Poisonings among Arizona Residents 2015

Resources for the development of this report were provided through funding to the Arizona Department of
Health Services from the Centers for Disease Control and Prevention, Cooperative Agreement 5U17CE002023
Core Violence and Injury Prevention Program.
Permission to quote from or reproduce materials from this publication is granted when acknowledgment is
made.

Prepared by: Kyle Gardner, MSPH
150 North 18th Avenue, Suite 320
Phoenix, AZ 85007
Office of Injury Prevention
Bureau of Women’s and Children’s Health
Arizona Department of Health Services
January 2017

1

Table of Contents
Executive Summary ............................................................................................................... 3
Overview of Poisonings among Arizona Residents .................................................................. 3
Poison Control Centers Serving Arizona.................................................................................. 6
Five-Year Trends in Poisonings among Arizona Residents ....................................................... 7
Mortality ...................................................................................................................................... 7
Non-Fatal Inpatient Hospitalizations ........................................................................................ 11
Non-Fatal Emergency Department Visits .................................................................................. 16
Poisoning-Related Mortality ................................................................................................ 19
Poisoning Fatalities by Manner ................................................................................................. 22
Non-Fatal Poisoning-Related Inpatient Hospitalizations ....................................................... 24
Non-Fatal Poisoning-Related Inpatient Hospitalizations by Manner ........................................ 27
Non-Fatal Poisoning-Related Emergency Department Visits ................................................. 30
Non-Fatal Poisoning-Related Emergency Department Visits by Manner ................................. 33
Poisoning and Prescription Drug Overdoses ......................................................................... 36
Poisoning Prevention Tips and Resources ............................................................................. 37
Methodology ....................................................................................................................... 38

2

Executive Summary
The data presented in this report show that poisoning is a public health problem that impacts the lives of
thousands of Arizona residents each year. These injuries can occur throughout the life span, and like so many
injuries, poisonings are preventable. Understanding the circumstances of poisonings is an important step
towards educating and empowering communities and implementing prevention strategies.
Poisoning was the leading cause of injury-related mortality among Arizona residents in 2015 accounting for a
total of 1,335 deaths. The age-adjusted poisoning mortality rate in 2015 was 20.1 deaths per 100,000
residents and represents a 5.2% increase from 2014 (19.1 deaths per 100,000 residents). Males aged 45 to 54
years had the highest rate of poisoning-related deaths with 45.9 deaths per 100,000 residents. Age-adjusted
poisoning mortality rates per 100,000 residents were highest among American Indians or Alaska Natives (36.5)
and White non-Hispanics (24.8). The manner of death for majority of poisoning related deaths was
unintentional (78%, n=1,046), followed by suicides (14%, n=192), and then undetermined (7%, n=96).
The poisons most commonly specified on death certificates in 2015 were pharmaceutical opioids (n=401),
methamphetamines and other stimulants (n=365), and alcohol (n=291). Seventy-seven percent of
pharmaceutical opioids were among White non-Hispanic residents. Among pharmaceutical opioids deaths,
females aged 45 to 54 years had the highest rate (15.1 deaths per 100,000), while for males the 35 to 44 years
age group had the highest rate (10.7) Fifty-two percent of pharmaceutical opioids related deaths occurred in
Maricopa County and twenty-three percent in Pima County. The age-adjusted Heroin poisoning mortality rate
for 2015 was 3.7 deaths per 100,000 residents and represents a 37% increased from 2014 (2.7 deaths per
100,000 residents). In 2015, the 25-34 years age group had the highest rate for fatal heroin poisoning. Across
all age groups, the fatal heroin poisoning rate for males was two times more than the females.
There were 5,796 non-fatal inpatient hospitalizations due to poisonings, and represents an 8.3% decrease
since 2014. Overall, inpatient hospitalization (IP) rates due to poisoning have decreased by 21% since 2011.
Adult females continue to have the highest rates of poisoning-related inpatient hospitalizations. Females aged
45-54 years old had the highest rate with 131.0 hospitalizations per 100,000 residents, followed by females
aged 15-24 years old (122.4 hospitalizations per 100,000 residents), and then females aged 35-44 years old
(120.6 hospitalizations per 100,000 residents). American Indian or Alaska Native had the highest age-adjusted
poisoning-related rate of IP with 125.8 hospitalizations per 100,000 residents, followed by Black or AfricanAmericans (114.7 hospitalizations per 100,000 residents), and then White non-Hispanic residents (103.2
hospitalizations per 100,000). Unintentional poisoning accounted for 45% of poisoning-related IP (n=2,636),
intentional poisonings comprised an additional 45% (n=2,583), and undetermined intent accounted for 10% of
poisonings. Hospital charges for non-fatal poisoning-related inpatient hospitalizations totaled more than $208
million in 2015, with charges to AHCCCS totaling over $91 million (n=2,659, 45%). Arizona residents spent a
total of 21,110 days hospitalized for poisoning injuries. Gila County had the highest age-adjusted rate of IP due
to poisonings (113.9 hospitalizations per 100,000 residents), followed by Pima County (112.2 hospitalizations
per 100,000 residents).
There were 12,658 non-fatal poisoning-related emergency department visits among Arizona residents. Overall,
Emergency Department Visits (EDV) rates due to poisoning have decreased by 2.7% since 2011. The highest
age-specific rates of poisoning-related emergency department visits were among children aged 1-4 years old
with 421.4 EDV per 100,000 residents. For this age group, the rate for males and females were 431.5 and
410.9 per 100,000 residents, respectively. Fifty-four percent of the non-fatal poisoning-related EDV were the
result of unintentional poisonings (n=6,764), and thirty-five percent of the visits resulted from intentional
injuries (n=4,385). Graham County and Gila County had the highest rate with 326.4 and 293.2 visits per
100,000 residents, respectively.

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Overview of Poisonings among Arizona Residents
Poisoning, particularly drug poisoning, has emerged as a significant public health concern in the United States
and Arizona. Beginning in 2007, poisoning-related deaths surpassed motor-vehicle crashes as the leading
injury-related cause of death among Arizonans.1 As this report shows, the burden of poisoning-related injuries
has been increasing steadily over the past decade, accounting for a greater percentage of injury-related
morbidity and mortality. Figure 1 shows the overview of the number of poisoning-related events by outcome
and illustrates the limitations of currently available data sources and the inability to enumerate the true
number of poisonings.

Figure 1. Poisoning Outcomes Pyramid, Arizona 2015

1,335 Deaths

5,796 Non-fatal Inpatient
Hospitalizations

12,658 Non-fatal Emergency
Department Visits

??? Poisonings treated in physician's offices,
other outpatient facilities, at home, via Poison
Control Center, or not treated

This report presents a comprehensive picture of poisoning-related injuries among Arizona residents in 2015, as
well as poisoning trends during the five years since 2011. To help better understand the data, information
about poison control centers is also presented. For additional information about data sources and methods
used, please refer to the Methodology section of this report. In order to learn about preventing poisonings,
please refer to the Prevention Tips and Resources section of this report. Figure 2 illustrates when poisoning
surpassed motor vehicle traffic crashes and shows trends in Arizona for the last ten years, 2005 through 2015.
Also included in figure 2 are drug overdose fatalities, a sub-category of poisoning deaths that include
overdoses from prescription drugs, illicit drugs and/or over-the-counter drugs, as the underlying cause of
poisoning death. Since 2005 poisoning deaths have increased over 36 percent, while motor vehicle crash
deaths have decreased over 38 percent during the same time period.

1

Please refer to the Methodology Section for a description of the types of poisonings included in this report; these numbers may not match
other publications.

4

Figure 2. Poisoning and Drug Overdose Mortality Age-adjusted Rates
compared to Motor Vehicle-Related Mortality Rates,
Arizona Residents, 2005-2015
Deaths per 100,000 Residents

25.0
20.0
15.0
10.0
5.0
0.0
2005

2006

2007

2008

2009

2010

2011

2012

2013

2014

2015

Year
Motor Vehicle Traffic-related

Poisoning

Drug Overdose

5

Poison Control Centers Serving Arizona
Poison Control Centers (PCCs) are widely considered to be a cost-effective tool for reducing healthcare costs
resulting from poisoning events. A recent study on the cost-savings analysis and return on investment
regarding poison control centers found that every dollar invested in America’s poisoning centers saves $13.39
in health care costs and lost productivity. 2 In total, the poison center system saves approximately $1.8 billion
per year in medical costs and productivity.3 Because of the clear benefit to citizens, the state of Arizona has
mandated the existence of a PCC since 1980. Per Arizona Revised Statutes (ARS) 36-1161 through 36-1163, the
Arizona Department of Health Services is responsible for establishing a poison and drug information system
consisting of two poison control centers. While the poison control centers are charged with serving as a
resource for poison identification and treatment, they are also tasked with educating the public about
poisoning prevention.
Two of the nation’s 57 nationally recognized PCCs are located in Arizona. The Arizona Poison and Drug
Information Center (APDIC) is affiliated with the University of Arizona College of Pharmacy located in Tucson.
The Banner Good Samaritan Poison & Drug Information Center (BGSPDIC) is located in Phoenix. The BGSPDIC
serves Maricopa County, including the metropolitan Phoenix area. The APDIC serves the remainder of the
state. While the BGSPDIC serves a smaller geographic area, it covers about 60 percent of the state’s residents.
Similar to other nationally recognized PCCs, both Arizona centers are accessed by calling the National Poison
Control Center toll-free telephone number: 1-800-222-1222. Calls to this number are routed to the appropriate
PCC based on geography. Because calls are routed based on the telephone number from which the call is
placed, individuals with an Arizona telephone area code will speak to either BGSPDIC or APDIC, even if they are
calling from outside Arizona. Individuals are encouraged to call PCCs with any concerns, whether or not an
incident has occurred. While providing information and medical advice about poisonings, both of Arizona’s
centers provide additional services to residents including drug information and identification, medical
consultation with clinicians, and poisoning prevention education and outreach.
In 2015, the APDIC documented 20,283 calls for human exposures to toxins and poisons, out of 34,199 total
calls (59 percent). Twenty of these cases resulted in death while 35 percent (n=7,163) of the calls were
managed in a healthcare facility.
In 2015, the BGSPDIC documented 42,859 calls for human exposures to toxins and poisons, out of more than
62,173 total calls (70 percent). Forty-three percent of all human exposures involved children 12 years or
younger (n=18,544) and 36 percent of involved children five years and younger (n=15,336). Eighty-seven
percent of children’s poison or drug exposures were managed without the need for a costly emergency
department visit. Seventy-three percent of all human exposures to toxins and poisons were managed at home.
The availability of a 24-hour poison control center allows many people who may have sought emergency care
to be treated in their own homes, resulting in financial savings for themselves and the healthcare facilities they
may have otherwise visited. Combining both APDIC and BGSPDIC numbers, it is estimated that more than
50,000 callers may have sought medical treatment at an emergency department in 2015 if they had not been
able to consult with the poison control center and care for themselves at home. PCC centers means the
community prevented more than $58 million in emergency treatment costs.

2,3

The Lewin Group. (2012) Final Report on the value of the Poison Center System. [White Paper]. Retrieved from
https://aapcc.s3.amazonaws.com/files/library/Value_of_the_Poison_Center_System_FINAL_9_26_2012_--_FINAL_FINAL_FINAL.pdf

6

Five-Year Trends in Poisonings among Arizona Residents, 2011-2015
Mortality
Injuries account for approximately ten percent of deaths among Arizona residents each year and the
proportion of injuries have remained relatively stable over time. Since 2011, the percentage of poisoningrelated deaths have remained relatively the same, from 25 percent of all injury-related deaths in 2011
(n=1,144) to 26 percent of injury-related deaths in 2014 (n=1,335). Over this five-year period, the number of
injury-related deaths has increased slightly, from 4,546 deaths in 2011 to 5,081 deaths in 2015. Figure 3 shows
the distribution of injury-related deaths by mechanism of injury over the five year period from 2011 through
2015.

Figure 3. Proportion of Injury-Related Fatalities by Mechanism of Injury,
Arizona 2011-2015
100%
90%

25%

24%

26%

27%

26%

7%

8%

8%

9%

8%

21%

20%

19%

19%

18%

16%

16%

15%

14%

15%

17%

18%

18%

19%

20%

14%

14%

14%

12%

12%

2011 (n=4,546)

2012 (n=4,496)

2013 (n=4,836)

2014 (n=4,600)

2015 (n=5,081)

80%
70%
60%
50%
40%
30%
20%
10%
0%
Other Causes

Fall

Motor Vehicle Traffic

Firearm

Suffocation

Poisoning

Between 2011 and 2015, the age-adjusted poisoning-related mortality rate increased by 11% for Arizona
residents. This overall increase is attributable to the rate of unintentional poisoning deaths, which has
increased by 13% in 2015 (15.9 deaths per 100,000 residents) from since 2011 (14.0 deaths per 100,000
residents). Overall from 2011-2015, suicide-related poisonings have decreased by 7% since 2011. However
there was an 8% increase in suicide-related poisonings from 2014. Figure 4 displays the age-adjusted
poisoning-related mortality rates by manner of death for Arizona residents from 2011 to 2015.

7

Figure 4. Age-Adjusted Poisoning-Related Mortality Rates by Intent,
Arizona 2011-2015

Rate per 100,000 Residents

25.0
20.0
15.0
10.0
5.0
0.0
2011

2012

2013

Unintentional

Suicide

2014

2015

Total (All Manners)

Overall, male mortality rates due to poisoning were consistently higher than females between 2011 and 2015.
The age-adjusted poison mortality rate increased by 18.5% for males (24.9 deaths per 100,000 residents) and
1.3% for females (15.3 deaths per 100,000 residents) in 2015 compared to 2011 (21.0 deaths per 100,000 for
males and 15.1 deaths per 100, 000 residents for females). Figure 5 shows the age-adjusted poisoning-related
mortality rates by gender during the five year period.

Figure 5. Age-Adjusted Poisoning-Related Mortality Rates by Sex,
Arizona 2011-2015

Rate per 100,000 Residents

30.0
25.0
20.0
15.0
10.0
5.0
0.0
2011

2012

2013
Males

Females

2014

2015

Total

8

Overall the age-adjusted poison-related mortality increased across all race and ethnicity groups from 20112015. American Indians or Alaska Native residents continued to have the highest poisoning-related mortality
rate at 36.5 deaths per 100,000 residents, and represents a 41% increase from 2014 (25.8 deaths per 100,000
residents). Mortality rates increased 9% for Black or African American and 6% for White non-Hispanic residents
in 2014 Figure 6 shows the age-adjusted poisoning-related mortality rates by race/ethnicity for Arizona
residents from 2011 to 2015. Due to small numbers, age-adjusted poisoning-related mortality rates have not
been presented for Asian residents.

Figure 6. Age-Adjusted Poison-Related Mortality Rates by Race/Ethnicity,
Arizona 2011-2015

Rate per 100,000 Residents

45.0
40.0
35.0
30.0
25.0
20.0
15.0
10.0
5.0
0.0
2011

2012

2013

2014

White non-Hispanic

Latino or Hispanic

American Indian or Alaska Native

Black or African American

2015

9

While the trend is not supported in all counties, the rate of poisoning-related fatalities in Arizona increased
11% between 2011 and 2015. Age-adjusted mortality rates increased from last year for the following counties
Apache, Cochise, Coconino, Graham, Greenlee, La Paz, Maricopa, Mohave, Pima, Pinal, Santa Cruz, Yavapai,
and Yuma. Table 1 shows the age-adjusted mortality rate per 100,000 residents for poisoning-related deaths
by county of residence from 2011 to 2015.

Table 1. Age-Adjusted Mortality Rates per 100,000 Residents for Poisoning-Related Deaths by County
Arizona 2011-2015
2011
2012
2013
2014
2015
Apache*
23.3
22.1
9.5
30.0
42.7
Cochise*
9.4
19.4
9.8
15.7
31.5
Coconino*
21.0
17.7
36.1
24.2
26.9
Gila*
25.4
33.6
28.1
48.8
38.1
Graham*
19.9
18.2
20.4
17.4
23.6
Greenlee*
16.2
**
**
20.9
43.6
La Paz*
14.0
**
28.8
36.9
48.8
Maricopa
16.7
14.9
16.7
17.0
17.6
Mohave
28.3
27.6
30.7
24.8
32.3
Navajo*
35.1
37.6
58.8
39.1
33.9
Pima
20.7
20.8
23.0
22.6
24.9
Pinal
13.0
12.3
13.3
9.5
14.1
Santa Cruz*
5.5
5.7
7.3
9.0
11.8
Yavapai
31.0
35.2
34.1
27.4
26.2
Yuma*
12.2
15.5
11.1
20.7
13.8
Statewide Total
18.1
18.2
19.1
19.1
20.1
*Rates are unstable for counties indicated, as they had fewer than 20 deaths in at least one year.
** No poisoning-related deaths were recorded for these counties.

10

Drug Overdose Deaths
Every poisoning-related death has its own circumstances, including the type of poison used. Multiple drugs
may be listed as contributing to a single death. Prescription drug overdoses, specifically from opiate pain
relievers such as hydrocodone, oxycodone and methadone, have become an epidemic in the United States.
The graph shows that overdoses due to prescription opiate pain relievers were declining in Arizona from 2011
to 2013 but increased from 2013 to 2015. The number of deaths involving heroin continues to rise and have
doubled since 2011 from 120 deaths to 235 deaths. Deaths involving stimulants (including methamphetamine)
also continues to rise, increasing from 154 deaths in 2010 to 365 deaths in 2015.
An emerging public health concern with drug overdoses is the appearance of new or altered drugs. These
synthetic drugs, composed of several drug classes or unknown substances, are difficult to identify by
laboratory testing. This also creates challenges with monitoring drug overdose trends by specific drug. Other
and unspecified drugs and unspecified narcotics are examples of synthetic groups that may also contain multi
or poly-drug combination overdose. The decrease in Other and unspecified drugs group, may be due to the
ability of the State Laboratory and Medical Examiners to identify specific drug classes within these synthetic
drugs. Further analysis of death records shows while opiate drugs were not specifically coded as the main
cause of death, they still contributed to the increasing number of overdoses in combination with other
prescription illicit drugs. An example of a poly drug overdose death listed with a code of other and unspecified
drugs/narcotic could include an opiate derivative mix with a stimulant, benzodiazepine, and alcohol use. In
such a case the agent solely responsible for the death is unknown, and not be classified into a definitive drug
category. Figure 7 illustrates the specific drugs that were listed on the death certificates contributing to the
overdose fatality.

Number of Drug Poisoning Deaths

450

Figure 7. Number of Drug Overdoses Deaths Involving Selected Drugs,
Arizona 2011-2015

400
350
300
250
200
150
100
50
0
2011

2012

2013

2014

2015

Year
Opioid pain relievers (T40.2-T40.4)

Cocaine (T40.5)

Heroin (T40.1)

Benzodiazepines (T42.4)

Other and unspecified narcotics (T40.6)

Psychostimulants with abuse potential (T43.6)

Other and unspecified drugs (T50.9)

11

Approximately one Arizona resident dies per day due to a prescription opioid poisoning. Figure 8 illustrates
the trends in prescription opioid poisonings along with heroin overdose rates from 2011 to 2015. The
Prescription opiate poisoning mortality rate decreased by 18% from 2011 to 2013. However, from 2013 to
2015, the prescription opioid poisoning mortality rate increased by 18% and bringing the rate back to where it
was for 2011 (6.1 deaths per 100,000 residents). Heroin overdose deaths continue to rise almost doubling
during the last five years. From 2011 to 2015, the Heroin poisoning mortality rate increased by 94.7%.

Rate per 100,000 Residents

Figure 8. Drug Poisoning Mortality Rates Due to Pharmaceutical Opiates and
Heroin, Arizona 2011-2015
7.0
6.0
5.0
4.0
3.0
2.0
1.0
0.0
2011

2012

2013

Year
Pharmaceutical Opioid Poisoning

2014

2015

Heroin Poisoning

Figure 9 shows the mortality rates for pharmaceutical opiate poisonings by age group. The highest
pharmaceutical opiate poison mortality rate per 100,000 deaths among age groups were adults 45-54 years
old (12.1), followed by 35-44 years old (10.8), and then 55-64 years old (9.5) age group. Mortality rates for
teens and young adults 15 to 24 years old declined from 2011 to 2014 by 36 percent. However, the mortality
rate for teen and young adults have increased by 48% from 2014 (2.1 deaths per 100,000 residents) to 2015
(3.1 deaths per 100,000 residents).

12

Figure 9. Drug Overdose Mortality Rates Involving Pharmaceutical Opiates by
Age Group, Arizona 2011-2015

Rate per 100,000 Residents

14.0
12.0
10.0
8.0
6.0
4.0
2.0
0.0
2011

2012
15 to 24 Yrs
55 to 64 Yrs

2013
25 to 34 Yrs
65 to 74 Yrs

2014
35 to 44 Yrs
75 to 84 Yrs

2015
45 to 54 Yrs
85+ Yrs

13

Non-Fatal Inpatient Hospitalizations
Overall, between 2011 and 2015, the age-adjusted rate of non-fatal poisoning-related Inpatient
Hospitalizations (IP) among Arizona residents decreased by 21%, from 108.4 hospitalizations per 100,000
residents in 2011 to 85.6 hospitalizations in 2015. In 2015, the rate of unintentional poisonings-related IP
was 37.9 hospitalizations per 100,000 residents (n=2,636). This rate represents a 5.3% decrease in
unintentional poisoning from 2014, where the rate was 40.0 hospitalizations per 100,000 residents. Since
2013, the age-adjusted rate for intentional poisoning-related IP has remained higher than the age-adjusted
rate for unintentional poisoning-related IP. The age-adjusted rate for intentional poisoning-related IP
decreased by20.5% over five year period. Figure 10 shows the age-adjusted poisoning-related rates for nonfatal Inpatient Hospitalizations (IP) by injury intent for Arizona residents from 2011 to 2015.

Rate per 100,000 Residents

Figure 10. Age-Adjusted Poisoning-Related Inpatient Hospitalization Rates by
Manner, Arizona 2011-2015
120.0
110.0
100.0
90.0
80.0
70.0
60.0
50.0
40.0
30.0
20.0
2011

2012
Unintentional

2013
Intentional

2014

2015

Total (all manners)

The age-adjusted rates for poisoning-related inpatient hospitalizations were higher for females than for males.
Rates increased from 2011 to 2012, but decreased 2013 to 2015 among both males and females. Figure 11
shows the age-adjusted rates by sex for non-fatal poisoning-related inpatient hospitalizations from 2011
through 2015.

14

Figure 11. Age-Adjusted Poisoning-Related Inpatient Hospitalization Rates by
Sex, Arizona 2011-2015
140.0

Rate per 100,000 Residents

120.0
100.0
80.0
60.0
40.0
20.0
0.0
2011

2012

2013
Males

Females

2014

2015

Total

The rates of the counties with at least 20 hospitalizations in one year varied between 2011 and 2015. Table 2
shows the age-adjusted inpatient hospitalization poisoning rate by county of residence from 2011 through
2015. Four of the state’s 15 counties had at least one year in which there were fewer than 20 events, making
the rates for those counties unstable over time.
Table 2. Age-Adjusted Rate per 100,000 Residents for Non-Fatal Poisoning-Related Inpatient Hospitalizations
by County of Residence, Arizona 2011-2015
2011
2012
2013
2014
2015
Apache*
43.0
61.6
54.7
55.6
69.9
Cochise
73.7
63.5
56.7
66.3
69.6
Coconino
85.2
81.8
101.5
92.6
108.1
Gila
156.0
149.2
136.0
139.9
113.9
Graham
88.4
63.6
58.9
46.3
40.8
Greenlee*
127.2
125.6
80.3
64.7
28.3
La Paz*
68.1
40.4
57.8
78.2
64.2
Maricopa
117.3
115.5
102.0
93.4
82.6
Mohave
123.2
142.5
160.5
137.9
109.5
Navajo
103.9
110.6
112.5
132.6
109.9
Pima
109.6
123.6
113.0
112.5
110.9
Pinal
92.3
113.7
83.1
81.8
74.6
Santa Cruz*
59.3
40.5
42.6
18.3
36.8
Yavapai
85.4
97.7
94.0
96.0
68.2
Yuma
38.9
43.0
42.3
38.8
48.3
Statewide Total
108.4
111.0
100.2
94.5
85.6
*Rates are unstable for counties indicated, as they had fewer than 20 cases in at least one year.

15

From 2011 to 2015, the number of Opioid Inpatient Hospitalization (IP) decreased by 24.3%, and there was a
20.3% decrease in the rate for Opioid IP from last year. Over the last five years, the number of Heroin IP visits
increased by 37.6%, and there was a 9.1% increase in the rate for Heroin IP from last year. Over the last five
years, the number of Benzodiazepines IP decreased by 36.8%, and there was a 20% decrease in the rate for
Benzodiazepines IP from last year. Figures 12 and 13 illustrate the trends in prescription opiate poisonings
along with heroin and benzodiazepine poisoning from 2011 to 2015.
Figure 12. Number of Poisoning Inpatient Hospitalizations by Drug Type*,
Arizona 2011-2015
1,600
1,400
Number of Visits

1,200
1,000
800
600
400
200
0
2011

2012

2013

2014

2015

Year
Opioid Poisoning Visits

Heroin Poisoning Visits

Benzodiazepine Poisoning Visits

*Primary Diagnosis Code and E-Codes only

Figure 13. Age-adjusted Rate of Poisoning Inpatient Hospitalizations by Drug Type*,
Arizona 2011-2015

Rate per 100,000 Residents

25
20
15
10
5
0
2011

2012

2013

2014

2015

Year
Opioid Poisoning Visits

Heroin Poisoning Visits

Benzodiazepine Poisoning Visits

*Primary Diagnosis Code and E-Codes only

16

Non-Fatal Emergency Department Visits
Overall, between 2011 and 2015, the age-adjusted rate of non-fatal poisoning-related Emergency Department
Visits (EDV) among Arizona residents decreased by 2.7%, from 196.9 EDV per 100,000 residents in 2011 to
191.6 EDV per 100,000 residents in 2015. However the overall age-adjusted rate of poisoning EDV increased by
4.7% from last year. In 2015, the rate of unintentional poisonings-related EDV was 101.3 EDV per 100,000
residents (n=6,764), and represents a 4.9% from 2014 (96.6 EDV per 100,000 residents). In 2015, the ageadjusted rate for intentional related EDV was 67.3 EDV per 100,000 residents (n=4,385) and represents a 4.5%
increase from 2014 (64.4 EDV per 100,000 residents). Figure 14 shows the age-adjusted poisoning-related
rates for non-fatal emergency department visits by injury intent from 2011 to 2015.

Rate per 100,000 Residents

210.0

Figure 14. Age-Adjusted Poisoning-Related Emergency Department Visit Rates
by Manner, Arizona 2011-2015

190.0
170.0
150.0
130.0
110.0
90.0
70.0
50.0
30.0
2011

2012
Unintentional

2013

2014
Intentional

2015
Total (all manners)

The age-adjusted rates for non-fatal poisoning-related emergency department visits were higher for females
then for males. The rates decreased among males and females from 2011 to 2013 and increased in 2014. In
2015, the poisoning-related emergency department visit rate increased by 5.7% for males and increased 3.8%
for females from the previous year. Figure 15 shows the age-adjusted rates by sex for non-fatal poisoningrelated emergency department visits from 2011 through 2015.

17

Figure 11. Age-Adjusted Poisoning-Related Emergency Department Visit Rates
by Sex, Arizona 2011-2015

Rate per 100,000 Residents

250.0

200.0

150.0

100.0

50.0

0.0
2011

2012

2013
Males

Females

2014

2015

Total

The rates of the counties with at least 20 visits per year varied between 2011 and 2015 and are listed below.
Table 3 shows the age-adjusted poisoning-related emergency department visit rates per 100,000 residents by
county of residence from 2011 to 2015. Three of the state’s 15 counties had at least one year in which there
were fewer than 20 events, making the rates for those counties unstable over time.
Table 3. Age-Adjusted Rate per 100,000 Residents for Non-Fatal Poisoning-Related Emergency Department
Visits by County of Residence, Arizona 2011-2015
2011
2012
2013
2014
2015
Apache
137.5
138.4
150.4
110.2
114.6
Cochise
256.0
231.3
249.5
205.3
192.5
Coconino
203.9
184.5
186.3
174.3
186.8
Gila
250.9
188.2
281.2
326.0
293.2
Graham
307.7
284.4
309.6
352.6
326.4
Greenlee*
246.9
205.7
187.2
182.5
155.7
La Paz*
278.0
245.2
220.4
168.5
192.1
Maricopa
184.0
174.2
165.6
172.7
176.7
Mohave
329.1
301.5
29.0
288.6
285.1
Navajo
249.0
368.6
261.8
219.2
208.1
Pima
197.3
197.7
195.9
198.0
232.6
Pinal
176.6
172.8
158.9
180.1
191.8
Santa Cruz*
172.9
141.5
136.8
74.6
136.2
Yavapai
327.5
28.9
232.7
258.5
267.2
Yuma
186.4
172.3
164.8
144.4
148.3
Statewide Total
196.9
188.2
179.1
183.0
191.6
*Rates are unstable for counties indicated, as they had fewer than 20 cases in at least one year.

18

From 2011 to 2015, the number of Opioid Emergency Department Visits (EDV) decreased by 7.3%, and there
was a 2.3% decrease in the rate for Opioid EDV from last year. Over the last five years, the number of Heroin
EDV increased by 70.8%, and there was a 8.3% increase in the rate for Heroin EDV from last year. Over the last
five years, the number of Benzodiazepines EDV decreased by 22.48%, and the rate remained the same from
last year. Figures 16 and 17 illustrate the trends in prescription opiate poisonings along with heroin and
benzodiazepine poisonings from 2011 to 2015.
Figure 16. Number of Poisoning Emergency Department Visits by Drug Type*,

Arizona 2011-2015
1,800
1,600
Number of Visits

1,400
1,200
1,000
800
600
400
200
0
2011

2012

2013

2014

2015

Year
Opioid Poisoning Visits

Heroin Poisoning Visits

Benzodiazepine Poisoning Visits

*Primary Diagnosis Code and E-Codes only

Figure 17. Age-Adjusted Poisoning Emergency Department Visit Rates by Drug Type*,
Arizona 2011-2015

Rate per 100,000 Residents

30.0
25.0
20.0
15.0
10.0
5.0
0.0
2011

2012

Opioid Poisoning Visits

2013
Year
Heroin Poisoning Visits

2014

2015

Benzodiazepine poisoning

*Primary Diagnosis Code and E-Codes only

19

Poisoning-Related Mortality, 2015
There were 1,335 deaths among Arizona residents attributed to poisoning in 2015. Sixty-one percent of deaths
were among males (n=818), and 39 percent were among females (n=517). In 2015, the age-adjusted poisoning
mortality rate among females was 15.3 deaths per 100,000 residents, while the rate among males was 24.9
deaths per 100,000 residents. Males had higher mortality rates than females in each age group. In 2015, adults
45 through 54 years of age had the highest rate of fatalities among males (45.9 deaths per 100,000 residents
and females (33.0 deaths per 100,000 residents). Adults 35-44 years old had the highest ratio of deaths among
males versus females. The poison-related mortality rate for males 15-24 increased by 44.3% from 2014 (11.5
deaths per 100,000 residents) to 2015 (16.6 deaths per 100,000 residents). Figure 18 shows the poisoningrelated mortality rates per 100,000 residents by age group and sex.

Figure 18. Poisoning Mortality Rates by Age Group and Sex,
Arizona 2015
50.0
Rate per 100,000 Residents

45.0
40.0
35.0
30.0
25.0
20.0
15.0
10.0
5.0
0.0
15-24
Yrs

25-34
Yrs
Males (n=818)

35-44
Yrs
Female (n=517)

45-54
Yrs

55-64
Yrs

65+
Yrs

Total (n=1,335)

American Indian or Alaska Native residents had the highest age-adjusted poisoning-related mortality rate in
2014 (36.5 deaths per 100,000 residents), followed by White non-Hispanic residents (24.8 deaths per 100,000
residents) then Black or African American residents (17.4 deaths per 100,000 residents). Though Asian or
Pacific Islander residents had a very low mortality rate, the rate is not stable due to the low number of deaths.
Figure 19 shows the age-adjusted poisoning-related mortality rates by race/ethnicity for Arizona residents in
2015.

20

Figure 19. Age-Adjusted Poisoning-Related Mortality Rate by Race/Ethnicity,
Arizona 2015
40.0

Rate per 100,000 Residents

35.0
30.0
25.0
20.0
15.0
10.0
5.0
0.0
American Indian or White non-Hispanic
Alaska Native (n=93)
(n=963)

Black or African
American (n=51)

Hispanic or Latino
(n=220)

Total (n=1,335)

In 2015, drugs (over-the-counter medication, prescription and illicit drugs) were the underlying cause of death
for 90 percent of all poisoning deaths (n=1,199). This means that 9 out of every 10 poisoning deaths were due
to drugs. Of the drug overdose deaths, 78.8% were unintentional (n=945), 13.6% were suicide or intentional
self-harm (n=163), and 7.6% had an undetermined intent (n=91). For each age group, males had higher rates
than females. Figure 20 shows the drug overdose mortality rates by age group and sex.

Figure 20. Drug Overdose Mortality Rates by Age Group and Sex,
Arizona 2015
45

Rate per 100,000 Residents

40
35
30
25
20
15
10
5
0
15-24
Yrs

25-34
Yrs

35-44
Yrs

Males (n=714)

45-54
Yrs
Female (n=485)

55-64
Yrs

65+
Yrs

Total

Total (n=1,199)

21

Poisoning Fatalities by Manner
As in previous years, the majority of poisoning-related deaths were determined to be unintentional. In 2015,
79 percent of poisoning-related deaths among Arizona residents were unintentional (n=1,046). Of the 77
percent of unintentional deaths, 65 percent were among males (n=678), and 35 percent were among females
(n=368). In 2015, there were 192 poisoning-related suicides (14 percent) and was roughly equal across males
and females. There were no poisoning-related suicides in children below the age of 15 years among either sex.
Figure 21 shows the percentage of poisoning-related deaths for 2015.

Figure 21. Percentage of Poisoning-Related Fatalities by Intent,
Arizona 2015

Unintentional

7%

Suicide

14%

Undetermined
79%

In 2015, males aged 45-54 years old had the highest mortality rate for unintentional poisoning-related deaths
(36.8 deaths per 100,000 residents) followed by males aged 35-44 years old (36.2 deaths per 100,000). Males
had higher unintentional poisoning-related mortality rates than females in all age groups. In 2015, females had
higher suicide mortality rates than males in the following age groups: 25-34 years, 35-44 years, and 55-64
years. The highest suicide rates overall were among females aged 55-64 years old (6.2 suicides per 100,000
residents), followed by females aged 45-54 years old (5.2 suicides per 100,000 residents). Figures 22 and 23
show the mortality rates for poisonings by age group, manner, and sex in 2015.

22

Figure 22. Unintentional Poisoning-Related Mortality Rates by Age Group and
Sex, Arizona 2015

Rate per 100,000 Residents

40.0
35.0
30.0
25.0
20.0
15.0
10.0
5.0
0.0
15-24
Yrs

25-34
Yrs

35-44
Yrs

Males (n=678)

45-54
Yrs
Female (n=368)

55-64
Yrs

65+
Yrs

Total

Total (n=1,046)

Figure 23. Suicide Poisoning-Related Mortality Rates by Age Group and
Sex, Arizona 2015

Rate per 100,000 Residents

7.0
6.0
5.0
4.0
3.0
2.0
1.0
0.0
15-24
Yrs

25-34
Yrs

35-44
Yrs

Males (n=95)

45-54
Yrs
Female (n=97)

55-64
Yrs

65+
Yrs

Total

Total (n=192)

23

Non-Fatal Poisoning-Related Inpatient Hospitalizations, 2015
There were 5,796 non-fatal inpatient hospitalizations among Arizona residents attributed to poisoning in 2015;
overall, an age-adjusted rate of 85.6 hospitalizations per 100,000 residents. Forty-four percent of the visits
were among males (n=2,553) and fifty-five percent were among females (n=3,243). Forty-five percent of the
poisoning-related inpatient hospitalizations were attributed to unintentional poisonings (n=2,636), forty-five
percent resulted from intentional poisonings (n=2,583), and ten percent of poisonings were undetermined in
nature (n=565).
Across all age groups, females had higher rates of non-fatal poisoning-related inpatient hospitalizations than
males. The 45 to 54 year age group had the highest rate among both males and females. Figure 24 shows the
poisoning-related inpatient hospitalization rates per 100,000 Arizona residents by age group and sex.

Figure 24. Poisoning-Related Inpatient Hospitalization Rates, by Age Group
and Sex, Arizona 2015

Rate per 100,000 Residents

140.0
120.0
100.0
80.0
60.0
40.0
20.0
0.0
<1
Yrs

1-4
Yrs

5-14
Yrs

15-24
Yrs

Males (n=2,590)

25-34
Yrs

35-44
Yrs

45-54
Yrs

Age Group
Females (n=3,258)

55-64
Yrs

65-74
Yrs

75-84
Yrs

85+
Yrs

Total

Total (n=5,848)

American Indian or Alaska Natives residents had the highest age-adjusted poisoning-related inpatient
hospitalization rate in 2015 (125.0 hospitalizations per 100,000 residents) followed by Black or African
American residents (114.5 hospitalizations per 100,000 residents), and then White non-Hispanic (102.4
hospitalizations per 100,000 residents) residents. Asian or Pacific Islander residents had the lowest poisoningrelated rate with 27.3 hospitalizations per 100,000 residents. Figure 25 shows the age-adjusted poisoningrelated inpatient hospitalization rates by race/ethnicity for Arizona residents in 2015.

24

Figure 25. Age-Adjusted Poisoning-Related Inpatient Hospitalization Rate by
Race/Ethnicity, Arizona 2015*
140.0
Rate per 100,000 REsidents

120.0
100.0
80.0
60.0
40.0
20.0
0.0
American Indian
or Alaska Native
(n=341)

White nonHispanic
(n=3,972)

Black or African
American
(n=353)

Hispanic or
Latino (n=987)

Asian or Pacific
Islander (n=64)

Total (n=5,796)

*There were 79 hospitalizations among individuals of other or unknown race/ethnicity.

In 2015, Gila County had the highest rate of inpatient hospitalizations for non-fatal poisonings (113.9
hospitalizations per 100,000 residents) followed by Pima County (110.9 hospitalizations per 100,000 residents)
and then Navajo County (109.9 hospitalization per 100,000 residents. Figure 26 displays the rate of non-fatal
poisoning-related inpatient hospitalizations among residents of Arizona by counties as shown in Figure 26.

Figure 26. Age-Adjusted Poisoning-Related Inpatient Hospitalization Rates
by County, Arizona 2015

Rate per 100,000 Residents

120.0
100.0
80.0
60.0
40.0
20.0
0.0

* Counties with counts <20 are unstable.

25

Among all manners of non-fatal poisoning-related inpatient hospitalizations, 94% were due to drug use
(n=5,451). This percentage includes prescription, non-prescription, and illicit drugs. Figure 27 shows
percentage of poison hospitalizations by poison type.

Figure 27. Poisoning-Related Inpatient Hospitalizations by Poison Type,
Arizona 2015

6%

Drugs, Medicinals And Biological
Substances
Toxic Effects of Nonmedicinal
Substances

94%

In 2015, the average poisoning-related inpatient hospitalization was over $35,000 in hospital charges and
averaged 3.6 days (the median cost was $25,320 and the length of stay was 3 days). Arizona residents spent a
total of 21,110 days in the hospital for non-fatal poisoning-related events and the longest hospital stay for a
non-fatal case was 51 days. Hospital charges for inpatient hospitalizations due to poisonings totaled over $208
million for Arizona residents in 2015. Forty-six percent of the poisoning-related inpatient hospitalizations were
charged to the Arizona Health Care Cost Containment System (AHCCCS) (n=2,644 and more than $91 million in
cost). Hospital charges do not reflect hospital reimbursement rates, nor do they include charges or costs
related to emergency medical services, outpatient care, rehabilitation, legal fees, or lost work/ school time.

26

Non-Fatal Poisoning-Related Inpatient Hospitalizations by Manner
There were 2,636 non-fatal inpatient hospitalizations among Arizona residents attributed to unintentional
poisoning in 2015 (45%) and 2,583 hospitalizations attributed to intentional poisoning (45%). Figure 28 shows
the distribution of non-fatal poisoning-related inpatient hospitalizations by manner.

Figure 28. Percentage of Poisoning-Related Inpatient Hospitalizations by
Manner, Arizona 2015

10%

Unintentional
Intentional
45%

Undetermined

45%

In 2015, fifty-two percent of unintentional poisoning-related inpatient hospitalizations (IP) and sixty-one
percent of intentional poisoning-related IP were among females (n=1,366 and n=1,582, respectively). Female
residents aged 15-24 years old had the highest rate of intentional non-fatal poisoning-related IP (91.3
hospitalizations per 100,000), while males within the same age group were lower (43.8 hospitalizations per
100,000 residents). Female residents aged 65-74 years old had the highest rate of unintentional poisoningrelated IP (63.5 hospitalizations per 100,000 residents), while males within the same age group were lower
(45.8 hospitalizations per 100,000 residents). In general, the highest rates of intentional poisoning-related
hospitalizations were among adults and teenagers aged 15-54 years old, whereas unintentional poisonings
were highest among those aged 45 years and older. Figure 29 shows the non-fatal poisoning-related inpatient
hospitalization rates per 100,000 residents by age group and sex, separated by manner.

27

Figure 29. Age-Specific Poisoning-Related Inpatient Hospitalization Rates by Age, Sex
and Manner, Arizona 2015
85+ Yrs
75-84 Yrs
65-74 Yrs

Age Group

55-64 Yrs
45-54 Yrs
35-44 Yrs
25-34 Yrs
15-24 Yrs
5-14 Yrs
1-4 Yrs
<1 Yrs
150.0

100.0

50.0

0.0

50.0

100.0

150.0

Rate per 100,000 Residents
Unintentional Males

Unintentional Females

Intentional Males

Intentional Females

American Indian or Alaska Natives had the highest unintentional poisoning hospitalization rate in 2015 with
57.6 visits per 100,000 residents, followed by Black or African Americans (53.2 hospitalizations per 100,000
residents,) and then White non-Hispanics residents (42.8 hospitalizations per 100,000 residents). American
Indian or Native Americans also had the highest intentional poisoning hospitalization rate with 55.3 per
100,000 residents, followed by White non-Hispanic residents (49.6 hospitalizations per 100,000 residents).
Figure 30 shows the age-adjusted poisoning-related hospitalization rates by race/ethnicity and manner for
Arizona residents in 2015.
Figure 30. Age-Adjusted Poisoning-Related Inpatient Hospitalizations Rates by
Race/Ethnicity and Manner, Arizona 2015*
Rate per 100,000 Residents

70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0
American Indian
or Alaska Native

White nonHispanic

Black or African
American

Unintentional (n=2,636)

Hispanic or
Latino

Asian or Pacific
Islander

Total

Intentional (n=2,583)

*There were 65 hospitalizations among individuals of other or unknown race/ethnicity.

28

Navajo County had the highest non-fatal inpatient hospitalization rate for unintentional poisonings (50.6
hospitalizations per 100,000 residents) followed by Pima County (49.9 hospitalizations per 100,000 residents).
Gila County had the highest rate of intentional poisonings in 2015. Poisoning-related hospitalizations were
distributed among residents of Arizona’s counties as shown in Figure 31.
Figure 31. Age-Adjusted Poisoning-Related Inpatient Hospitalization Rates by
County and Manner, Arizona 2015
Rate per 100,000 Residents

80.0
70.0
60.0
50.0
40.0
30.0
20.0
10.0
0.0

Unintentional (n=2,636)

Intentional (n=2,583)

29

Non-Fatal Poisoning-Related Emergency Department Visits, 2015
There were 12,658 non-fatal emergency department visits among Arizona residents attributed to poisoning in
2015. Forty-five percent of the visits were among males (n=5,651), and fifty-five percent were among females
(n=7,007). Except for children aged one through four, females consistently had higher rates of poisoningrelated emergency department visits (EDV) than males. This trend is consistent with previous years of data as
well. Children aged 1-4 years old had the highest rate of EDV (421.4 EDV per 100,000 residents), followed by
young adults aged 15-24 years old (316.0 EDV per 100,000 residents). One study has shown that a substantial
proportion of young children brought to an urban tertiary-care emergency department with apparent lifethreatening events had positive toxicology screenings, even when parents denied medicating the child.4
Though the rate of non-fatal poisoning events among Arizona’s young children is very high, the results of that
study suggest that the rate may be higher still if all young children presenting in the emergency department
with an apparent life-threat were screened for potential poisons. Figure 32 shows the non-fatal poisoningrelated emergency department visits rates per 100,000 residents by age group and sex.

Figure 32. Poisoning-Related Emergency Department Visits Rates, by Age
Group and Sex, Arizona 2015
500.0

Rate per 100,000 Residents

450.0
400.0
350.0
300.0
250.0
200.0
150.0
100.0
50.0
0.0
<1
Yrs

1-4
Yrs

5-14
Yrs

15-24
Yrs

Males (n=5,651)

25-34
Yrs

35-44
Yrs

45-54
Yrs

Age Group
Females (n=7,007)

55-64
Yrs

65-74
Yrs

75-84
Yrs

85+
Yrs

Total

Total (n=12,658)

Black or African American had the highest poisoning-related emergency department visit rate (251.5 EDV per
100,000 residents, followed by White non-Hispanic residents (235.2 EDV per 100,000 residents). The lowest
rate was among Asians or Pacific Islander with 65.2 EDV per 100,000 residents. Figure 33 shows the rate
distribution of emergency department visits by race/ethnicity in 2015.

4

Pitetti RD, Whitman E, Zaylor A. Accidental and Nonaccidental Poisonings as a Cause of Apparent Life-Threatening Events in Infants.
Pediatrics 2008; 122:e539-e362.

30

Figure 33. Age-Adjusted Poisoning-Related Emergency Department Visit Rate
by Race/Ethnicity, Arizona 2015*
300.0
Rate per 100,000 REsidents

250.0
200.0
150.0
100.0
50.0
0.0
American Indian
or Alaska Native
(n=560)

White NonHispanic
(n=8,108)

Black or African
Hispanic or
Asian or Pacific Total (n=12,658)
American
Latino (n=2,885) Islander (n=157)
(n=824)

*Does not include 143 records with unknown or refused race/ethnicity.

Graham County had the highest rate of poisoning-related emergency department visits in 2015 with 326.4 EDV
per 100,000 residents, followed by Gila County with 293.2 EDV visits per 100,000 residents, and then Mohave
County with 285.1 EDV per 100,000 residents. Non-fatal poisoning-related emergency department visits were
distributed among residents of Arizona’s counties as shown in Figure 34.

Figure 34. Age-Adjusted Poisoning-Related Inpatient Emergency
Department Visits Rates by County, Arizona 2015
350.0

Rate per 100,000 Residents

300.0
250.0
200.0
150.0
100.0
50.0
0.0

* Counties with counts <20 are unstable.

31

The vast majority of non-fatal poisoning-related emergency department visits were due to drug use (84%,
n=10,643). This percentage includes prescription, non-prescription, and illicit drugs. Figure 35 shows
percentage of poison hospitalizations by poison type.

Figure 35. Poisoning-Related Emergency Department Visits by Poison Type,
Arizona 2015
16%
Toxic Effects of Nonmedicinal
Substances
Drugs, Medicinals, and Biological
Substances
84%

In 2015, the average non-fatal poisoning-related emergency department visit resulted in $6,035 in hospital
charges (median=$5,049). Hospital charges for emergency department visits due to poisonings totaled more
than $76 million for Arizona residents in 2015. Forty-seven percent of those hospital charges were charged to
the Arizona Health Care Cost Containment System (AHCCCS) totaling more than $34 million. Hospital charges
do not reflect hospital reimbursement rates, nor do they include charges or costs related to emergency
medical services, rehabilitation, legal fees, or lost work/school time.

32

Non-Fatal Poisoning-Related Emergency Department Visits by Manner
Majority of non-fatal poisoning-related emergency department visits were identified as being unintentional
injuries (54%, n=6,764). Thirty-five percent of emergency department visits were attributed to intentional
poisonings (n=4,385), and poisonings of undetermined intent accounted for eleven percent of visits (n=1,404).
Figure 36 shows the distribution of non-fatal emergency department visits by manner.

Figure 36. Poisoning-Related Emergency Department Visits by Manner,
Arizona 2015

11%

Unintentional
Intentional
35%

54%

Undetermined

Children one through four years of age had the highest rates of unintentional poisoning-related emergency
department visits among both males and females. Teens and young adults aged 15-24 years old had the
highest intentional poisoning-related emergency department rates. Females in all age groups had higher rates
of intentional poisoning-related visits. Figure 37 shows the poisoning-related emergency department visit rates
per 100,000 residents by age group and sex, separated by manner.

33

Age Group

Figure 37. Poisoning-Related Emergency Department Visit Rates by Age
Group, Manner and Sex, Arizona 2015
85+ Yrs
75-84 Yrs
65-74 Yrs
55-64 Yrs
45-54 Yrs
35-44 Yrs
25-34 Yrs
15-24 Yrs
5-14 Yrs
1-4 Yrs
<1 Yrs
1,000.0

800.0

600.0

400.0

200.0

0.0

200.0

400.0

Rate per 100,000 Residents
Unintentional Males

Unintentional Females

Intentional Males

Intentional Females

The highest rates of emergency department visits were among Black or African American residents for both
unintentional and intentional poisonings, followed by White non-Hispanic residents. It is important to note
that American Indian or Alaska Native residents are known to be under-represented in emergency department
data since the hospital discharge database does not include records from Indian Health Services facilities, and
therefore the rates presented here are most likely an underrepresentation of poisoning-related visits for that
race group. Figure 38 shows the distribution of emergency department visits by race/ethnicity and manner.

Figure 38. Age-Adjusted Poisoning-Related Emergency Department Visit
Rates by Race/Ethnicity and Manner, Arizona 2015*

Rate per 100,000 Residents

160.0
140.0
120.0
100.0
80.0
60.0
40.0
20.0
0.0
American Indian
or Alaska Native

White nonHispanic

Black or African
American

Unintentional (n=6,764)

Hispanic or
Latino

Asian or Pacific
Islander

Total

Intentional (n=4,385)

*Does not include 115 records with unknown or refused race/ethnicity.

34

Mohave County had the highest emergency department visit rates for unintentional poisonings and Graham
County had the highest emergency department visit rate for intentional poisonings. Poisoning-related
emergency department visits were distributed among residents of Arizona’s counties as shown in Figure 39.

Figure 39. Age-Adjusted Poisoning-Related Emergency Department Visits by
County and Manner, Arizona 2015
180.0

Rate per 100,000 Residents

160.0
140.0
120.0
100.0
80.0
60.0
40.0
20.0
0.0

Unintentional (n=6,764)

Intentional (n=4,385)

35

Poisoning and Prescription Drug Overdoses as an Arizona Public Health Concern
Deaths


In 2015, poisoning was the leading cause of injury-related deaths (26%) accounting for more deaths among
Arizonans than car crashes, falls, or firearm injuries.



Between 2011 and 2015, the age-adjusted poisoning-related mortality rate increased 11% for Arizona residents.



Drugs (prescription, non-prescription and illicit) were responsible for 90 percent of poisoning-related deaths. The
poisons most commonly specified on death certificates in 2015 were pharmaceutical opioids (n=401),
methamphetamine or other stimulants (n=365), and alcohol (n=291). The number of Heroin poisoning deaths
increased by 32% in 2015 (n=238 or 3.7 deaths per 100,000 residents) from 2014 (n=180 or 2.7 deaths per
100,000 residents).



In 2015, as in previous years, poisoning-related fatality rates were highest among American Indian or Alaska
Natives (36.5 per 100,000 residents) and White non-Hispanic Arizonans (24.8 per 100,000 residents).

Non-Fatal Hospitalizations and Emergency Department Visits


Between 2011 and 2015, the age-adjusted rate of non-fatal poisoning-related Inpatient Hospitalizations among
Arizona residents decreased by 21%, from 108.4 hospitalizations per 100,000 residents in 2011 to 85.6
hospitalizations in 2015.



In 2015, females aged 45-54 years old had the highest rate of non-fatal poisoning-related inpatient
hospitalizations (131.0 hospitalizations per 100,000 residents). Females aged 65-74 years old had the highest
unintentional non-fatal poisoning-related inpatient Hospitalization rate (63.5 hospitalization per 100,000
residents) and females aged 15-24 years old had the highest intentional non-fatal poisoning-related Inpatient
Hospitalization rate (91.3 hospitalization per 100,000 residents).



Between 2011 and 2015, the age-adjusted rate of non-fatal poisoning-related Emergency Department Visits
(EDV) among Arizona residents decreased by 2.7%, from 196.9 EDV per 100,000 residents in 2011 to 191.6 EDV
per 100,000 residents in 2015.The highest rates of emergency department visits were among male and female
children one through four years of age (431.5 per 100,000 for males, 410.9 per 100,000 for females).



Hospital charges for non-fatal poisoning-related inpatient hospitalizations totaled more than $208 million in
2015, and Arizona residents spent a total of 21,110 days hospitalized for non-fatal poisonings. Hospital charges
for poisoning-related emergency department visits totaled over $76 million in 2015.

Arizona’s Response


Arizona’s Prescription Drug Misuse and Abuse Initiative (http://www.azcjc.gov/acjc.web/rx/default.aspx), which
began in 2012, has multi-faceted strategies at both the state and community level to address prescription drug
abuse:
o Patient and provider education: The Arizona Opioid Prescribing Guidelines for the treatment of acute
pain and chronic non-terminal pain were published in November of 2014.
http://azdhs.gov/clinicians/clinical-guidelines-recommendations/index.php?pg=prescribing. The Arizona
Guidelines for Emergency Department Controlled Substance Prescribing were developed in 2012.
Arizona has two nationally affiliated poison control centers providing education and drug exposure
response throughout the state.
o Prescription monitoring: Arizona’s Controlled Substances Prescription Monitoring Program is managed
by the Arizona State Board of Pharmacy. Dispensing pharmacies and practitioners are required under
Arizona law to report information on Schedule II, III, and IV prescriptions to the database.
http://www.azpharmacy.gov/CS-Rx_Monitoring/aboutpmp.asp
o Drug disposal: Since 2008, sites throughout Arizona have offered drug drop-off services as both
individual and ongoing events. These efforts have been expanded in 2014 under the Prescription Drug
Reduction Initiative. www.dumpthedrugsaz.org

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Poisoning Prevention Tips and Resources
Call 1-800-222-1222 to be connected to a local Poison Control Center.
You can prevent poisonings!
 Store household cleaners in their original containers, away from children
o Pills, vitamins, antifreeze, nail polish remover, or insecticide may look similar to children’s
candy or beverages. Teach children not to eat or drink something without first asking an adult.
o Teach children to identify medication, and don’t refer to pills as ‘candy’.
 Identify poisonous plants around your home and remove from children’s reach
o Visit the Cornell University Department of Animal Science website on poisonous plants at
http://www.ansci.cornell.edu/plants or contact your local PCC to learn about poisonous
plants.
 Read the label and follow directions for using household products or medications
 Check with your doctor or pharmacist to prevent dangerous medication interactions
 Properly discard unused, unneeded, or expired medication
o Look for drug disposal events in your community. These provide a safe, easy way to
responsibly get rid of unneeded medication. Such events may be sponsored by local hospitals,
pharmacies, police or fire departments.
 Go to www.dumpthedrugsaz.org for a map of prescription drug drop-off sites.
o Only flush drugs down the toilet if the label specifically says to do so
 Ask your pharmacist if you’re unsure about proper disposal
o To dispose of all other medications:
 Remove the medication from the original packaging
 Crush the pills and mix them with kitty litter, coffee grounds, or sand
 Seal the mixture in a plastic bag and dispose of it with your household trash
 Properly discard unused or unneeded household poisons and their containers
o Check with your city or county for hazardous waste collection events and locations.
o Household poisons can include paints and solvents, auto fluids, household cleaners, pesticide,
and pool chemicals
 Participate in National Poison Prevention Week, held annually during the 3rd week of March
o The federal Health Resources and Services Administration (HRSA) provides an Event Planner
Kit to help your agency or business get involved. Visit www.poisonprevention.org for more
information.
Visit Arizona’s Poison Control Centers on the internet at:
Arizona Poison and Drug Information Center, Tucson, Arizona
http://www.pharmacy.arizona.edu/outreach/poison/index.php
Banner Good Samaritan Poison and Drug Information Center, Phoenix, Arizona
http://www.bannerhealth.com/Locations/Arizona/Banner+Poison+Control+Center/_Banner+Poison+Control+
Center.htm

37

Methodology
Mortality data for 2011 through 2015 were compiled from the death certificates registered with the Arizona Department
of Health Services Office of Vital Records. Poisoning Deaths presented in this report were analyzed and compiled at a date
that was before final year close out. Lag times for examining, confirming toxicology, and reporting unusual deaths from
Medical Examiners to Office of Vital Records may vary from 4-6 months. ADHS anticipates the numbers of drug poisoning
deaths will be higher than what is reported in this report. ADHS is currently analyzing close out and an enhanced drug
poison report will be released after analysis is complete. Deaths in Any death record for an Arizona resident assigned an
th
International Classification of Diseases, 10 Revision (ICD-10) code for poisoning as the underlying cause of death was
included in the count. Poisonings due to envenomation by animals, plants, or insects (X20 – X29) were excluded from this
report. Table 4 shows the ICD-10 codes included in this report.

Table 4. International Classification of Diseases, 10th Revision (ICD-10) Codes Used in This Report
ICD-10
Code
X40
X41
X42
X43
X44
X45
X46
X47
X48
X49
X60
X61
X62
X63
X64
X65
X66
X67
X68
X69
X85
X86
X87
X88
X89
X90
Y10
Y11
Y12
Y13
Y14
Y15
Y16
Y17
Y18
Y19

ICD-10 Code Description
Unintentional poisoning by non-opioid analgesics, including aspirin and ibuprofen
Unintentional poisoning by sedative or hypnotic drugs, including antidepressants and barbiturates
Unintentional poisoning by narcotic or hallucinogenic drugs, including marijuana, heroin, and methadone
Unintentional poisoning by drugs acting on the autonomic nervous system
Unintentional poisoning by other and unspecified drugs
Unintentional poisoning by alcohol meant for ingestion
Unintentional poisoning by organic solvents
Unintentional poisoning by other gases, including carbon monoxide and motor vehicle exhaust
Unintentional poisoning by pesticides or herbicides
Unintentional poisoning by other and unspecified chemicals
Suicide by poisoning using non-opioid analgesics, including aspirin and ibuprofen
Suicide by poisoning using sedative or hypnotic drugs, including antidepressants and barbiturates
Suicide by poisoning using narcotic or hallucinogenic drugs, including marijuana, heroin, and methadone
Suicide by poisoning using drugs acting on the autonomic nervous system
Suicide by poisoning using other and unspecified drugs
Suicide by poisoning using alcohol meant for ingestion
Suicide by poisoning using organic solvents
Suicide by poisoning using other gases, including carbon monoxide and motor vehicle exhaust
Suicide by poisoning using pesticides or herbicides
Suicide by poisoning using other and unspecified chemicals
Homicide by poisoning using drugs or a biological substance
Homicide by poisoning using corrosive gas
Homicide by poisoning using pesticide
Homicide by poisoning using gas or vapors
Homicide by poisoning using other specified chemicals
Homicide by poisoning using unspecified chemicals
Poisoning by non-opioid analgesics, including aspirin and ibuprofen, undetermined intent
Poisoning by sedative or hypnotic drugs, including antidepressants and barbiturates, undetermined intent
Poisoning by narcotic or hallucinogenic drugs, including marijuana, heroin, and methadone, undetermined intent
Poisoning by drugs acting on the autonomic nervous system, undetermined intent
Poisoning by other and unspecified drugs, undetermined intent
Poisoning by alcohol meant for ingestion, undetermined intent
Poisoning by organic solvents, undetermined intent
Poisoning by other gases, including carbon monoxide or motor vehicle exhaust, undetermined intent
Poisoning by pesticides or herbicides, undetermined intent
Poisoning by other and unspecified chemicals, undetermined intent

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Inpatient hospitalization discharge data and emergency department discharge data from 2011 through 2015 were
compiled from the Arizona Hospital Discharge Database at the Arizona Department of Health Services. The discharge
database contains information from private, acute-care facilities in the state of Arizona, and do not include visits to
federal facilities, such as Veterans’ Affairs Hospitals or Indian Health Services facilities. The discharge databases do not
contain data from urgent care facilities, private physician practices, or medical clinics. Hospital discharge data include
hospital transfers and readmissions. Therefore, a single injured individual may be counted more than once. These data
should be interpreted as episodes of medical treatment, not individual injuries.

Additionally, the data do not allow for analysis of the combined effect of two or more poisonous agents.
th

Records for Arizona residents assigned an International Classification of Diseases, 9 Revision, Clinical Modification (ICD9-CM) External Cause of Injury Code (E-Code) for poisoning as the primary cause of injury were included in this report. The
following E-Code ranges were included: E850 – E858, E860 – E869, E950 – E952, E962, E972, E980 – E982. Table 15 lists
the general categories of poisonings included in these ICD-9-CM E-Codes. Poisonings due to envenomation by animals,
plants, or insects (E905.0 – E905.9) were excluded from this report, as were cases in which medications caused an adverse
reaction after therapeutic use (E930 – E949). Medications were counted as poisoning events only if they were
administered incorrectly or with the intent to harm. This could include the administration of the wrong drug, or an
incorrect dose of a prescribed medication. This methodology was used for the first three quarters of 2015 (JanuarySeptember).

Table 5. International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) Codes Used in
This Report up to the first three quarter of 2015
ICD-9-CM Codes
E850 – E858
E860 – E869
E950 – E952
E962
E972
E980 – E982

ICD-9-CM Category Description
Unintentional poisoning by drugs, medicinal substances, and biologicals
Unintentional poisoning by other solid and liquid substances, gases, and vapors
Suicide and self-inflicted poisoning by solid or liquid substances, gases in domestic use, and other
gases or vapors
Assault by poisoning
Injury due to legal intervention by gas, including poisoning by gas
Poisoning by solid or liquid substances, gases in domestic use, and other gases, undetermined
whether unintentionally or purposely inflicted

ICD-9-CM transition to ICD-10-CM
In October 2015, the federal government’s new mandate for ICD, the conversion of ICD-9-CM diagnostic and procedural
codes to the implementation and use of ICD-10-CM codes, went into effect. This new mandate provides health
providers a wider and more detail range for diagnosing diseases for the last quarter year of 2015 (October.
December). The last quarter uses ICD-10-CM codes that are comparable or approximately similar to ICD-9-CM codes to
identify poisons. Poisons were identified by analyzing principal diagnosis code for ICD-10 codes relating to Poisoning
by, adverse effect of and underdosing of drugs, medicaments and biological substances (T36-T50) and Toxic effects
of substances chiefly nonmedicinal as to source (T51-T65). Once cases were identified poisoning
due to adverse reaction after therapeutic use were removed.

39

Table 6. International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)
Codes Used in This Report up to the last quarter of 2015
ICD-10-CM Codes

ICD-10-CM Category Description

T36

Poisoning by, adverse effect of and underdosing of systemic antibiotics

T37

Poisoning by, adverse effect of and underdosing of other systemic anti- infectives and
antiparasitics
Poisoning by, adverse effect of and underdosing of hormones and their synthetic
substitutes and antagonists, not elsewhere classified
Poisoning by, adverse effect of and underdosing of nonopioid analgesics, antipyretics and
antirheumatics
Poisoning by, adverse effect of and underdosing of narcotics and psychodysleptics
[hallucinogens]
Poisoning by, adverse effect of and underdosing of anesthetics and therapeutic gases

T38
T39
T40
T41
T42

T51

Poisoning by, adverse effect of and underdosing of antiepileptic, sedative- hypnotic and
antiparkinsonism drugs
Poisoning by, adverse effect of and underdosing of psychotropic drugs, not elsewhere
classified
Poisoning by, adverse effect of and underdosing of drugs primarily affecting the
autonomic nervous system
Poisoning by, adverse effect of and underdosing of primarily systemic and hematological
agents, not elsewhere classified
Poisoning by, adverse effect of and underdosing of agents primarily affecting the
cardiovascular system
Poisoning by, adverse effect of and underdosing of agents primarily affecting the
gastrointestinal system
Poisoning by, adverse effect of and underdosing of agents primarily acting on smooth and
skeletal muscles and the respiratory system
Poisoning by, adverse effect of and underdosing of topical agents primarily affecting skin
and mucous membrane and by ophthalmological, otorhinorlaryngological and dental
drugs
Poisoning by, adverse effect of and underdosing of diuretics and other and unspecified
drugs, medicaments and biological substances
Toxic effect of alcohol

T52

Toxic effect of organic solvents

T53

Toxic effect of halogen derivatives of aliphatic and aromatic hydrocarbons

T54

Toxic effect of corrosive substances

T55

Toxic effect of soaps and detergents

T56

Toxic effect of metals

T57

Toxic effect of other inorganic substances

T58

Toxic effect of carbon monoxide

T59

Toxic effect of other gases, fumes and vapors

T60

Toxic effect of pesticides

T61

Toxic effect of noxious substances eaten as seafood

T62

Toxic effect of other noxious substances eaten as food

T63

Toxic effect of contact with venomous animals and plants

T64

Toxic effect of aflatoxin and other mycotoxin food contaminants

T65

Toxic effect of other and unspecified substances

T43
T44
T45
T46
T47
T48
T49

T50

40

Rates for 2011-2015 were calculated using Arizona population data compiled by the Arizona Department of Health
Services’ Bureau of Public Health Statistics, available on the internet at:
http://www.azdhs.gov/plan/menu/info/pop/index.php.
To help compare groups over time, rates have been age-adjusted. Age-adjusting is a statistical procedure used to remove
the effect of age differences between populations. All age-adjusted rates in this report were computed using the ‘direct’
method in which the age-specific rates for a given year are weighted by the age distribution of the 2000 standard
population. For information on how to calculate an age-adjusted rate, or to see the 2000 standard age distribution, visit
the National Cancer Institute Surveillance Epidemiology and End Results (SEER) program at
http://seer.cancer.gov/seerstat/tutorials/aarates/definition.html.

41