https://orcid.org/0000-0003-3060-5994
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Julian Santaella-Tenorio, Staci Hepler, David M Kline, Rivera-Aguirre Ariadne, Magdalena Cerda, Santaella-Tenorio et al. respond to: Re: Estimation of opioid misuse prevalence in New York State counties, 2007-2018. A Bayesian spatio-temporal abundance model approach, American Journal of Epidemiology, Volume 194, Issue 3, March 2025, Pages 869–870, https://doi.org/10.1093/aje/kwae408
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Bradley et al.1 discuss our article in which we estimate opioid misuse prevalence in New York State (NYS) using a spatiotemporal abundance model approach.2 We appreciate their thoughtful comments and take this opportunity to address the 5 main issues they posed.
First, Bradley et al. correctly highlight that International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes 40–44, ×60–64, ×85, and Y10–14 should not be used in the emergency department visit data. We acknowledge this oversight in our data description. The emergency department data comprised only T40.0-T40.4 and T40.6 codes and excluded opioid “adverse effect” or “sequela” visits (T400X5 and T400X6, respectively).
Second, Bradley et al., indicate that estimates from the National Survey on Drug Use and Health (NSDUH) are likely biased because NSDUH excludes individuals experiencing houselessness or incarceration and has a disproportionately high level of nonresponse among persons with substance use disorder. We agree with Bradley et al. and noted this limitation in our study: “Fifth, household survey estimates usually exclude populations of individuals who are incarcerated or experiencing homelessness, which underestimates the state prevalence of opioid misuse.”2 It is important to note that NSDUH does include homeless populations living in shelters and that NSDUH calibrates weights to account for nonresponse and poststratification, which may partly compensate for nonresponse. Our methodology integrates NSDUH data on state-level prevalence of people who misuse opioids to overcome challenges with identifiability, because person-level linkage is not possible across multiple data systems in NYS. As Bradley et al. indicate in their letter,1 this is a common issue in most states, including NYS. Although NSDUH data are not perfect, this is the only survey that provides annual estimates of opioid misuse for NYS. Also, relative risk estimates are generally robust to bias or misspecification of intercepts in abundance models, such as the one we used in our study.3
