December 8, 2011

Emergency Department Visits Involving Illicit Drug Use among Females

Although females have lower rates of illicit drug use than males, a significant number of females still use illicit drugs. Specifically, data from the National Survey on Drug Use and Health (NSDUH) show that 6.6 percent of females aged 12 or older reported past month illicit drug use in 2009, which represented a slight increase from the 2007 rate (5.8 percent).¹ Current evidence shows important differences between males and females with respect to illicit drug use or abuse. Compared with males, for example, females may progress from first use to dependence more quickly and be less likely to seek treatment.^2,3 Also, females who enter drug abuse treatment have a higher prevalence of co-occurring mental health disorders compared with males.⁴ The study of the characteristics of female patients entering the emergency department (ED) for medical emergencies related to illicit drug use may help identify the treatment needs of women and ensure their inclusion in drug treatment planning.

The Drug Abuse Warning Network (DAWN) is a public health surveillance system that monitors drug-related ED visits in the United States. To be a DAWN case, an ED visit must have involved a drug, either as the direct cause of or as a contributing factor to the ED visit. Data are collected on numerous illicit drugs, including cocaine, marijuana, heroin, amphetamines and hallucinogens, as well as prescription drugs, over-the-counter medications, and nutritional supplements. Data also are collected for visits involving alcohol in combination with other drugs for persons aged 21 or older and for visits with any alcohol involvement for persons aged 20 or younger. This issue of The DAWN Report focuses on ED visits involving illicit drug use among females based on annual averages for combined 2004 to 2009 data and the trends between these years. A separate issue of The DAWN Report addresses ED visits involving illicit drug use among males.⁵

Combined 2004 to 2009 data indicate that females made an annual average of 333,780 ED visits that involved illicit drugs. From 2004 to 2009, the number of ED visits involving illicit drugs among females was unchanged overall, with no significant improvements for cocaine, heroin, or stimulants. The number of visits involving marijuana among females was 88,317 visits in 2004 compared with 130,672 visits in 2009, although the difference was not statistically significant.

Visits involving one illicit drug showed a statistically significant increase. Specifically, the number of ED visits involving Ecstasy among females increased 91.7 percent, from 4,627 visits in 2004 to 8,871 visits in 2009 (Figure 1).

Figure 1. Emergency Department (ED) Visits Involving Ecstasy among Females, by Year: 2004 to 2009*

Combined 2004 to 2009 data indicate that females aged 21 to 50 accounted for about 75 percent of ED visits involving abuse of illicit drugs by females (Figure 2). Specifically, females aged 21 to 30 made 28.2 percent, females aged 31 to 40 made 25.3 percent, and females aged 41 to 50 made 23.4 percent of these ED visits.

Figure 2. Age Distribution for Emergency Department (ED) Visits Involving Illicit Drugs among Females: 2004 to 2009

For ED visits among females, the most frequently involved illicit drug was cocaine (53.7 percent) (Table 1). Nearly one third (31.9 percent) of visits involved marijuana, nearly one fifth (18.3 percent) involved heroin, and more than one tenth (12.8 percent) involved stimulants. Among females aged 17 or younger and those aged 18 to 20, marijuana was the drug most commonly involved (72.6 and 55.1 percent, respectively); however, cocaine was the drug most commonly involved in visits made by females aged 21 or older (data not shown).

Among ED visits involving illicit drugs among females, about two fifths (42.8 percent) of visits involved only one illicit drug, while about three fifths (57.2 percent) involved an illicit drug in combination with other drugs (Table 1). Overall, one fifth (20.3 percent) involved multiple illicit drugs with no alcohol or pharmaceutical involvement. Other visits involved illicit drug(s) in combination with alcohol only (20.7 percent) or illicit drug(s) in combination with pharmaceutical(s) only (19.5 percent).

Among ED visits by females involving illicit drugs, 56.9 percent were treated and released (Figure 3). Of these, 46.6 percent were discharged to home, 7.0 percent were referred to drug detoxification treatment, and 3.4 percent were discharged back into police custody (data not shown).

Figure 3. Disposition of Emergency Department (ED) Visits Involving Illicit Drugs among Females: 2004 to 2009

Over one in four (28.7 percent, or 95,857 visits annually) ED visits involving illicit drugs by females resulted in hospitalization. Of these, 9.3 percent were admitted to the psychiatric unit, 3.8 percent were admitted to an intensive or critical care unit, 3.0 percent were admitted to an inpatient chemical dependency or drug detoxification unit, and 12.6 percent were admitted to another inpatient unit (data not shown).

Comparison of these findings with those in a previously published report⁵ regarding ED visits involving illicit drugs among males reveals that visits by women are more likely to involve combinations of illicit drugs with pharmaceuticals, while visits by men are more likely to involve combinations of illicit drugs with alcohol. These differences in substance use behaviors can be considered during planning of prevention and treatment programs.

The findings in this report suggest that prevention and intervention campaigns focusing on illicit drug use can benefit females of all ages. Health clinics that specialize in women's health, including obstetric and gynecologic medical practices, may be one avenue for prevention efforts to reach both younger and older females. Middle and high schools, community colleges, and universities may provide additional avenues for prevention campaigns targeting younger females.

For the 3 in 10 ED visits involving illicit drugs that result in hospitalization, the hospital stay may extend the opportunity for providers to give women information about the risks of using illicit drugs in general and combining drugs in particular. In addition, the stay may be an opportunity for assessment of and screening for substance abuse. Hospital and ED services also can provide a link to available treatment options within the community.

In order to be comprehensive, substance abuse treatment programs must address issues specific to women's needs. Services associated with parenting and pregnancy can promote positive birth outcomes and child welfare; ancillary services such as child care support a mother's ability to stay in treatment. Mental health services also are important; studies show that women with substance abuse problems are more likely than men to have co-occurring mental health disorders.⁶ The Substance Abuse and Mental Health Administration (SAMHSA) makes available materials addressing women's specific treatment needs to assist providers who treat adult women with substance use disorders. For example, SAMHSA's Center for Substance Abuse Treatment has published a review on gender-specific research and best practices, such as common patterns of initiation of substance use among women, and specific treatment issues and strategies.⁷