Table 1.

Key Considerations in Data Sources

Consideration	Source	Yearsa	Availability	Example parameters	Key considerations
Prescription opioid utilization data
	Medicare Part D CMS	2013–2017	Reports, public-release research data set	Total opioid prescriptions paid for by Medicare Part D per year.	Limited lag, includes misclassifications. Excludes prescriptions paid for by other insurers or with cash. Linking prescription and treatment data is not feasible, except for data by CMS, but these were impacted by CMS redaction (2013–2017).
	Symphony Health PRA Health Sciences, Inc.	2009–2016	Proprietary data set, accessible with fee	Total individuals receiving >5 opioid prescriptions in a given year.	Reported with limited lag and contain filled prescriptions regardless of the source of payment. Cannot be linked to other medical treatment, including behavioral therapies for OUD.
	NPA, NSP IQVIA, Inc.	1990s-2020	Proprietary data set, accessible with fee	Total opioid prescriptions filled by mail order pharmacies. Total MOUD prescriptions filled by retail pharmacies.	Reported with limited lag time and contain filled prescriptions regardless of the source of payment. Cannot be linked to other medical treatment, including behavioral therapies for OUD. Some issues with unit measurement and overlap between what NPA/NSP cover.
	ARCOS: Automation of Reports and Consolidated Orders System DEA	2006–2019	Reports, selected restricted use data files	Total prescription opioids manufactured (by class). Locations to which these prescriptions were distributed.	Excludes transfer of substances from retailer to patient. Many distributors submit written forms which contain errors. ARCOS was formerly not publicly available at a localized geographic level (i.e., ZIP code) and information by drug is not public, just by drug class, so cannot standardize by MME.
	MEPS-HC: Medical Expenditure Panel Household Component AHRQ	1996–2017	Reports, public-release research data set	Total number of individuals with an opioid prescription. Average number of days’ supply in an opioid prescription.	Does not include information on inpatient drugs, institutionalized populations, or misuse of prescription drugs. Drugs for brief acute conditions are more likely to be underreported by patient reporters.
Illicit use of prescription opioids and heroin data
	NSDUH: the National Survey on Drug Use and Health SAMHSA	2002–2017	Reports, Public-Release research data set. Restricted data set accessible with special application at federal facilities	Total number of people who misuse prescription opioids or heroin. Total number of people who have an opioid or heroin- use disorder.	Restricted NSDUH includes location and dates for better calculation of substance use initiation. Nonmedical prescription opioid use definition changed in 2015, introducing a trend break. Underreporting likely based on numerous factors.
	NFLIS: National Forensic Laboratory Information System DEA	2007–2018	Reports, selected restricted use data files	Percentage of illicit substances, including opioids, identified and secured in law enforcement operations that contain fentanyl.	Details identified in the field are not included unless confirmed in the lab. Reporting schedules and level of detail vary across labs. Most labs report with significant delays.
Opioid addiction treatment data
	TEDS: The Treatment Episode Data Set SAMHSA	2006–2017 (discharge) 1992–2017 (admission)	Reports, public-release research data set	Percentage of opioid use treatment episodes where heroin is the primary substance of abuse. Percentage of treatment episodes for heroin where the individual also indicated problematic use of benzodiazepines.	Length of Stay data area mix of continuous and categorical, which limits analysis of treatment duration. Captures treatment episodes, so does not reflect repeat visits. Only some states include private facilities and individual practitioners; details of this are not included in the data set.
	NSDUH: the National Survey on Drug Use and Health SAMHSA	2002–2017	Reports, Public-Release research data set. Restricted data set accessible with special application at federal facilities	Total number of people whose last treatment episode was for their use of heroin.	Does not include detailed information on MOUDs received during treatment or treatment duration.
	N-SSATS: National Survey of Substance Abuse Treatment Services SAMHSA	2000–2018	Reports, public-release research data set	Total individuals receiving buprenorphine, methadone, or naltrexone per year (reported in most years).	Does not distinguish repeat visits. Data include categorical numbers of patients per center (e.g., “25–50”), which requires the use of annual reports to find total persons. Census of all treatment facilities, but response rates range year to year (60%−90%). Size of clinics missed is unknown, thus estimating underreporting is impossible.
Overdose, hospitalizations, mortality data
	NIS component of HCUP: Healthcare Costand Utilization Project AHRQ	1988–2017	Reports, public-release research data set	Total number of hospitalizations involving opioid poisoning/overdoses per year. Total number of hospitalizations involving opioid poisoning/overdoses per year resulting in a fatality.	Forty-eight states and the District of Columbia report to HCUP, but states report different levels of information and data are not state representative. HCUP also includes the State Inpatient Database (SID), but not all states contribute to this.
	NEMSIS: National Emergency Medical Services Information System University of Utah and DOT	2006–2018	Reports, public-release research data set	Fraction of overdose events involving EMS that are fatal versus nonfatal.	NEMSIS does not distinguish between individuals so shows 2 entries for transport and inpatient care of the same individual. Reports the care provided, not the diagnoses.
	Drug Overdose Mortality Data - NVSS: National Vital Statistics System CDC	1968–2018	Reports, public-release research data set as well as restricted use data set	Fraction of fatal overdoses Involving fentanyl alone versus fentanyl and benzodiazepines.	Coded In ICD-10, which provides categories, not specific drugs. Information about intent (misuse, suicide, etc.) difficult to reflect. Multiple substances are Included If present, but most lethal substance Is not specified. Reporting detail and frequency vary by locality.

^aThe years of availability in Table 1 reflect the years data are available in any form. AHRQ, Agency for Healthcare Research and Quality; CDC, Centers for Disease Control and Prevention; CMS, Centers for Medicare and Medicaid Services; DEA, Drug Enforcement Administration; DOT, Department of Transportation; EMS, emergency medical services; MME, morphine milligram equivalent; MOUD, medication for opioid use disorder; NIS, Nationwide Inpatient Sample; NPA, National Prescription Audit; NSP, National Sales Perspective; OUD, opioid use disorder; SAMHSA, Substance Abuse and Mental Health Services Administration.