about the same as the rate for other places in NC over time.

Overview of Overdose Metrics

The interactive overdose data include metrics that describe overdose deaths, ED visits, opioid and buprenorphine dispensing, opioid use disorder treatment services, and foster care due to parental substance use.

• Some metrics are reported as a rate per 100,000 while others are reported as a percentage (rate per 100).
  • For more information on the differences between these rates, visit Understanding Counts and Rates.
• The timeframe of data used for each metric and how often data are updated depends on the source of the data.
• For more detailed information on the case definitions used for each metric, visit NC IVPB Injury Case Definitions. [UPDATE link]

Death Data Metrics

• Include annual data for 2010 forward.
• The death metrics for the most recent year are projected yearly estimates based on what has been reported so far. For example:
  • There were 1,071 overdose deaths from Jan – Apr 2024, representing a projected 3,213 overdose deaths in 2024.
     

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• Estimates will always be made using at least three months of provisional data.
  • For example, estimates of 2025 overdose deaths will not be reported until data for Jan-Mar 2025 are close to being complete, likely in March 2026.
  • Because of these data availability requirements and the delay in death data, there is at least a 3-month lag in reporting projected deaths for the previous year. 
• These estimates of overdose death are updated monthly and likely become more accurate as additional cases are finalized.
• For more information, visit Using Provisional Overdose Data or the general injury provisional factsheet.

ED Visit Data Metric

• Includes annual data for 2016 forward. See Using Provisional Data for Monitoring Injuries for more information.
• ED visit data are the timeliest data available but take time to finalize.
  • ED visit data are updated monthly with a one-month delay in reporting.
  • The most recent ED visit data are provisional and subject to change as visit data are finalized. For more information, visit Using Provisional Overdose Data.
• The ED visit data metric for the most recent year is also a projected yearly estimate based on what has been reported so far.
  • See the example above for Death Data Metrics.

Other Metrics

• All other metrics are updated annually with the most recent year of final data.
• Controlled Substances Reporting System (CSRS) metrics include data for 2013 forward.
• Division of Mental Health, Developmental Disabilities, and Substance Use Services (DMH) treatment metric includes data 2014 forward.
• Division of Social Services (DSS) metric includes data for 2015 forward.

Use the downloadable statewide overdose data to conduct your own analyses and create your own data visualizations using NC overdose data.

All of the data used to populate the Interactive Overdose Data on the NC Overdose Epidemic Data webpage are included in a downloadable CSV file.

• Data are available for each metric at the state and county level.
• Each row represents the data for a given metric for each year and each place (county/statewide).
  • Data include the number of events for each metric, the rate (percentage or rate per 100,000 NC population), and the change in the rate compared to the previous year.
• There is an accompanying data dictionary available that describes each of the variables included in the downloadable data.

Use the core overdose prepared PowerPoint slides to include overdose data in your next presentation, or as a resource to understand more about overdoses in NC.

The Core Overdose Slide Set gives an overview of the history of the epidemic in NC, present statewide overdose trends, our state’s actions to prevent overdoses, and the connection between overdoses and other public health topics.

These slides can be used to:

• Understand the who, what, when, where, and why of overdose in NC.
  • These PowerPoint slides are meant to offer a state-level background on drug overdose.
  • The slides were created to provide basic data trends and public health surveillance around the drug overdose epidemic.
• Incorporate overdose data into your own presentations, grant proposals, reports, or any other way they may be useful.
  • Each slide includes detailed notes explaining the information on the slide.
  • Technical notes are also available to help with understanding and presenting data.

NC-SUDORS combines data from death certificates, medical examiner reports, and toxicology results. The system is a critical tool for understanding the overdose epidemic and providing high quality data to guide public health interventions.

These data include information on circumstances surrounding unintentional overdose deaths, like overdose and substance abuse treatment history, routes of drug use, and if naloxone was given.

Case-Level Data 

Use case-level NC-SUDORS data to research overdose deaths of unintentional and undetermined intent or to inform local overdose response efforts.

• Researchers may request NC-SUDORS data to conduct their own research.
• Local health departments may request their jurisdiction’s NC-SUDORS data to aid in their response efforts, including overdose fatality reviews.
• More information on how to request detailed case-level NC-SUDORS data is available on the NC Overdose Epidemic Data webpage.

NC-SUDORS Factsheets

Use NC-SUDORS fact sheets for data on overdose deaths by county and congressional district.

NC-SUDORS creates fact sheets for each NC county and congressional district that include data specific to that area of the state. These factsheets can be used to:

• Understand which groups are experiencing overdoses within a given county or congressional district
• Understand how overdoses in a county or congressional district compare to overdoses across the state.
• Understand the circumstances surrounding overdoses in a given county or congressional district to help inform overdose prevention in that area. 

Use these additional data resources to understand factors that contribute to the overdose crisis in NC.

• Resources include information on mental health and overdose, homelessness and overdose, and other overdose-related topics.

• Because data are always being collected and updated, provisional data can change as new information is added.
• How complete provisional data are varies by data source, data system, and when the data are accessed.
• The quality and completeness of the information can also be different for different groups of people.

Whenever provisional data are used a note should be included to indicate the data are provisional.

• This allows people to know that the data can change so they can use the data appropriately.
• For example:
  • Report Title – North Carolina Emergency Department (ED) Visits for Opioid Overdose: April 2025* Update
  • Report Footnote – *Data for 2024 - 2025 ED visits are provisional.

• ED data from the NC Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT) are used to create monthly overdose reports at the state and county levels on ED visits for opioid overdose and ED visits for all drug overdoses.
• These reports are posted to the NC IVPB Overdose Epidemic Data website and are shared with partners across the state to help health officials and communities make decisions.

Provisional ED visit data are also available to authorized local or state public health users in “near real time” through the NC DETECT data portal. Since the data are updated often, running the same search at different times might give varying results as new information is added.

Using provisional death certificate data as soon as they are reported can show fewer overdose deaths than there really were.

This is because some records may not be fully updated with the correct overdose code.

• There is a delay in death certificate data in all states.
  • Overdose deaths take longer to finalize because they need time for investigation.
  • It takes time to confirm the cause of death and assign an International Classification of Diseases 10 (ICD-10) code. These are codes used to classify and describe the primary and underlying causes of death.
• Coding of death certificates currently takes longer in NC than in most other states because of system changes and delays in autopsy reporting.
• Provisional death certificates may have a pending ICD-10 cause of death code (R99) when they are first reported into the state’s system to track death records, NC DAVE (Database Application for Vital Events).
  • This code is usually updated to a more specific cause of death code before the
  • NC death certificate data are finalized.
  • Many deaths confirmed as overdoses in the final death certificate data were first reported to NC DAVE with a R99 code.

Why is this important?

• CDC, the media, and others report estimated overdoses for states using data states submit to a national system at CDC.
• For NC, using provisional data from the national system can be a problem.
  • Longer delays in death certificate coding in NC may cause provisional data to be more incomplete than they are for other states.
• Delays in coding can make it look as if there have been fewer overdose deaths in NC than there really were.

Each indicator considers the delay in death certificate coding in its own way.

Because of this, data from the Centers for Disease Control and Prevention (CDC) and other NC programs can be different from the data shared by IVPB. NC and national indicators are described further below.

IVPB has worked with the Office of the Chief Medical Examiner (OCME) to create faster indicators to track overdose deaths using OCME data.

• These indicators are used to create the IVPB Monthly Overdose Reports on suspected overdose deaths and fentanyl-positive deaths.
• For more information on differences between IVPB data and other sources, visit Differences in Reported Data.

Not all overdose deaths have been assigned an ICD-10 code for overdose in the provisional death certificate data yet.

• This can make it seem like there has been a big decrease in overdoses in NC.
• The NC Suspected Overdose Deaths indicator using OCME data provides a more realistic idea of the changes in overdose deaths in the state.
• IVPB waits 6 months before using provisional death certificate data, allowing more time for overdose deaths to be assigned an ICD-10 code for overdose.

Percent Change in the Number of Overdose Deaths from October 2023 to October 2024 Across Provisional Overdose Death Indicators

In 2025, IVPB updated the indicators used to monitor emergency department (ED) visits for overdoses of unintentional and undetermined intent in the North Carolina Disease Event Tracking and Epidemiologic Collection Tool (NC DETECT). 

These indicators track ED visits related to acute medication/drug overdoses, including opioid overdoses. They do not include ED visits related to alcohol or chronic effects of substance use, unless a medication/drug overdose was also identified within the visit. 

This change in the indicators:

• Identifies more ED visits due to overdose in NC DETECT.
• Aligns IVPB case definitions for overdose ED visits more closely to CDC overdose case definitions that were released in 2024.
  • Visit the “About nonfatal overdose syndromic surveillance” drop-down on the CDC Drug Overdose Surveillance and Epidemiology (DOSE) webpage for more information on CDC overdose case definitions.
• Gives a more realistic idea of the burden of overdose in NC.

What is Syndromic Surveillance?

Syndromic surveillance systems help to detect, understand, and monitor health
threats quickly, in near real time.

• These systems use syndromes, a type of indicator, to identify ED visits based on keywords and phrases, as well as ICD-10-CM diagnosis codes.
• For more information, visit Understanding Surveillance Case Definitions.
• NC DETECT is NC's statewide syndromic surveillance system.
• NC DETECT is the timeliest data source available to monitor overdoses. 
   

Monthly Overdose ED Visit Reports have been updated to use these new indicators.

What Changed

Case definitions for NC overdose indicators were updated to be more similar to indicators the CDC uses.

Below is a comparison of what elements are included in the new NC indicators and the CDC indicators compared to the old NC indicators. 

The table above shows the differences between what is included in the new NC and CDC overdose indicators and what was included in the overdose indicators NC used previously.

New indicators find about 450 more overdose cases statewide each month. However, the trend, or overall pattern in overdose ED visits over time, does not change. 

The figure above shows the difference in the estimated number of all drug overdoses and of opioid overdoses that were identified using the old NC indicator compared to the new NC indicator. The new indicator identifies additional ED visits for both indicators.

Why Were the NC Overdose Indicators Updated?

The CDC released updated overdose case definitions in 2024. After validating the new CDC case definitions, IVPB decided to implement similar changes to align NC's overdose case definitions more closely to CDC's.

• IVPB compared the CDC indicators used to monitor overdose ED visits nationally with NC indicators in NC DETECT.
  • CDC indicators identified more cases by using overdose keywords found in the chief complaint, ICD-10-CM codes for substance abuse and overdoses of undetermined intent, and additional ICD-10-CM codes in their case definitions.
  • Including keywords can help find ED visits for overdoses that haven’t been assigned an ICD-10-CM code for an overdose yet.
  • After a detailed review, most of these additional cases could be validated as overdoses and should be included.