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Of the estimated 5.1 million drug-related ED visits in 2011, approximately 15,471 visits were attributed to intentional poisoning. About three quarters (77 percent) of these visits were made by patients aged 21 or older, which was not significantly higher than the proportion involving this age group in 2009 (73 percent).9 Females accounted for approximately two thirds of these visits (66 percent), which was similar to the proportion involving females in 2009 (63 percent).
ED visits attributed to intentional poisoning can involve both identified and unidentified drugs. In 2011, approximately 65 percent of such ED visits involved unidentified drugs (Table 1). For this report, the "unidentified drug" category includes 5,991 visits for which patients lacked knowledge about the specific drug that was given to them (e.g., "a date rape drug") and 4,023 visits that involved a drug to which DAWN was unable to assign a code (e.g., ambiguous slang names, foreign drug names). Overall, 40 percent of drug-related ED visits attributed to intentional poisoning involved unidentified drugs combined with alcohol, 23 percent involved unidentified drugs only, and 4 percent involved unidentified drugs combined with identified illicit drugs. About two thirds of ED visits (69 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 | Number of ED Visits |
Percentage of Visits* |
---|---|---|
Total ED Visits | 15,471 | 100% |
Any Unidentified Drug | 10,014 | 65% |
Unidentified Drugs Only | 3,498 | 23% |
Combinations of Unidentified Drugs with Other Drugs or Alcohol | 6,516 | 42% |
Unidentified Drugs and Alcohol | 6,128 | 40% |
Unidentified Drugs and Illicit Drugs | 617 | 4% |
* 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: 2011 SAMHSA Drug Abuse Warning Network (DAWN). |
Approximately three in five (62 percent) drug-related ED visits attributed to intentional poisoning involved alcohol in combination with other drugs (Figure 1). Overall, alcohol was combined with unidentified drugs in 40 percent of visits, with illicit drugs in 23 percent of visits, and with pharmaceuticals in 7 percent of visits. 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 Combination | Percentage of ED Visits |
---|---|
Any Alcohol Combination | 62% |
Alcohol and Unidentified Drugs | 40% |
Alcohol and Illicit Drugs | 23% |
Alcohol and Pharmaceuticals | 7% |
* 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: 2011 SAMHSA Drug Abuse Warning Network (DAWN). |
About one third (34 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 (13 percent) and illicit stimulants (i.e., amphetamines and methamphetamine; 7 percent). With respect to drug combinations, 8 percent of ED visits attributed to intentional poisoning involved illicit drugs only, 23 percent involved illicit drugs and alcohol, and 4 percent involved illicit drugs and unidentified drugs (Table 1 and Figure 2).
Drug Category | Number of ED Visits |
Percentage of Visits* |
---|---|---|
Total ED Visits | 15,471 | 100% |
Alcohol** | 9,595 | 62% |
Illicit Drugs | 5,275 | 34% |
Marijuana | 1,975 | 13% |
Illicit Stimulants | 1,097 | 7% |
Pharmaceuticals | 2,049 | 13% |
Anti-Anxiety and Insomnia Medications*** | 1,125 | 7% |
Benzodiazepines | 550 | 4% |
Pain Relievers | 705 | 5% |
Combination of Alcohol and Illicit Drugs | 3,518 | 23% |
Illicit Drugs Only | 1,201 | 8% |
Combination of Alcohol and Pharmaceuticals | 1,023 | 7% |
* 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 in combination with other drug(s) and excludes visits in which alcohol was the only drug. ***This drug category was previously labeled "Drugs to treat anxiety and insomnia." Source: 2011 SAMHSA Drug Abuse Warning Network (DAWN). |
Drug Combination | Percentage of ED Visits |
---|---|
Any Illicit Drug Combination | 34% |
Illicit Drugs and Alcohol | 23% |
Illicit Drugs Only | 8% |
Illicit Drugs and Unidentified Drugs | 4% |
* 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: 2011 SAMHSA Drug Abuse Warning Network (DAWN). |
Approximately 13 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 (7 percent), followed by pain relievers (5 percent).
Most drug-related ED visits attributed to intentional poisoning resulted in the patient being treated and released from the ED (89 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 (6 percent), such as being transferred to another medical facility or leaving against medical advice.
Visit Disposition | Percent of ED Visits |
---|---|
Treated and Released | 89% |
Admitted to Hospital | 5% |
All Other Dispositions | 6% |
Source: 2011 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. According to 2011 DAWN data, 6 out of 10 ED visits attributed to intentional poisoning involved drugs combined with alcohol. Also, in 65 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 or 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. However, the finding that adults aged 21 or older comprised the majority of the ED visits attributed to intentional poisoning emphasizes that no one, not just young people, should permit their drinks to be handled by others. Also, any 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 Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities. 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 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 2012 Lexi-Comp, Inc., and/or Cerner Multum, Inc. The Multum Licensing Agreement governing use of the Lexicon can be found at https://www.samhsa.gov/data/data-we-collect/dawn-drug-abuse-warning-network. DAWN is one of three major surveys conducted by the SAMHSA's Center for Behavioral Health Statistics and Quality (CBHSQ). For more information on other CBHSQ surveys, go to https://www.samhsa.gov/data/. 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 https://www.samhsa.gov/data/data-we-collect/dawn-drug-abuse-warning-network. |
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