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Heroin, Cocaine, and Alcohol + Drugs Top Lists of Drug-Related Deaths

Heroin, cocaine, and alcohol-in-combination with other drugs were the three most common substances implicated in drug-related deaths by medical examiners participating in SAMHSA's Drug Abuse Warning Network (DAWN) in 2000. Narcotic analgesics—including methadone, codeine, hydrocodone, and oxycodone—also frequently ranked in the top 10 drugs mentioned by medical examiners in the survey. In 2000, 137 medical-examiner jurisdictions from 43 metropolitan areas reported on drug-related deaths to DAWN.

Among the jurisdictions participating, the highest numbers of drug-related deaths were reported from Los Angeles (1,192), Philadelphia (942), New York (924), Chicago (869), and Detroit (704). Twenty or fewer drug abuse deaths were reported from Boulder, Casper, Fargo, Indianapolis, Manchester-Nashua, Middlesex-Somerset, and Sioux Falls. However, not all jurisdictions within these metropolitan areas necessarily participate in DAWN.

The report, Mortality Data from the Drug Abuse Warning Network, 2000, found drug abuse deaths among adolescents and young adults were relatively rare—fewer than 20 percent of deaths reported to DAWN were under age 25. In about half of the participating areas, those under age 25 represented less than 10 percent of all the drug-related deaths. In contrast, more than one-third of all drug abuse deaths in nearly half of the cities were people age 45 and older. In every metropolitan area, more than half of the drug-related deaths were men. In 30 metropolitan areas, more than half of the drug abuse deaths reported to DAWN were drug-induced (overdoses) and usually involved multiple drugs.

"Too many people realize too late that substance abuse can lead to incredible losses. Lost family and friends. Lost jobs and opportunity. And, as this report shows, lost lives," said Health and Human Services Secretary Tommy G. Thompson. "We are committed to supporting treatment programs that combat the personal despair and community disintegration brought by drug addiction."

"One life lost to drugs is one too many. Effective prevention and treatment programs are key to helping reduce the needless loss of life 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 and to implement the most effective treatment services available."

The release of Mortality Data from the Drug Abuse Warning Network, 2000, marks the debut of a redesigned DAWN report on drug-abuse-related mortality. It replaces the previous DAWN Annual Medical Examiner Data reports. Changes in the format and content of this report are designed to provide more information about the metropolitan areas represented in DAWN and about their component jurisdictions.

The report now includes three sections: metropolitan area profiles, abbreviated profiles for areas with few cases, and area "spotlights." This design provides more detailed information about the larger metropolitan areas, but also includes basic information about jurisdictions with fewer deaths, without compromising the confidentiality of decedents. Jurisdictions of special interest (such as urban counties) now have their own "spotlight" sections.

Among other key findings in the report:

Major Drugs of Abuse

In half of the participating metropolitan areas, heroin, cocaine, and alcohol-in-combination accounted for 40 percent or more of all drug mentions. They accounted for the vast majority of drug mentions in reported cases from Newark (66 percent), Portland (67 percent), and Chicago (74 percent).

No consistent trends appeared in heroin mentions across the metropolitan areas. From 1999 to 2000, the number of heroin/morphine mentions decreased in 12 metro areas and increased in 13 other metropolitan areas.

No consistent trends appeared in cocaine mentions across the metropolitan areas. Twelve cities reported a decrease in the frequency of cocaine involvement from 1999 to 2000, while 11 cities saw an overall increase in deaths involving cocaine during that time period.

In three cities (Minneapolis, Baltimore, and Norfolk), alcohol was involved in more than half of all drug-related deaths.

Other Drugs of Abuse

Only three metropolitan areas had a drug other than heroin/morphine, cocaine, or alcohol-in-combination as the most frequently mentioned substance in their drug abuse-related deaths. Oklahoma City's most common drug was methamphetamine (56 mentions); Louisville's most common drug was cannabis (45); and in Providence, the most frequently mentioned substance was unspecified narcotic analgesics (24).

Methamphetamine deaths continue to be concentrated in the Midwest and West. Among participating areas on the East Coast, only Long Island had more than a few mentions (38).

Club Drugs

In DAWN, "club drugs" is a category that includes mentions of the following drugs: Ketamine; methylenedioxymethamphetamine (MDMA or Ecstasy); gamma hydroxy butyrate (GHB) and its precursor gamma butyrolactone (GBL); and flunitrazepam (Rohypnol).

As in prior years, club drugs together accounted for very few deaths in any of the metropolitan areas participating in DAWN. Only 10 cities reported more than five mentions of club drugs in drug-related deaths. The cities with the most mentions were Los Angeles (27 mentions), Dallas (10), Chicago (9), and Miami (9).

In nearly all cases, club drugs were reported in combination with at least one other substance.

Abuse of Prescription Drugs

Codeine ranked in the top 10 drugs mentioned in 17 cities, including Philadelphia (216 mentions), Los Angeles (201), Phoenix (124), Detroit (103), San Francisco (92), and Chicago (88).

Hydrocodone ranked among the 10 most common drugs in 15 cities, including Los Angeles (80 mentions), Detroit (48), Dallas (25), Oklahoma City (22), and San Diego (22).

Oxycodone ranked among the 10 most common drugs in 15 cities, including Philadelphia (87 mentions), Las Vegas (27), and Boston (21). These mentions cannot be attributed to specific brands, such as OxyContin.

Of non-narcotic prescription drugs, diazepam (a benzodiazepine) and diphenhydramine were the most frequently mentioned.

Methadone ranked in the top 10 drugs in 19 cities, including New York (146 mentions), Phoenix (47), and Chicago (46).

DAWN reports annually on deaths related to drug abuse, using data provided by participating death investigation jurisdictions in metropolitan areas in the United States. In 2000, 137 jurisdictions in 43 metropolitan areas participated.

The DAWN mortality data capture deaths where an illegal drug or a legal drug used for nonmedical purposes contributed to a death, either directly (overdose) or indirectly. Deaths involving prescription drugs are reportable to DAWN only when the death involved intentional abuse. Accidental ingestions with no intent of abuse or adverse reactions to drugs taken as prescribed are not reportable.

The drug-abuse deaths described in this report do not represent the Nation as a whole, nor do they necessarily represent the total number of deaths related to drug abuse in any given metropolitan area. Rather, DAWN cases reflect the number of drug abuse deaths reviewed, identified, and reported by participating medical examiners and coroners in selected metropolitan areas. DAWN also collects information on drug-related, emergency department visits from a national sample of hospitals. These data are contained in a separate report, Emergency Department Trends from the Drug Abuse Warning Network.

To obtain a copy of Mortality Data from the Drug Abuse Warning Network, 2000, and other DAWN reports, contact SAMHSA's National Clearinghouse for Drug and Alcohol Information at P.O. Box 2345, Rockville, MD 20847. Telephone: 1 (800) 729-6686 (English and Spanish) or 1 (800) 487-4889 (TDD). The report can also be found on SAMHSA's Web site, dawninfo.samhsa.gov/.

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