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2021 Drug Abuse Warning Network (DAWN) Releases

This report presents 2021 data from the Drug Abuse Warning Network (DAWN).

Preliminary Findings from Drug-Related Emergency Department Visits, 2021

2021 DAWN Frequently Asked Questions

1. What is DAWN?

  • The 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 and misuse 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.

2. Who is responsible for DAWN?

  • Authorized by the 21st Century Cures Act in December 2016, DAWN is a data collection program of CBHSQ. SAMHSA is required and authorized, under section 42 U.S.C. §290aa-4(d), to collect DAWN data on the number of ED visits for drug-related reasons. SAMHSA is authorized by law to receive protected health information from hospital ED’s 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. SAMHSA has contracted with Westat—a private research firm based in Rockville, Maryland—to serve as a public health authority for the purpose of collecting and processing DAWN data.

3. Can I compare data from legacy DAWN to data from the DAWN launched in 2018?

  • Data should not be compared between legacy DAWN and the current DAWN version. The sample designs are different with the current iteration’s design established to provide surveillance.

4. What year of data is presented in this report?

  • This report presents preliminary findings from 2021. A final report with complete 2021 findings is planned for latter part of 2022.

5. How does DAWN define a drug?

  • 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).

6. What is the DAWN 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.

7. How does DAWN define a drug-related emergency department visit?

  • In DAWN, a drug-related 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.

8. How does DAWN ensure patient confidentiality?

  • 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.

9. Where do the data for the 2021 Preliminary Findings Report come from?

  • The 2021 Preliminary Findings Report is based on data abstracted from 52 participating hospitals. Originally, DAWN was intended to be comprised of 50 hospitals, but the DAWN redesign in 2019 led to the retention of three hospitals, making the DAWN participating hospital sample size 53. DAWN hospital recruitment began in 2018 on an ongoing basis, with the 53rd hospital joining in February 2022. Since DAWN abstracted no data from the 53rd participating hospital in 2021, the 2021 Preliminary Findings Report is based on 52 participating hospitals.

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

  • In DAWN, a sentinel hospital is defined as a large urban hospital selected from a high-priority sentinel area. A high priority sentinel area is defined as counties with high mortality and morbidity associated with opioid, cocaine, and psychostimulant overdose.
  • Sentinel hospitals are expected to yield cases of concern, allowing for the collection and analysis of data quickly so a plan of action for addressing key and emerging problems can be developed. Therefore, DAWN includes 10 sentinel hospitals selected by SAMHSA across the nation.

11. How are DAWN data abstracted?

  • DAWN medical record abstractors review ED records to identify drug-related visits. They access hospital’s electronic health record systems to review records and abstract data when an ED visit meets the DAWN case definition.

12. How is the quality of DAWN data assessed?

  • 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 on each abstractor’s data bi-annually to focus training needs and assess quality.

13. Why does the report include findings based on weighted and unweighted data?

  • The section titled Weighted National Estimates of the Top Five Drugs in Drug-Related ED Visits, 2021 presents weighted data on the top 5 drugs involved in drug-related ED visits. The data was weighted in order to generate nationally representative estimates for these drug-related ED visits by age, sex, race, ethnicity census region, and quarter.
  • The section titled Key Findings from Sentinel Hospitals, April 2021 – November 2021 presents unweighted data from eight sentinel hospitals. As of March 2022, DAWN had consistent and complete data from eight of the ten selected sentinel hospitals for the chosen analytical period. The analysis based on unweighted data from sentinel hospitals was conducted in order to assess drug-related ED visit trends and polysubstance use.

14. How should this report be cited?

  • Substance Abuse and Mental Health Services Administration. (2022). Preliminary Findings from Drug-Related Emergency Department Visits, 2021; Drug Abuse Warning Network Publication PEP22-07-03-001. Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from

Preliminary 2021 Report

Preliminary Findings from Drug-Related Emergency Department Visits, 2021

This preliminary report focuses on key findings from drug-related emergency department visits collected by the Drug Abuse Warning Network (DAWN) in 2021. The information presented in the report is organized into three sections as follows:

  1. Weighted national estimates for the top five drug-related ED visits by age, sex, race, ethnicity, census region, and quarter
  2. Monthly trends and drugs involved in polysubstance ED visits in a subset of sentinel DAWN hospitals, and
  3. Drugs that are new to DAWN’s Drug Reference Vocabulary (DRV).

In addition to these sections, the preliminary report provides an overview of DAWN, its sample design, and the weighting and estimation methods used.