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The number of ED visits involving ADHD stimulant medications increased between 2005 and 2010 from 13,379 to 31,244 visits (Figure 1). The number of ED visits involving ADHD stimulant medications increased among both males and females: visits among females increased between 2005 and 2010 from 4,315 to 14,068 visits, and visits among males nearly doubled from 9,059 to 17,174 visits.
Gender | 2005 | 2006 | 2007 | 2008 | 2009 | 2010 |
---|---|---|---|---|---|---|
All** | 13,379 | 16,947 | 26,369 | 23,735 | 26,711 | 31,244 |
Males** | 9,059 | 10,614 | 14,979 | 12,287 | 14,503 | 17,174 |
Females** | 4,315 | 6,332 | 11,390 | 11,448 | 12,208 | 14,068 |
* Because gender is unknown in a small number of visits, estimates for males and females do not add to the total. ** The change from 2005 to 2010 is statistically significant at the .05 level. Source: 2005 to 2010 SAMHSA Drug Abuse Warning Network (DAWN). |
Although the number of ED visits involving ADHD stimulant medications did not increase significantly for children younger than 18 between 2005 and 2010, increases were seen among multiple age groups for persons aged 18 or older (Figure 2). Specifically, visits increased from 2,131 to 8,148 visits among persons aged 18 to 25, from 1,754 to 6,094 visits among persons aged 26 to 34, and from 2,519 to 7,957 visits among adults aged 35 or older.
Age Group | 2005 | 2010 |
---|---|---|
Aged 5 to 11 | 3,322 | 3,791 |
Aged 12 to 17 | 2,702 | 3,461 |
Aged 18 to 25* | 2,131 | 8,148 |
Aged 26 to 34* | 1,754 | 6,094 |
Aged 35 or Older* | 2,519 | 7,957 |
* The change from 2005 to 2010 is statistically significant at the .05 level. Source: 2005 and 2010 SAMHSA Drug Abuse Warning Network (DAWN). |
In 2010, half of ADHD stimulant medication-related ED visits involved nonmedical use of pharmaceuticals8 (50 percent), and nearly one third involved adverse reactions9 (29 percent) (Figure 3). The number of ED visits related to ADHD stimulant medications involving nonmedical use of pharmaceuticals increased significantly from 5,212 visits in 2005 to 15,585 visits in 2010 (Table 1). Among demographic subgroups, ED visits involving nonmedical use of pharmaceuticals increased significantly among males, females, and adults aged 18 or older.
Reason for Visit | Percent |
---|---|
Nonmedical Use | 50% |
Adverse Reactions | 29% |
Other* | 21% |
* Includes accidental ingestions and suicide attempts. Source: 2010 SAMHSA Drug Abuse Warning Network (DAWN). |
Demographic Characteristic |
Nonmedical Use in 2005: Number of ED Visits |
Nonmedical Use in 2010: Number of ED Visits |
---|---|---|
Total ED Visits | 5,212 | 15,585** |
Male | 3,770 | 8,650** |
Female | 1,439 | 6,932** |
Aged 5 to 11 | *** | *** |
Aged 12 to 17 | 1,578 | 1,830 |
Aged 12 to 14 | 429 | 534 |
Aged 15 to 17 | 1,149 | 1,296 |
Aged 18 or Older | 3,175 | 13,570** |
Aged 18 to 25 | 1,310 | 5,766** |
Aged 26 to 34 | 851 | 3,556** |
Aged 35 or Older | 1,014 | 4,248** |
Demographic Characteristic |
Adverse Reactions in 2005: Number of ED Visits |
Adverse Reactions in 2010: Number of ED Visits |
---|---|---|
Total ED Visits | 5,085 | 9,181** |
Male | 3,500 | 5,234 |
Female | 1,584 | 3,947** |
Aged 5 to 11 | 2,630 | 3,513 |
Aged 12 to 17 | 647 | 685 |
Aged 12 to 14 | *** | 459 |
Aged 15 to 17 | 436 | 226 |
Aged 18 or Older | 1,637 | 4,983** |
Aged 18 to 25 | 539 | 1,264 |
Aged 26 to 34 | *** | 1,122 |
Aged 35 or Older | 790 | 2,597** |
* Because gender or age is unknown in a small number of visits, estimates do not add to the total. ** The change from 2005 to 2010 is statistically significant at the .05 level. *** Estimate not reported due to low precision. Source: 2005 and 2010 SAMHSA Drug Abuse Warning Network (DAWN). |
The number of ED visits related to ADHD stimulant medications involving adverse reactions increased significantly from 5,085 visits in 2005 to 9,181 visits in 2010 (Table 1). Among demographic subgroups, ED visits for adverse reactions increased significantly among females and adults aged 18 or older.
Of the 31,244 ED visits involving ADHD stimulant medications in 2010, one quarter (25 percent) involved one other drug, and nearly two fifths (38 percent) involved two or more other drugs (Table 2). Other pharmaceutical drugs were involved in nearly half (45 percent) of visits; one quarter (26 percent) involved anti-anxiety and insomnia medications, and about one sixth (16 percent) involved narcotic pain relievers.10 About one fifth involved illicit drugs (21 percent), and 14 percent involved marijuana. Nearly one fifth involved alcohol (19 percent).
Drug Combination | Estimated Number of ED Visits |
Percentage of Visits |
---|---|---|
Total ED Visits | 31,244 | 100% |
ADHD Stimulant Medication Only | 11,644 | 37% |
ADHD Stimulant Medication with One Other Drug |
7,667 | 25% |
ADHD Stimulant Medication with Two or More Other Drugs |
11,933 | 38% |
ADHD Stimulant Medication with Other Drugs | ||
Other Pharmaceutical Drugs | 14,010 | 45% |
Anti-anxiety and Insomnia Medications | 8,083 | 26% |
Narcotic Pain Relievers | 5,140 | 16% |
Antidepressants | 3,199 | 10% |
Antipsychotics | 2,050 | 7% |
Cardiovascular Agents | 1,741 | 6% |
Anticonvulsants | 1,150 | 4% |
Respiratory Agents | 1,063 | 3% |
Illicit Drugs | 6,683 | 21% |
Marijuana | 4,228 | 14% |
Stimulants | 1,306 | 4% |
Cocaine | 1,277 | 4% |
Heroin | 770 | 3% |
Alcohol | 5,783 | 19% |
Note: Because multiple drugs may be involved in each visit, estimates of visits by drug add to more than the total, and percentages add to more than 100 percent. Source: 2010 SAMHSA Drug Abuse Warning Network (DAWN). |
Drug combinations involved in ED visits related to ADHD stimulant medications varied across age groups. Marijuana was the most common drug combined with ADHD stimulant medications among adolescents aged 15 to 17 (32 percent), and alcohol was the most common drug combined with ADHD stimulant medications among young adults aged 18 to 25 (30 percent) (data not shown). Anti-anxiety and insomnia medications were the most common drug combined with ADHD stimulant medications among adults aged 26 to 34 (44 percent) and those aged 35 or older (31 percent). Visits for children aged 14 or younger did not yield statistically reliable estimates for drug combinations with ADHD stimulant medications.
Because ADHD stimulant medications have historically been prescribed for developmental disorders in children, nonmedical use among adolescents and young adults has received much attention.11 This report shows that ED visits for nonmedical use have not increased among children and adolescents, but they have increased among adults aged 18 or older. This suggests a need for increased attention toward efforts to prevent diversion and misuse among adults.
Even when taken as directed, ADHD stimulant medications entail some risk,4 and the data in this report show that the number of visits involving adverse reactions increased between 2005 and 2010, especially for adults aged 18 and older. As treatment for ADHD among adults becomes more widespread,3 prescribing physicians (including psychiatrists and other mental health professionals) may carefully consider associated risks among those who have chronic health conditions and/or take other medications that may interact with ADHD stimulant medications. A variety of treatment options, both pharmaceutical and nonpharmaceutical, are available for adults with ADHD.3,12
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 2010 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 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 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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