Legacy Drug Abuse Warning Network (DAWN 1992-2011)

Legacy DAWN (data collection through 2011) was a public health surveillance system that monitored emerging drug trends in both (1) emergency department visits in hospitals and (2) deaths reported by medical examiners and coroners (ME/C) across the Nation.

Legacy DAWN was a longitudinal probability sample of hospitals located throughout the United States, including Alaska and Hawaii. Non-Federal, short-stay, general surgical and medical hospitals located in the United States, with at least one 24-hour emergency department (ED) were eligible to participate. Data were collected from a representative sample of hospitals in the Nation and select metropolitan areas. The mortality component of Legacy DAWN did not rely on a statistical sample of ME/Cs.

Details

Drug-related ED visits were identified through a retrospective review of ED visits in participating hospitals and decedent case files in each participating death investigation jurisdictions for ME/Cs.

Eligible drugs included:

Illegal or illicit drugs, such as heroin, cocaine, marijuana, and Ecstasy;
Prescription drugs, such as Prozac®, Vicodin®, OxyContin®, alprazolam, and methylphenidate;
Over-the-counter medications, including aspirin, acetaminophen, ibuprofen, and multi-ingredient cough and cold remedies;
Dietary supplements, including vitamins, herbal remedies, and nutritional products;
Psychoactive, non-pharmaceutical inhalants;
Alcohol in combination with drugs; and
For those under age 21, alcohol alone without any other drug

Data files are made available by SAMHSA for research and statistical purposes. Along with codebooks and questionnaires, ASCII, SAS, SPSS, Stata, R, and TSV files are shared for public use. Read more here.

What is DAWN?

Drug Abuse Warning Network (DAWN) is a nationwide public health surveillance system administered by the U.S. Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Center for Behavioral Health Statistics and Quality (CBHSQ). DAWN captures data on emergency department (ED) visits related to recent substance use directly from the electronic health records of participating hospitals. SAMHSA administered DAWN from 1992 through 2011 (legacy DAWN) and re-established the current DAWN in 2018.

Who is responsible for DAWN?

Authorized by the 21st Century Cures Act in December 2016, the Drug Abuse Warning Network (DAWN) is a data collection program of CBHSQ. SAMHSA is required and authorized, under section 42 U.S.C. §290aa-4(d)(1)(A), to collect the number of individuals admitted to the emergency rooms of hospitals as a result of the abuse of alcohol or other drugs. SAMHSA is authorized to receive protected health information from hospital EDs for the purpose of public health surveillance under the HIPAA Privacy Rule (45 C.F.R. 164.512(b)(1)). Such disclosures are permitted and do not require the authorization of the patient.

Can I compare data from the legacy DAWN (1992-2011) to data from the DAWN launched in 2018?

Data should not be compared between the legacy Drug Abuse Warning Network (DAWN) and the current DAWN version. The sample designs differ from the current iteration’s design established to provide surveillance.

How does DAWN define a drug-related emergency department (ED) visit?

In the Drug Abuse Warning Network (DAWN), a drug-related emergency department (ED) visit is a visit in which the patient was treated in the ED for a condition that was induced by or related to recent drug and/or alcohol use.

How does DAWN define and classify drugs?

The Drug Abuse Warning Network (DAWN) defines a drug as any substance and/or combination that falls under the following categories: alcohol, illicit drugs, prescription medications, over-the-counter medications (OTCs), dietary supplements, non-pharmaceutical inhalants, and substances that are vaped. DAWN classifies drugs using DAWN’s Drug Reference Vocabulary (DRV).

The DAWN DRV is a comprehensive drug vocabulary and classification system for all the substances collected by DAWN. The DAWN DRV is derived from the Multum Lexicon©, 2020 Cerner Multum, Inc. The classification was modified to meet DAWN’s unique requirements.

What is the DAWN Drug Reference Vocabulary (DRV)?

How are DAWN data abstracted and how does DAWN ensure patient confidentiality?

The Drug Abuse Warning Network (DAWN) utilizes trained medical record abstractors to review key areas of each patient’s Emergency Department visit record to determine whether drugs and/or alcohol were either the direct cause or a contributing factor to the visit. If it was, they abstract key data items from the record into a web-based reporting system.

DAWN data elements do not include direct identifiers. All DAWN project staff are trained on protections and procedures to ensure the privacy and confidentiality of all health information. Additionally, suppression rules are applied to minimize disclosure risk.

What is a sentinel hospital? Why does DAWN include sentinel hospitals?

In the Drug Abuse Warning Network (DAWN), a sentinel hospital is defined as a hospital selected from a high-priority catchment area characterized by social vulnerabilities of high-risk populations. Sentinel hospital selection utilizes geographic characteristics to support epidemiologic investigations, better allocation of resources for prevention, treatment, and recovery for policymakers and public health officials.

How is the quality of DAWN data assessed?

The Drug Abuse Warning Network (DAWN) uses a multi-step process to ensure data quality. Automated checks are embedded in the web-based abstraction system at initial entry to minimize errors, and machine learning algorithms are applied to each drug-related visit once submitted. Cases flagged by the machine learning model are subject to human review for accuracy. Quality audits are performed bi-annually on each abstractor’s data to focus training needs and assess quality.