Highlights of the 2011 Drug Abuse Warning Network (DAWN) Findings on Drug-Related Emergency Department Visits

Excerpt

Background: The Drug Abuse Warning Network (DAWN) provides nationally representative patient demographic and visit-level information on emergency department (ED) visits resulting from substance misuse or abuse, adverse reactions to drugs taken as prescribed or directed, accidental ingestion of drugs, drug-related suicide attempts, and ED admissions for substance abuse treatment. 2011 is the eighth year that the Substance Abuse and Mental Health Services Administration (SAMHSA) has collected data on drug-related ED visits in the U.S. using the new sampling and study design introduced in 2004. Methods: 2011 DAWN data are compared with 2004 and 2009 for visits involving illicit drug use, misuse or abuse of pharmaceuticals, alcohol use, adverse reactions to drugs, and accidental ingestions. All changes over time and between age groups are measured by comparing the rate of ED visits per 100,000 population, not point estimates. Results: In 2011, there were 5.1 million drug-related ED visits; 49% were attributed to drug misuse or abuse with 45% attributed to adverse drug reactions. ED visits involving use of illicit drugs were relatively stable from 2004 (estimated 991,640 visits) to 2009 (974,392 visits) but increased from 2009 to 2011 (1,252,500 visits); between 2009 and 2011, the rate of visits involving illicit stimulants increased 68%, and the rate of visits involving marijuana rose 19%. ED visits involving misuse or abuse of pharmaceuticals increased from 2004 (626,470 visits) through 2011 (1,428,145 visits); the most commonly involved drugs were anti-anxiety and insomnia medications and narcotic pain relievers (160.9 and 134.8 visits per 100,000 population, respectively). ED visits involving adverse reactions to drugs increased from 1,250,377 visits in 2005 to 2,287,271 visits in 2009; however, no increase occurred between 2009 and 2011 (2,301,059 visits). Conclusion: A central finding of the 2011 DAWN is that the involvement of certain commonly abused pharmaceuticals in ED visits associated with drug misuse or abuse did not change from 2009 to 2011. There were no significant increases in the rates of visits involving narcotic pain relievers from 2009 to 2011. Visits involving anti-anxiety or insomnia medications increased a small amount in general, but no specific drugs in this category showed increases. No increases occurred from 2009 to 2011 for ED visits involving adverse reactions to pharmaceuticals overall. Pharmaceuticals continue to be involved at a higher rate than illicit drugs. A second critical finding is that there may be an increase in the involvement of illicit drugs. After 5 years of relative stability, an upward trend was observed between 2009 and 2011. Visits involving marijuana, illicit stimulants, and synthetic cannabinoids increased between 2009 and 2011. Involvement of legal stimulants (e.g., CNS stimulants used to treat attention deficit/hyperactivity disorder) also rose over this period. A more thorough analysis of 2011 and previous data is available at the SAMHSA website (http://www.samhsa.gov/data/), including a comprehensive set of detailed tables that display drug-specific ED visit counts by various patient demographics and visit characteristics for the U.S and select metropolitan areas.