December 15, 2011

Illicit Drug-Related Emergency Department Visits in Metropolitan Areas of the United States: 2009

Patterns and types of drug use, misuse, and abuse vary widely across communities, metro areas, regions, and states.¹ These differing patterns across varied geographic areas must be understood if appropriate prevention and treatment interventions are to be undertaken. As the front line of prehospital care for individuals experiencing acute adverse consequences of drug use, emergency departments (EDs) provide valuable insights into the more serious aspects of certain patterns of drug use.

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, the ED visit must have involved a drug, either as the direct cause of the visit or as a contributing factor. Data are collected on numerous illicit drugs, including cocaine, marijuana, heroin, and stimulants (i.e., amphetamines and methamphetamines). This issue of The DAWN Report focuses on geographic variations in ED visits involving illicit drug use in 2009, comparing 11 metropolitan statistical areas (MSAs) or metropolitan divisions with the national rates (Table 1).²

In 2009, there were an estimated 973,591 ED visits involving illicit drug use in the Nation as a whole, which occurred at a rate of 317 per 100,000 pop. (Figure 1). Four metropolitan areas had significantly higher rates than the Nation for ED visits involving illicit drugs: Boston (571 per 100,000 pop.), New York City (555 per 100,000 pop.), Chicago (507 per 100,000 pop.), and Detroit (462 per 100,000 pop.).

Figure 1. Rates of Emergency Department (ED) Visits Involving Illicit Drugs, by Metropolitan Statistical Area (MSA) or Metropolitan Division: 2009

Differences by specific illicit drugs were examined by metropolitan area, including cocaine, marijuana, heroin, and stimulants (i.e., amphetamines and methamphetamines). The national rate for ED visits involving cocaine was 138 per 100,000 pop. in 2009 (Figure 1). Compared with the national rate, the rates of ED visits involving cocaine were significantly higher in New York City (309 per 100,000 pop.), Boston (244 per 100,000 pop.), Chicago (244 per 100,000 pop.), and Detroit (217 per 100,000 pop.).

The national rate of ED visits involving heroin was 69 per 100,000 pop. (Figure 1). In comparison, the rates of ED visits involving heroin were significantly higher in Boston (251 per 100,000 pop.), Chicago (216 per 100,000 pop.), New York City (153 per 100,000 pop.), Detroit (150 per 100,000 pop.), and Seattle (118 per 100,000 pop.).

Nationally, ED visits involving stimulants occurred at a rate of 30 per 100,000 pop. (Figure 1). Rates of ED visits involving stimulants were significantly higher than those in the Nation as a whole in San Francisco (159 per 100,000 pop.), Phoenix (96 per 100,000 pop.), and Seattle (65 per 100,000 pop.). Several metropolitan areas (all with rates of 10 per 100,000 pop. or less)—including Boston, Fort Lauderdale, Miami-Dade, Chicago, New York City, and Detroit—had lower rates than those in the Nation as a whole.

The rates of ED visits involving marijuana ranged from 93 per 100,000 pop. (Phoenix) to 182 per 100,000 pop. (New York City) (Figure 1). None of the metropolitan areas had rates that were statistically different from the national rate (123 per 100,000 pop.).

ED visits involving illicit drugs in combination with other substances—including alcohol and pharmaceuticals—were examined to determine if there were any geographic differences. Nationally, the rate of visits involving illicit drugs only was 155 per 100,000 pop. (Figure 2). Five metropolitan areas had significantly higher rates than the Nation: San Francisco (328 per 100,000 pop.), Chicago (313 per 100,000 pop.), Boston (275 per 100,000 pop.), New York City (260 per 100,000 pop.), and Detroit (251 per 100,000 pop.).

Figure 2. Rates of Emergency Department (ED) Visits Involving Illicit Drugs Only in Metropolitan Areas: 2009

Nationally, ED visits involving illicit drugs in combination with alcohol occurred at a rate of 69 per 100,000 pop. (Figure 3). Five metropolitan areas had significantly higher rates: New York City (223 per 100,000 pop.), Boston (153 per 100,000 pop.), San Francisco (150 per 100,000 pop.), Chicago (120 per 100,000 pop.), and Detroit (112 per 100,000 pop.).

Figure 3. Rates of Emergency Department (ED) Visits Involving Illicit Drugs in Combination with Alcohol in Metropolitan Areas: 2009

The national rate for ED visits involving illicit drugs combined with pharmaceuticals was 67 per 100,000 pop. There were no statistically significant differences found when the metropolitan area rates were compared against the national rate for ED visits involving these combinations. Rates of ED visits for these combinations ranged from 35 per 100,000 pop. (Miami-Dade) to 92 per 100,000 pop. (Boston).

The 2011 National Prevention Strategy encourages local governments to reduce drug use and its associated negative outcomes and highlights the accomplishments of the Drug Free Communities Program.³ ED data can help identify how often specific illicit drugs are involved in medical emergencies; such local information on drug abuse and its negative consequences can be used to plan for prevention activities, emergency medical services, and treatment needs. As local governments and health care facilities develop policies and strive to use their resources as effectively as possible, ED data can be used to help officials make decisions about current and emerging drug abuse-related issues.