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| July 26, 2012 |
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The number of ED visits involving pharmaceutical misuse or abuse by older adults has steadily increased since 2004 (Figure 1). Specifically, the number of visits increased 159 percent among this age group between 2004 and 2009 (115,798 vs. 300,082 visits) and 17 percent between 2008 and 2009 (255,953 vs. 300,082 visits). In comparison, visits involving pharmaceutical misuse or abuse by younger patients aged 12 to 49 increased 85 percent between 2004 and 2009 (502,901 vs. 931,318 visits), and the change from 2008 to 2009 was not statistically significant (860,413 vs. 931,318 visits).
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| Year | Number of ED Visits |
|---|---|
| 2004 | 115,798 |
| 2005 | 161,632 |
| 2006 | 193,061 |
| 2007 | 224,873 |
| 2008 | 255,953 |
| 2009 | 300,082 |
| Source: 2004 to 2009 SAMHSA Drug Abuse Warning Network (DAWN). |
Because the population of older adults has increased over time, an increase in the number of ED visits involving pharmaceutical misuse or abuse among this age group is expected to occur. However, when population growth is taken into account, the increase in ED visits cannot be attributed solely to an increase in the population size. That is, population rates confirm the increase for older adults. Specifically, population rates increased from 2004 to 2009 (135.1 vs. 308.6 visits per 100,000 population) and from 2008 to 2009 (269.6 vs. 308.6 visits per 100,000 population).
Pain reliever involvement in ED visits for pharmaceutical misuse or abuse by older adults increased 27 percent between 2008 and 2009 (from 111,360 to 141,709 visits); narcotic pain reliever involvement increased 17 percent (Table 1). The increase in visits involving a specific narcotic pain reliever, oxycodone (45 percent increase), contributed substantially to the overall increase. Although visits involving acetaminophen accounted for a much smaller number of visits, such visits increased 60 percent from 2008 to 2009.
| Drug | Estimated Number of ED Visits, 2008 |
Percentage of ED Visits, 2008* |
Estimated Number of ED Visits, 2009 |
Percentage of ED Visits, 2009* |
Percent Increase in Number of Visits** |
|---|---|---|---|---|---|
| Total ED Visits | 255,953 | 100% | 300,082 | 100% | 17% |
| Pain Relievers | 111,360 | 44% | 141,709 | 47% | 27% |
| Narcotic Pain Relievers |
86,699 | 34% | 101,836 | 34% | 17% |
| Oxycodone | 27,405 | 11% | 39,736 | 13% | 45% |
| Acetaminophen Products |
5,119 | 2% | 8,183 | 3% | 60% |
| Anti-anxiety and Insomnia Drugs |
81,413 | 32% | 96,019 | 32% | 18% |
| * Because multiple drugs may be involved in each visit, estimates of visits by drug may add to more than the total, and percentages may add to more than 100 percent. ** Drugs with no statistically significant increase in ED visit involvement between 2008 and 2009 are not listed in the table. Source: 2008 and 2009 SAMHSA Drug Abuse Warning Network (DAWN). |
Anti-anxiety and insomnia drug involvement in ED visits for pharmaceutical misuse or abuse by older adults increased 18 percent between 2008 and 2009 (from 81,413 to 96,019 visits). This percent increase was similar to that of all visits between 2008 and 2009 (from 255,953 to 300,082 visits).
Among older adult patients visiting the ED in 2009, about half of visits for pharmaceutical misuse or abuse occurred among females (53 percent). One third (33 percent) of visits for pharmaceutical misuse or abuse were made by those aged 50 to 54 (Table 2). Visits by adults aged 55 to 59 accounted for 23 percent of such visits, and 20 percent were made by adults aged 70 or older.
| Age | Estimated Number of ED Visits |
Percentage of ED Visits |
Rate per 100,000 Population* |
|---|---|---|---|
| Total ED Visits | 300,082 | 100% | 308.6 |
| Aged 50 to 54 | 99,157 | 33% | 449.9** |
| Aged 55 to 59 | 68,452 | 23% | 354.7 |
| Aged 60 to 64 | 44,809 | 15% | 276.9 |
| Aged 65 to 69 | 29,139 | 10% | 240.1 |
| Aged 70 or Older | 58,524 | 20% | 212.3 |
| * Rates take into consideration the population size of each group; therefore, variation in the number of ED visits between groups may be due to differences in population size if groups have similar population rates. ** The rate for visits among patients aged 50 to 54 is statistically significantly higher than any other age group at the .05 level. Source: 2009 SAMHSA Drug Abuse Warning Network (DAWN). |
Table 2 shows population rates, which take into consideration the population size of each age group. Adults aged 50 to 54 had a higher rate (449.9 visits per 100,000 population) than any other age group. Although adults aged 70 or older had a higher number of visits than adults aged 60 to 64 or adults aged 65 to 69, the population rate was not higher (212.3 vs. 276.9 and 240.1 visits per 100,000 population, respectively).
Among patients aged 50 or older who visited the ED for pharmaceutical misuse or abuse, more than half (54 percent) were treated and released, and more than one third (36 percent) were admitted to the hospital. Of those admitted to the hospital, 71,208 were admitted to an inpatient unit (66 percent), 25,995 (24 percent) were admitted to an intensive care unit, and 10,518 (10 percent) were admitted to a chemical dependency/detoxification or psychiatric unit.
The recent increase in ED visits for pharmaceutical misuse or abuse by older adults can be used to guide drug use prevention activities among this growing population. Because many substance abuse treatment and prevention programs were designed for adolescents and young adults, new approaches to treating substance abuse in older adults may help address these trends.4 Specifically, prevention messages that target older adults could warn against the misuse of pain relievers and anti-anxiety and insomnia drugs. With one fifth of ED visits by older adults that involve pharmaceutical misuse or abuse occurring among adults aged 70 or older, caregivers (e.g., adult children of aging parents) may be an appropriate target audience for pharmaceutical misuse prevention messages. Adults aged 50 to 54 may also need targeted messages regarding medications that can potentially lead to dependency because this age group had the highest rate of ED visits for misuse or abuse of pharmaceuticals.
The results in this report suggest that pharmacy and medical personnel, as well as behavioral health specialists (e.g., social workers, psychologists, and psychiatrists), should be mindful of warning signs of prescription drug misuse or abuse by older adults. Also, physicians can be extra vigilant in obtaining information on all pharmaceutical use, especially when new medications are prescribed, and can suggest that older patients bring a list of medications or their medication containers to visits if recall is an issue. These measures can help decrease medical costs associated with drug misuse or abuse in older adults and prevent life-threatening drug interactions and dependency.
| 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://www.samhsa.gov/data/DAWN.aspx. 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://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 http://www.samhsa.gov/data/DAWN.aspx. |
| 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://www.samhsa.gov/data/. Citation of the source is appreciated. For questions about this report, please e-mail: shortreports@samhsa.hhs.gov.
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