December 28, 2010 |
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In 2009, there were nearly 4.6 million drug-related ED visits of which about one half (49.8 percent, or 2.3 million) were attributed to adverse reactions to pharmaceuticals and almost one half (45.1 percent, or 2.1 million) were attributed to drug misuse or abuse (Table 1).3,4 Of the 2.1 million ED visits involving drug misuse or abuse, 1.2 million visits involved the misuse or abuse of pharmaceuticals, almost 1.0 million were related to illicit drugs, and about 200,000 visits were associated with underage drinking.5,6,7 Alcohol was involved in more than 650,000 visits, or slightly less than one third (31.8 percent) of visits resulting from drug misuse or abuse.8
Type of Drug-Related ED Visit | Number of ED Visits* |
Percent* |
---|---|---|
Total Drug-Related ED Visits | 4,595,263 | 100.0% |
Drug Misuse or Abuse | 2,070,439 | 45.1% |
Misuse or Abuse of Pharmaceuticals | 1,244,679 | 27.1% |
Illicit Drug Use | 973,591 | 21.2% |
Alcohol Involvement** | 658,263 | 14.3% |
Alcohol Involvement with Drug Use | 519,650 | 11.3% |
Underage Drinking | 199,429 | 4.3% |
Adverse Reactions | 2,287,273 | 49.8% |
* Because each visit may represent multiple types of visits and multiple types of drugs, the estimates add to more than the total number of visits and the percentages add to more than 100. ** Alcohol involvement includes use of alcohol in combination with other drugs for patients of all ages and use of alcohol only for persons aged 20 or younger. Underage drinking includes both use of alcohol in combination with other drugs and use of alcohol only for persons aged 20 or younger. Source: 2009 SAMHSA Drug Abuse Warning Network (DAWN). |
Patients aged 20 or younger accounted for 19.1 percent (877,802 visits) of all drug-related ED visits in 2009. About one half (415,351 visits) of these visits involved drug misuse or abuse, representing a rate of 473.3 ED visits per 100,000 population aged 20 or younger. The majority of drug-related ED visits were made by patients aged 21 or older (80.9 percent, or 3,717,030 visits). Of these, slightly less than one half (1,654,784 visits) involved drug misuse or abuse, reflecting a rate of 754.8 visits per 100,000 population aged 21 or older.
In 2009, ED visits resulting from the misuse or abuse of pharmaceuticals occurred at a rate of 405.4 visits per 100,000 population compared with a rate of 317.1 per 100,000 population for illicit drugs (Table 2). About one half of ED visits for misuse or abuse of pharmaceuticals involved pain relievers (194.0 visits per 100,000 population), which were most commonly narcotic pain relievers (e.g., oxycodone and hydrocodone products; 129.4 visits per 100,000 population). More than one third of ED visits for misuse or abuse of pharmaceuticals involved drugs to treat insomnia and anxiety (141.2 visits per 100,000 population), primarily benzodiazepines (e.g., alprazolam, clonazepam, and diazepam; 121.6 visits per 100,000 population).
Drugs | Number of ED Visits |
Number of ED Visits per 100,000 Population |
---|---|---|
Alcohol in Combination with Other Drugs* | 519,650 | 169.3 |
Underage Drinking** | 199,429 | 227.2 |
Illicit Drugs | 973,591 | 317.1 |
Cocaine | 422,896 | 137.7 |
Marijuana | 376,467 | 122.6 |
Heroin | 213,118 | 69.4 |
Pharmaceuticals | 1,244,679 | 405.4 |
Pain Relievers | 595,551 | 194.0 |
Narcotic Pain Relievers | 397,160 | 129.4 |
Oxycodone Products | 175,949 | 57.3 |
Hydrocodone Products | 104,490 | 34.0 |
Drugs to Treat Insomnia and Anxiety | 433,600 | 141.2 |
Benzodiazepines | 373,328 | 121.6 |
Antidepressants | 104,940 | 34.2 |
* Use of alcohol in combination with other drugs is recorded by DAWN for patients of all ages. ** Underage drinking includes both use of alcohol in combination with other drugs and use of alcohol only for persons aged 20 or younger. Source: 2009 SAMHSA Drug Abuse Warning Network (DAWN). |
For ED visits related to the use of illicit drugs, cocaine and marijuana had the highest rates involvement at 137.7 and 122.6 visits per 100,000 population, respectively. ED visits involving alcohol in combination with other drugs occurred at a rate of 169.3 visits per 100,000 population for all age groups. ED visits resulting from underage drinking occurred at a rate of 227.2 visits per 100,000 population aged 20 or younger in 2009.
The majority of drug-related ED visits in 2009 were made by patients aged 21 or older; of a total 4,595,263 drug-related ED visits, 3,717,030 (80.9 percent) were made by patients aged 21 or older. Among ED visits made by patients aged 20 or younger resulting from drug misuse or abuse, after alcohol, marijuana was the most commonly involved illicit drug (125.3 visits per 100,000 population) (Figure 1). For this age group, the rates for ED visits related to all other illicit drugs and all major pharmaceuticals were less than 30 visits per 100,000 population (Figures 1 and 2).
Drugs | 20 or Younger, per 100,000 population |
21 or Older, per 100,000 population |
---|---|---|
Cocaine | 28.0 | 181.6 |
Heroin | 19.4 | 89.4 |
Marijuana | 125.3 | 121.5 |
Stimulants | 13.5 | 37.2 |
Ecstasy (MDMA) | 12.6 | 5.4 |
PCP | * | 13.9 |
* Rate is suppressed due to low statistical precision. Source: 2009 SAMHSA Drug Abuse Warning Network (DAWN). |
Drugs | 20 or Younger, per 100,000 population |
21 or Older, per 100,000 population |
---|---|---|
Alprazolam | 21.2 | 55.7 |
Oxycodone Products | 20.7 | 71.9 |
Respiratory System Drugs | 17.2 | 11.5 |
Antidepressants | 16.7 | 41.2 |
Hydrocodone Products | 10.8 | 43.3 |
Zolpidem | 3.5 | 14.8 |
Source: 2009 SAMHSA Drug Abuse Warning Network (DAWN). |
For adults aged 21 or older, cocaine was involved in 398,229 visits, or 181.6 visits per 100,000 population. In this age group, marijuana was involved in 121.5 visits per 100,000 population, heroin was involved in 89.4 visits per 100,000 population, and stimulants (i.e., amphetamines and methamphetamines) were involved in 37.2 visits per 100,000 population (Figure 1). Among pharmaceuticals, the narcotic pain reliever oxycodone appeared in 71.9 visits per 100,000 population, and the benzodiazepine alprazolam was found in 55.7 visits per 100,000 population (Figure 2). Antidepressants and hydrocodone products each appeared in slightly more than 40 visits per 100,000 population.
The total number of drug-related ED visits increased 81 percent from 2004 (2.5 million visits) to 2009 (4.6 million visits). ED visits involving misuse or abuse of pharmaceuticals increased 98.4 percent between 2004 and 2009, from 627,291 visits in 2004 to 1,244,679 visits in 2009 (Figure 3). The corresponding rates of ED visits related to misuse or abuse of pharmaceuticals per 100,000 population were 214.1 in 2004 and 405.4 in 2009 (Table 3). Unlike pharmaceuticals, the level of ED visits involving illicit drug use was generally stable across that time period. ED visits resulting from alcohol involvement with drug use and underage drinking were also stable.
Type of Visit | 2004 | 2005 | 2006 | 2007 | 2008 | 2009 |
---|---|---|---|---|---|---|
Adverse Reactions* | * | 1,250,377 | 1,526,010 | 1,908,928 | 2,157,128 | 2,287,273 |
Misuse or Abuse of Pharmaceuticals | 627,291 | 766,330 | 860,108 | 985,316 | 1,127,681 | 1,244,679 |
Misuse or Abuse of Illicit Drugs | 991,363 | 921,127 | 958,164 | 974,272 | 993,379 | 973,591 |
* Data for ED visits involving adverse reactions to pharmaceuticals are not available for 2004. Source: 2004 to 2009 SAMHSA Drug Abuse Warning Network (DAWN). |
Type of Drug-Related ED Visit |
2004 | 2005 | 2006 | 2007 | 2008 | 2009 | Percent Change in Number of ED Visits, 2004 to 2009 |
---|---|---|---|---|---|---|---|
Total Drug-Related ED Visits | 866.0 | 1,017.4 | 1,152.7 | 1,325.8 | 1,440.2 | 1,496.8 | 81.1%* |
Drug Misuse or Abuse | 552.5 | 546.5 | 583.7 | 624.5 | 657.0 | 674.4 | 27.9% |
Pharmaceuticals | 214.1 | 259.1 | 288.1 | 326.7 | 370.5 | 405.4 | 98.4%* |
Illicit Drugs | 338.3 | 311.5 | 320.9 | 323.1 | 326.4 | 317.1 | −1.8% |
Alcohol Involvement** | 230.3 | 178.3 | 193.4 | 210.4 | 215.8 | 214.4 | −2.5% |
Alcohol Involvement with Drug Use | 178.8 | 140.9 | 151.0 | 164.9 | 172.2 | 169.3 | −0.8% |
Underage Drinking | 238.5 | 183.6 | 211.6 | 225.4 | 217.2 | 227.2 | −2.7% |
Adverse Reactions | *** | 422.8 | 511.1 | 633.0 | 708.7 | 745.0 | 82.9%* |
Accidental Ingestion | 23.8 | 19.1 | 26.5 | 30.4 | 33.0 | 31.0 | 36.2%* |
* The change is statistically significant at the .05 level. ** Alcohol involvement includes use of alcohol in combination with other drugs for patients of all ages and use of alcohol only for persons aged 20 or younger. Underage drinking includes both use of alcohol in combination with other drugs and use of alcohol only for persons aged 20 or younger. *** Data for ED visits involving adverse reactions to pharmaceuticals are not available for 2004. The percent change is calculated from 2005 to 2009. Source: 2004 to 2009 SAMHSA Drug Abuse Warning Network (DAWN). |
Several of the more commonly misused or abused pharmaceuticals were found to have increased more than 100 percent in ED visit involvement from 2004 to 2009 (Table 4). Of these, the largest increases were observed for oxycodone products (242.2 percent increase), alprazolam (148.3 percent increase), and hydrocodone products (124.5 percent increase). Large percent increases occurred among particular drugs contributing to relatively fewer visits: antidiabetic agents such as insulin (223.6 percent increase) and zolpidem, a drug to induce sleep (154.9 percent increase). Among ED visits involving illicit drugs, only those involving Ecstasy increased more than 100 percent from 2004 to 2009 (123.2 percent increase).
Drugs | Number of ED Visits in 2009 |
Percent Increase in Number of ED Visits, 2004 to 2009 |
---|---|---|
Drugs to Treat Insomnia or Anxiety: Zolpidem | 35,438 | 154.9% |
Drugs to Treat Insomnia or Anxiety: Alprazolam | 140,657 | 148.3% |
Drugs to Treat Insomnia or Anxiety: Clonazepam | 69,620 | 114.8% |
Drugs to Treat Insomnia or Anxiety: Lorazepam | 42,602 | 104.3% |
Illicit Drugs: Ecstasy (MDMA) | 22,816 | 123.2% |
Narcotic Pain Relievers: Oxycodone Products | 175,949 | 242.2% |
Narcotic Pain Relievers: Morphine Products | 34,282 | 133.3% |
Narcotic Pain Relievers: Hydrocodone Products | 104,490 | 124.5% |
Narcotic Pain Relievers: Fentanyl Products | 22,143 | 117.5% |
Metabolic Agents: Antidiabetic Agents | 28,088 | 223.6% |
Muscle Relaxants: Carisoprodol | 31,763 | 100.6% |
Source: 2004 to 2009 SAMHSA Drug Abuse Warning Network (DAWN). |
For patients aged 20 or younger, ED visits resulting from misuse or abuse of pharmaceuticals increased 45.4 percent between 2004 and 2009 (116,644 and 169,589 visits, respectively). Among patients aged 21 or older, there was an increase of 111.0 percent. There were no significant changes in the level of ED visits involving illicit drugs for either age group or those involving underage drinking for those aged 20 or younger.
ED visits involving adverse reactions to pharmaceuticals taken as prescribed increased 82.9 percent between 2005 and 2009, from 1,250,377 visits in 2005 to 2,287,273 visits in 2009 (Figure 3).9 The rate for adverse reactions ranged from 422.8 visits per 100,000 population in 2005 to 745.0 visits per 100,000 population in 2009 (Table 3).
The majority of adverse reaction visits were made by patients who were 21 or older (1.9 million visits, or 877.3 visits per 100,000 population). In particular, among patients aged 65 or older, the rate was 1,856.8 visits per 100,000 population. This rate represents an 89.2 percent increase from the number of adverse reaction ED visits among patients aged 65 or older in 2005. The type of drugs most commonly involved in adverse reactions for patients aged 65 or older in 2009 were blood modifiers (e.g., coumarin; 405.8 visits per 100,000 population). Other drugs found at high levels were cardiovascular drugs, including beta blockers (328.5 visits per 100,000 population), pain relievers (296.9 visits per 100,000 population), and cancer drugs (117.1 visits per 100,000 population).
The findings in this report demonstrate the increasing importance of pharmaceuticals to total drug-related ED visits. Pharmaceuticals, even those that are sometimes abused, can have very positive effects when used as prescribed or directed. However, when misused or abused, they can lead to serious negative side effects. Between 2004 and 2009, the number of ED visits involving the misuse or abuse of pharmaceuticals increased substantially. About twice as many people experienced ED visits caused by the misuse or abuse of pharmaceuticals in 2009 than in 2004, and this pattern was consistent across age groups.
The findings related to the misuse or abuse of pharmaceuticals call attention to several public health challenges. First, pharmaceuticals do not have the stigma of being illegal, and therefore health educators must change the perception that pharmaceutical drugs are safe to use recreationally. Another public health challenge is ensuring that pharmaceuticals are available for people who depend on them therapeutically, while finding a way to limit access to people who misuse or abuse them. The findings in this report also highlight the importance of heightening emergency room medical staff's awareness of nonmedical use of pharmaceuticals, because these personnel might be the first responders to people in need of intervention and treatment.
The findings in this report also underscore the growing public health problem of adverse reactions to pharmaceuticals when taken as prescribed or recommended. Recently, there has been increased attention on refining drug warning labels (i.e., the text and icons used) to increase patients' understanding of prescription drugs' potential side effects and possible interactions with other drugs and alcohol, regardless of literacy level.10,11 Beyond these efforts, the increased use of technology in pharmacies—such as software that allows pharmacists to keep a record of a patient's medications and potential interactions or contraindications—is another avenue to increase drug safety. Patients can reduce the potential for adverse reactions by keeping an updated list of all the drugs and supplements that they take so they can present it to doctors and pharmacists whenever they are prescribed a new medication.
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 http://dawninfo.samhsa.gov/drug_vocab. 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 http://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 Center for Behavioral Health Statistics and Quality (formerly the Office of Applied Studies), Substance Abuse and Mental Health Services Administration (SAMHSA). All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Additional copies of this report or other reports from the Center for Behavioral Health Statistics and Quality are available online: http://oas.samhsa.gov/. Citation of the source is appreciated. For questions about this report, please e-mail: shortreports@samhsa.hhs.gov.
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This page was last updated on December 10, 2010. |
SAMHSA, an agency in the Department of Health and Human Services, is the Federal Government's lead agency for improving the quality and availability of substance abuse prevention, addiction treatment, and mental health services in the United States.
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