|Issue 23, 2006R|
|According to the Drug Abuse Warning Network (DAWN) for 2004:
According to DAWN data, there were over a half million ED visits involving nonmedical use of pharmaceuticals in 2004 (Table 1). Of these visits, 32.2 percent involved opiates/opioids, 26.8 percent involved benzodiazepines, and 4.8 percent involved muscle relaxants.
|Drug||Estimated visits||95% CI|
|Number||Percentage||Lower bound||Upper bound|
|All ED visits involving nonmedical use of pharmaceuticals||536,247||100.0%||448,688||623,806|
|Note: CI = confidence interval.
Source: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2004 (03/2008 update).
An estimated 172,726 ED visits involved opiates/opioids. The most frequently listed opiates/opioids were oxycodone products (24.1% of opiates/opioids), hydrocodone products (23.1%), and methadone (21.3%). An estimated 143,546 ED visits involved benzodiazepines. Alprazolam and clonazepam, respectively, accounted for 32.4 and 19.6 percent of such visits. Carisoprodol was the most frequently named muscle relaxant (56.8% of the visits involving muscle relaxants).
Typically, ED visits for nonmedical use of pharmaceuticals involve multiple drugs. Multiple drugs were involved in 64.6 percent of visits for opiates/opioids, 75.9 percent of visits for benzodiazepines, and 83.7 percent of ED visits for muscle relaxants (Figure 1). Often, alcohol is one of these other drugs. Alcohol was involved in 18.2 to 27.7 percent of visits involving opiates/opioids, benzodiazepines, or muscle relaxants.
|Single drug||Two drugs||Three or more drugs||Alcohol involvement|
|Opiates/Opioids with alchohol||0.0%||0.0%||0.0%||18.2%|
|Benzodiazepines with alcohol||0.0%||0.0%||0.0%||27.7%|
|Muscle relaxants with alcohol||0.0%||0.0%||0.0%||26.1%|
|Source: a) U.S. Census Bureau; b) Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2004 (03/2008 update).|
Patients aged 21 to 54 had the highest rates of ED visits for nonmedical use for all three drug classes (Figure 2). Within this age group, there was no statistically significant difference in the rates for individuals aged 21 to 34 and those aged 35 to 54, with the exception of patients aged 21 to 24 and patients aged 35 to 44 for muscle relaxants.
|Source: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2004 (03/2008 update)|
Overall, about half of ED visits involving nonmedical use of opiates/opioids, benzodiazepines, or muscle relaxants ended with no evidence of follow-up care: ranging from 59.3 percent for opiates/opioids to 48.1 percent for benzodiazepines (Figure 3). Follow-up care is defined broadly to include referrals to detoxification or substance abuse treatment services, admission to an inpatient unit in the hospital, or transfer to another health care facility.
|No evidence of
|Source: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2004 (03/2008 update).|
As a disposition from the ED, deaths accounted for less than 1 percent of visits. However, these estimates do not account for patient deaths occurring before reaching the ED, after admission to an inpatient unit, or after transfer to another facility.
|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 or death related to recent drug use is included in DAWN. All types of drugs—licit and illicit—are covered. Alcohol is included for adults when it occurs with another drug. Alcohol is always included for minors. DAWN's method of classifying drugs was derived from the Multum Lexicon, Copyright © 2008, Multum Information Services, Inc. The Multum Licensing Agreement can be found in DAWN annual publications and at http://www.multum.com/license.htm.
DAWN is one of three major surveys conducted by the Substance Abuse and Mental Health Services Administration's Office of Applied Studies (SAMHSA/OAS). For information on other OAS 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 Office of Applied Studies (OAS), Substance Abuse and Mental Health Services Administration (SAMHSA). This issue was written by David Skellan (SAMHSA/OAS) with assistance from Scott Novak, Ph.D. (RTI International, a trade name of Research Triangle Institute), and Judy K. Ball, Ph.D., M.P.A. (SAMHSA/OAS). All material in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Citation of the source is appreciated.|