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SAMHSA News - Volume XI, Number 3, Summer 2003

Rise in Drug-Abuse-Related Narcotic Pain Medications Seen in Emergency Rooms

Narcotic pain medications implicated in drug-abuse-related emergency room visits rose 20 percent from 2001 to 2002, according to new estimates from SAMHSA's Drug Abuse Warning Network (DAWN). Emergency department mentions of narcotic pain medications rose from 99,317 in 2001 to 119,185 in 2002. The rise from 2000 to 2002 was 45 percent.

The 2002 DAWN estimates 670,307 drug-abuse-related hospital emergency department visits in the continental United States in 2002-about the same as drug-abuse-related visits in 2001.

In DAWN, a single drug abuse visit may include multiple drug "mentions" as many persons are poly-drug users. On average, each visit involved 1.8 drug mentions.

DAWN measures mentions of specific illicit, prescription, and over-the-counter drugs that are linked to drug abuse in visits to hospital emergency departments. It relies on a sample of hospital emergency departments chosen to represent hospitals nationally and in 21 metropolitan areas. In 2002, 437 hospitals participated in DAWN.

"We must educate the public about the dangers of misuse of prescription medications," said U.S. Health and Human Services Secretary Tommy G. Thompson. "We must continue to strengthen our prevention programs and build substance abuse treatment capacity so that people don't abuse drugs and tax the medical and economic resources of our emergency departments."

The new DAWN data show that emergency department mentions of marijuana increased 24 percent from 2000 to 2002. This is especially noteworthy because in the past, marijuana was frequently reported along with other drugs. Now, the number of visits for only marijuana rose 45 percent from 2000 to 2002. Over the same 2-year period, emergency department mentions of LSD dropped 78 percent but mentions of PCP rose 42 percent.

"This report proves that marijuana is more harmful than many people think," said White House Director of National Drug Control Policy John Walters. "The rising levels of marijuana potency that we've seen over the last several years correspond with dramatic increases in people seeking emergency medical care for marijuana-related incidents. But the huge decline in LSD mentions serves as a lesson that when we push back against a drug problem with a balanced supply-and-demand-reduction strategy, we save lives."

"One life corrupted by drug use is one too many. Effective prevention and treatment programs are key to helping reduce the needless waste of health, justice, and economic resources that results from abuse of drugs," said SAMHSA Administrator Charles G. Curie, M.A., A.C.S.W. "We are working with states and local drug treatment providers to build treatment capacity. SAMHSA expects that President Bush's new Access to Recovery program will be key to those efforts to provide treatment."

There was a dramatic 84-percent decline in mentions of LSD from 1995 to 2002, but there was a resurgence in visits involving PCP, particularly in Philadelphia and Washington, DC. The two most frequently mentioned substances-alcohol-in-combination with other drugs, and cocaine-were stable over the past 2 years; the rapid growth seen previously for emergency department visits involving Ecstasy and GHB has waned.

The six most frequently mentioned drugs of abuse in the 2002 DAWN were alcohol-in-combination with another drug, cocaine, heroin, marijuana, anti-anxiety drugs (benzodiazepines), and narcotic painkillers. Together, they accounted for 7 of every 10 drug mentions in drug-abuse-related emergency room visits in 2002.

DAWN estimates there were significant increases in emergency room visits related to drug abuse in 3 of the 21 metropolitan areas surveyed in DAWN: New Orleans (increased 22 percent from 2001 to 2002 from 3,729 visits to 4,566); Buffalo (increased 15 percent from 3,356 to 3,844 in 1 year); and Baltimore (an 11-percent increase in drug-abuse-related visits to hospital emergency departments from 11,625 in 2001 to 12,904 in 2002). Significant decreases in drug abuse visits were found in Dallas and San Diego.

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Results by Drug

Marijuana: Marijuana mentions in hospital emergency rooms increased from 19 to 47 mentions per 100,000 population from 1995 to 2002, with the increase affecting patients in all age groups. Increases in marijuana mentions were evident in Newark, Miami, and Baltimore. Decreases occurred in Dallas, San Francisco, Chicago, and Seattle.

Prescription Drugs: Abuse of anti-anxiety drugs (benzodiazepines) and narcotic pain relievers were each mentioned as often in hospital emergency rooms as heroin or marijuana in 2002, but ranked below mentions of cocaine and alcohol. Together, anti-anxiety drugs (benzodiazepines), antidepressants, and narcotic pain medications constituted 287,572 emergency department mentions in 2002, or 24 percent of total emergency department drug mentions. Narcotic pain medications accounted for 10 percent of total drug mentions in hospital emergency department visits related to drug abuse in 2002. Over the 8-year period from 1995 to 2002, mentions of narcotic pain medications rose 163 percent from 45,254 to 119,185.

Cocaine: Cocaine mentions were statistically unchanged from 2001 to 2002, but have increased 47 percent since 1995, from 135,711 to 199,198 in 2002. Over one-fifth of the cocaine mentions in 2002 were attributed to crack.

Heroin: Heroin mentions were statistically unchanged from 2001 to 2002, but increased 35 percent since 1995 from 69,556 to 93,519 in 2002. There were increases in heroin mentions in Seattle, Buffalo, Denver, and Baltimore and decreases in mentions in Dallas, Phoenix, and San Diego.

Methamphetamine: Amphetamines and methamphetamine accounted for 39,340 mentions in hospital emergency departments in 2002. There was no statistical change from 2001 to 2002, but these mentions have increased 54 percent since 1995 when there were 25,515 mentions. Mentions of amphetamines and methamphetamine were concentrated in six metropolitan areas in the western United States: San Francisco, San Diego, Phoenix, Seattle, Los Angeles, and Denver. There were large increases in St. Louis, Minneapolis, and Atlanta, as popularity of the drug moves eastward.

Ecstasy, GHB, PCP, and LSD: Increasing trends in emergency department mentions of Ecstasy (MDMA) and GHB appear to have leveled off with GHB mentions lower in 2002 than in 2000, dropping from 4,969 to 3,330. PCP mentions in emergency rooms increased 28 percent from 1995 to 2002. There was a 42-percent increase from the 5,404 seen in 2000 to 7,648 in 2002. There were significant increases in PCP mentions in Washington, DC; Newark; Philadelphia; Baltimore; and Dallas. Chicago had a decrease in mentions of PCP, declining 48 percent from 874 in 2001 to 459 in 2002. Estimates of LSD mentions in emergency rooms decreased, with 12 of 21 surveyed metropolitan areas posting declines.

Inhalants: Mentions of inhalants in emergency rooms increased 187 percent from 522 in 2001 to 1,496 in 2002, but show no consistent pattern from year to year. Denver was the only metropolitan area, among 21 surveyed, to exceed 50 mentions of inhalants in 2002.

Alcohol-in-Combination with Other Drugs: Mentions of alcohol-in-combination with another drug, while statistically unchanged from 2001 to 2002, have increased over the long term—from 1995 to 2002—by 24 percent, from 166,897 to 207,395. Significant increases were found in Seattle, Buffalo, New Orleans, and Baltimore. Decreases were noted in Dallas, Denver, Phoenix, and San Francisco.

Demographics of emergency department drug-abuse-related visits indicate increases for patients age 18 to 25 from 127,110 to 140,475 from 2001 to 2002. This compares to an increase from 88,540 to 101,541 in the age group 45 to 54, and an increase from 26,036 to 30,987 in the age group 55 and older.

To obtain a copy of the report, contact SAMHSA's National Clearinghouse for Alcohol and Drug Information (NCADI) at P.O. Box 2345, Rockville, MD 20847-2345. Telephone: 1 (800) 729-6686 (English and Spanish) or 1 (800) 487-4889 (TDD). The full report, as well as detailed tabulations for each of the 21 metropolitan areas, is also available online at

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