December 8, 2011

Emergency Department Visits Involving Illicit Drug Use among Males

The use of illicit drugs (e.g., marijuana, heroin, and cocaine) may lead to serious health issues such as unintentional injuries, car accidents, and overdoses that may require acute emergency care. National Survey on Drug Use and Health (NSDUH) data show that 1 in 10 males aged 12 or older reported past month illicit drug use in 2009, compared with 1 in 15 females.¹ The same data show that males were also more likely than females to be past month users of marijuana (8.6 vs. 4.8 percent),¹ the use of which has been found to contribute to traffic accidents and other injuries.² The higher illicit drug rates for males suggests that negative consequences associated with illicit drug use, such as emergency department (ED) visits, may be disproportionately found among males.

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 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 ED visits involving illicit drug use among males. Data for 2004 to 2009 are presented, both as trends over time and also as annual averages for the 6-year period. Illicit drug use among females is covered in a separate report.

Combined 2004 to 2009 data indicate that males made an annual average of 634,361 ED visits involving illicit drugs. From 2004 to 2009, the number of ED visits involving illicit drugs among males remained unchanged (Figure 1). Although the number of ED visits involving marijuana appeared to increase between 2004 (192,844 visits) and 2009 (245,505 visits), the difference was not statistically significant. Similarly, the number of stimulant-related ED visits appears to decline between 2004 (101,367 visits) and 2009 (55,776 visits), but the difference was not statistically significant.

Figure 1. Emergency Department (ED) Visits Involving Illicit Drugs among Males, by Year: 2004 to 2009

Approximately three fourths of drug-related visits among males involving illicit drugs were evenly distributed among three groups: males aged 21 to 30, males aged 31 to 40, and males aged 41 to 50 (Figure 2). Specifically, 26.9 percent of visits were made by males aged 21 to 30, 24.3 percent were made by males aged 31 to 40, and 24.1 percent were made by males aged 41 to 50. The remaining ED visits among persons aged 12 to 20 and aged 51 to 60 were similar to each other—each comprised slightly more than 10 percent of visits.

Figure 2. Emergency Department (ED) Visits Involving Illicit Drugs among Males, by Age: 2004 to 2009

Cocaine was the most commonly involved drug among ED visits involving the use of illicit drugs among males (49.7 percent) (Table 1). About 1 in 3 visits (33.4 percent) involved marijuana, about 1 in 5 visits (21.7 percent) involved heroin, and about 1 in 10 visits (11.1 percent) involved stimulants. Marijuana was the drug most commonly involved in visits among males aged 20 or younger, whereas cocaine was the drug most commonly involved in visits made by males aged 31 or older.

About two fifths (43.4 percent) of visits for illicit drugs among males involved one illicit drug only, whereas one fifth (20.3 percent) of visits involved multiple illicit drugs (Table 1). Many visits also involved illicit drugs combined with alcohol only (27.4 percent), illicit drugs combined with pharmaceuticals only (13.2 percent), and illicit drugs combined with alcohol and pharmaceuticals (6.5 percent).

More than half (57.0 percent) of males making an ED visit for illicit drugs were treated and released (Figure 3). Of the total ED visits, the majority (44.4 percent) were discharged to home, with 7.2 percent referred to drug detoxification treatment, and 5.4 percent discharged back into police custody (data not shown).

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

Nearly 3 in 10 (29.2 percent, or 185,016 visits annually) ED visits involving illicit drugs by males resulted in hospitalization. Of these, 3.1 percent were admitted to the intensive or critical care unit, 3.1 percent were admitted to an inpatient chemical dependency or drug detoxification unit, and 12.9 percent were admitted to another inpatient unit.

National rates of male ED visits for illicit drugs remained essentially unchanged between 2004 and 2009, indicating little improvement in preventing medically significant sequelae from use of illicit substances by this population. That approximately 30 percent of males who make ED visits related to illicit drugs are hospitalized as a result of their visit indicates that this is a serious public health problem. The findings in this report suggest that drug prevention and treatment programs including older males should address cocaine use and that programs involving younger males should emphasize the dangerous effects of marijuana. Although marijuana is sometimes perceived as harmless, studies show that marijuana impairs coordination, and early initiation and prolonged use can impact cognition and mental health.³

More than half of visits among males involved an illicit drug in combination with one or more other drugs. This is a cause for concern because polydrug use (use of more than one substance concurrently in the past year) has been found to be significantly associated with poorer mental health among the general population, and polydrug use in general is more common among males.⁴ In the short term, these patients may experience dangerous drug interactions, requiring more advanced treatment in the ED. Assessing and documenting the presence of multiple drugs in the ED can inform appropriate drug treatment and safe detoxification, especially when alcohol or pharmaceutical drugs are also involved.⁵ In the long term, the ED offers an effective venue to identify males at risk for experiencing the negative consequences of drug use and directing them to appropriate treatment within the community.