|November 3, 2011|
Of the estimated 4.6 million drug-related ED visits in 2009, approximately 14,720 visits were attributed to intentional poisoning. Almost three quarters (73 percent) of these visits were made by patients aged 21 or older, a proportion that corresponds to the percentage of the general population in this age group.7 Females accounted for nearly two thirds of these visits (63 percent).
ED visits attributed to intentional poisoning can involve both identified and unidentified drugs. In 2009, approximately 60 percent of such ED visits involved unidentified drugs (Table 1). For this report, the "unidentified drug" category includes 6,253 visits for which patients lacked knowledge about the specific drug that was given to them (e.g., "a date rape drug") and 2,532 visits that involved a drug to which DAWN was unable to assign a code (e.g., ambiguous slang names, foreign drug names). Overall, 37 percent of ED visits attributed to intentional poisoning involved unidentified drugs combined with alcohol, 19 percent involved unidentified drugs only, and 7 percent involved unidentified drugs combined with identified illicit drugs. About two thirds of ED visits (68 percent) attributed to intentional poisoning involved more than one drug (including alcohol and unidentified drugs), with an overall average of two drugs per ED visit.
|Drug Category||Estimated Number
of ED Visits
|Total ED Visits||14,720||100%|
|Any Unidentified Drug||8,785||60%|
|Unidentified Drugs Only||2,857||19%|
|Combinations of Unidentified Drugs
with Other Drugs or Alcohol
|Unidentified Drugs and Alcohol||5,513||37%|
|Unidentified Drugs and Illicit Drugs||1,039||7%|
|Unidentified Drugs and Pharmaceuticals||219||1%|
|* Because multiple drugs may be involved in each visit, estimates of visits by drug may add to more than the total, and percentages may add to more than 100 percent. Source: 2009 SAMHSA Drug Abuse Warning Network (DAWN).|
Approximately three in five (60 percent) drug-related ED visits attributed to intentional poisoning involved alcohol in combination with other drugs (Figure 1). Alcohol was combined with unidentified drugs in 37 percent of these visits, with illicit drugs in 17 percent, and with pharmaceuticals in 12 percent. It should be noted that DAWN does not collect data from ED visits in which alcohol is the only substance unless the patient is aged 20 or younger, and these visits are not included in the intentional poisoning cases.
|Alcohol Combinations||Number of Visits|
|Any Alcohol Combination||60|
|Alcohol and Unidentified Drugs||37|
|Alcohol and Illicit Drugs||17|
|Alcohol and Pharmaceuticals||12|
|* Because multiple drugs may be involved in each visit, percentages for each category may add to more than the overall percentage of alcohol combinations. Source: 2009 SAMHSA Drug Abuse Warning Network (DAWN).|
Nearly one third (30 percent) of drug-related ED visits attributed to intentional poisoning involved illicit drugs (Table 2). The specific illicit drugs most commonly identified in ED visits attributed to intentional poisoning include marijuana (7 percent), stimulants (6 percent), cocaine (5 percent), and Ecstasy (5 percent). With respect to drug combinations, about 9 percent of ED visits attributed to intentional poisoning involved illicit drugs only, 17 percent involved illicit drugs and alcohol, and 7 percent involved illicit drugs and unidentified drugs (Figure 2).
|Drug Category||Estimated Number
of ED Visits
|Total ED Visits||14,720||100%|
|Ecstasy (or MDMA)||706||5%|
|Drugs That Treat Anxiety and Insomnia||1,989||14%|
|Alcohol and Drug Combinations||6,719||46%|
|Alcohol and Illicit Drugs||2,446||17%|
|Alcohol and Pharmaceuticals||1,708||12%|
|Illicit Drugs Only||1,374||9%|
|Illicit Drugs and Pharmaceuticals||***||***|
|* Because multiple drugs may be involved in each visit, estimates of visits by drug may add to more than the total, and percentages may add to more than 100 percent.
** The alcohol category includes visits involving alcohol combined with another drug(s) and excludes visits in which alcohol was the only drug.
***The estimate for illicit drug and pharmaceutical combinations is suppressed because of low statistical precision.
Source: 2009 SAMHSA Drug Abuse Warning Network (DAWN).
|Illicit Drug Combinations||Number of Visits|
|Any Illicit Drug Combination||30|
|Illicit Drugs and Alcohol||17|
|Illicit Drugs Only||9|
|Illicit Drugs and Unidentified Drugs||7|
|* Because multiple drugs may be involved in each visit, percentages for each category may add to more than the overall percentage of drug combinations involving at least one illicit drug. Source: 2009 SAMHSA Drug Abuse Warning Network (DAWN).|
About one fifth (21 percent) of drug-related ED visits attributed to intentional poisoning involved pharmaceutical drugs (Table 2). Drugs that treat anxiety and insomnia were the most common pharmaceuticals (14 percent), followed by pain relievers (7 percent). Among ED visits attributed to intentional poisoning, about 7 percent involved pharmaceuticals only, 12 percent involved pharmaceuticals and alcohol, and 1 percent involved pharmaceuticals and unidentified drugs (Tables 1 and 2).
Most drug-related ED visits resulted in the patient being treated and released from the ED (84 percent) (Figure 3). The rest of the visits resulted in the patient either being admitted to the hospital (5 percent) or having some other disposition (11 percent), such as being transferred to another medical facility or leaving against medical advice.
|Treated and Released||84%|
|Admitted to Hospital||5%|
|All Other Dispositions||11%|
|Source: 2009 SAMHSA Drug Abuse Warning Network (DAWN).|
Various combinations of identified (e.g., alcohol and illicit drugs) and unidentified drugs were involved in ED visits attributed to intentional poisoning. Some drugs can be mixed easily in alcohol, which can both amplify the drugs' effects and also provide a surreptitious method to poison unsuspecting victims and render them vulnerable. In this report, 6 out of 10 ED visits attributed to intentional poisoning involved drugs combined with alcohol. Also, in 60 percent of the visits, patients did not know what specific drugs were given to them.
Such possibilities highlight the importance of heightening public awareness of the potential use of drugs for intentional poisoning in group settings—such as bars, dance clubs, and concerts—in which alcohol or drugs are often consumed. Informational campaigns can educate people about the risks involved with leaving beverages unattended and accepting alcoholic beverages or drugs from others, either from strangers or from people they know. These messages may be especially important for young adults who are not of legal drinking age and are therefore more open to accepting a "free" drink. Likewise, individuals consuming recreational drugs should be aware that the drugs they are using may have been adulterated with other substances that could have unexpected, potentially hazardous side effects. In situations and venues in which alcohol and drugs might be used, prevention campaigns could encourage friends to use the "buddy system" to ensure safety. Educational public service messages could instruct individuals to seek medical care immediately if a poisoning is suspected. Immediate action is critical because it can alert medical staff to evaluate the possibility of drug-induced adverse effects promptly.
The Drug Abuse Warning Network (DAWN) is a public health surveillance system that monitors drug-related morbidity and mortality. DAWN uses a probability sample of hospitals to produce estimates of drug-related emergency department (ED) visits for the United States and selected metropolitan areas annually. DAWN also produces annual profiles of drug-related deaths reviewed by medical examiners or coroners in selected metropolitan areas and States.
Any ED visit related to recent drug use is included in DAWN. All types of drugs—licit (such as pharmaceuticals) and illicit—are covered. Alcohol involvement is documented for patients of all ages if it occurs with another drug. Alcohol is considered an illicit drug for minors and is documented even if no other drug is involved. The classification of drugs used in DAWN is derived from the Multum Lexicon, copyright 2010 Lexi-Comp, Inc., and/or Cerner Multum, Inc. The Multum Licensing Agreement governing use of the Lexicon can be found at http://dawninfo.samhsa.gov/drug_vocab.
DAWN is one of three major surveys conducted by the Substance Abuse and Mental Health Services Administration's Center for Behavioral Health Statistics and Quality (SAMHSA/CBHSQ). For more information on other CBHSQ surveys, go to http://www.oas.samhsa.gov/. SAMHSA has contracts with Westat (Rockville, MD) and RTI International (Research Triangle Park, NC) to operate the DAWN system and produce publications.
For publications and additional information about DAWN, go to http://DAWNinfo.samhsa.gov/.
|The DAWN Report is published periodically by the Center for Behavioral Health Statistics and Quality (formerly the Office of Applied Studies), Substance Abuse and Mental Health Services Administration (SAMHSA). All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Additional copies of this report or other reports from the Center for Behavioral Health Statistics and Quality are available online: http://samhsa.gov/data/. Citation of the source is appreciated. For questions about this report, please e-mail: firstname.lastname@example.org.
This page was last updated on October 11, 2010.