This publication was prepared by the Substance Abuse and Mental Health Services Administration (SAMHSA), Office of Applied Studies (OAS) with RTI International under Contract No. 280-03-2602. Judy K. Ball, Ph.D., M.P.A. (DAWN Project Director, SAMHSA/OAS), Scott Novak, Ph.D. (RTI), and Darryl Creel, M.S. (RTI) wrote the publication. Other significant contributors included Victoria Albright, M.A. (Project Director, RTI), Karol Krotki, Ph.D. (RTI), Eric Johnson, Ph.D. (RTI), Francine Cannarozzi, M.Ed. (RTI), Erin Mallonee, M.S. (SAMHSA/OAS), and Elizabeth Crane, Ph.D., M.P.H. (SAMHSA/OAS). The DAWN data collection was conducted by Westat under Contract No. 283-02-9025 under the direction of Josefina Moran.
All material appearing in this publication is in the public domain and may be reproduced or copied without permission from the Substance Abuse and Mental Health Services Administration (SAMHSA). However, this publication may not be reproduced or distributed for a fee without the specific, written authorization of the Office of Communications, SAMHSA. Citation of the source is appreciated. Suggested citation:
Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Drug Abuse Warning Network, 2004: National Estimates of Drug-Related Emergency Department Visits. DAWN Series D-28, DHHS Publication No. (SMA) 06-4143, Rockville, MD, 2006.
Copies may be obtained, free of charge, from the National Clearinghouse for Alcohol and Drug Information (NCADI). The NCADI is a service of the Substance Abuse and Mental Health Services Administration (SAMHSA). Write or call NCADI at:
National Clearinghouse for Alcohol and Drug Information (NCADI)
P.O. Box 2345, Rockville, MD 20847-2345
301-468-2600 | 1-800-729-6686 | TDD 1-800-487-4889
This publication can be accessed electronically through Internet World Wide Web connections:
http://DAWNinfo.samhsa.gov/
http://www.samhsa.gov/
http://www.oas.samhsa.gov/
Substance Abuse and Mental Health Services Administration
Office of Applied Studies
1 Choke Cherry Road, Room 7-1044, Rockville, MD 20857
April 2006
Highlights
Total drug-related ED visits
ED visits involving drug misuse/abuse
Illicit drugs in ED visits
Alcohol and drug-related ED visits
Alcohol in combination with other drugs
Alcohol in patients under age 21
Non-medical use of pharmaceuticals and drug-related ED visits
Special types of drug-related ED visits
Suicide attempts
Seeking detox
Introduction
Major features of DAWN
What is a DAWN case?
Types of cases in DAWN
What drugs are included in DAWN?
Other DAWN features
Estimates in this publication
Hospital participation in 2004
The margin of error
Estimates adjusted for population size
Drug-related ED visits in 2004
Total drug-related ED visits
Drug-related ED visits by type of case
Drug misuse and abuse in ED visits
Alcohol and drug-related ED visits
Alcohol in combination with other drugs
Alcohol only in patients under the age of 21
Any alcohol in patients under the age of 21
Non-medical use of pharmaceuticals and drug-related ED visits
Non-medical use of pharmaceuticals
Special types of drug-related ED visits
Suicide attempt
Seeking detox
List of Tables
Table 1. DAWN ED sample and response rates: 2004
Table 2. Drug-related ED visits, by type of case: 2004
Table 3. Drug-use and misuse in ED visits in the U.S., by type of drug involvement: 2004
Table 4. Illicit drugs and alcohol in drug-related ED visits: 2004
Table 5. Illicit drugs, by type of case: 2004
Table 6. Illicit drugs, by patient characteristics: 2004
Table 7. Alcohol in drug-related ED visits: 2004
Table 8. Alcohol, by type of case: 2004
Table 9. Drugs reported most frequently with alcohol, by type of case: 2004
Table 10. Alcohol, by patient characteristics: 2004
Table 11. Alcohol only (age < 21), by patient and visit characteristics: 2004
Table 12. Alcohol in drug-related ED visits in patients under age 21: 2004
Table 13. Non-medical use of pharmaceuticals: 2004
Table 14. Non-medical use of pharmaceuticals, by patient and visit characteristics: 2004
Table 15. Suicide attempt: 2004
Table 16. Suicide attempt, by patient and visit characteristics: 2004
Table 17. Seeking detox: 2004
Table 18. Seeking detox, by patient and visit characteristics: 2004
List of Figures
Figure 1. Type of case decision tree
Figure 2. DAWN ED case form
Figure 3. Drug-related ED visits in the U.S., by type of case: 2004
Figure 4. Illicit drugs in ED visits: 2004
Figure 5. Illicit drugs, ED visit rates by age and gender: 2004
Figure 6. Alcohol with other drugs, ED visit rates by age and gender: 2004
Figure 7. Alcohol only (age < 21), ED visit rates by age and gender: 2004
Figure 8. Non-medical use of pharmaceuticals, ED visit rates by age and gender: 2004
Figure 9. Suicide attempt, ED visit rates by age and gender: 2004
Figure 10. Seeking detox, ED visit rates by age and gender: 2004
List of Appendixes
Appendix A: Multum Lexicon End-User License Agreement
Appendix B: DAWN Methodology
Appendix C : Glossary of Terms
Appendix D: Population Data
Appendix E: Race and Ethnicity in DAWN
This publication presents national estimates of drug-related visits to hospital emergency departments (EDs) for 2004, based on data from the Drug Abuse Warning Network (DAWN). These estimates pertain to the entire U.S., including Alaska, Hawaii, and the District of Columbia. The Substance Abuse and Mental Health Services Administration (SAMSHA) is the agency responsible for DAWN. SAMHSA is required to collect data on drug-related emergency department visits under section 505 of the Public Health Service Act.
DAWN estimates for 2004 are the first to be based on the new, redesigned sample of hospitals, which covers the entire U.S. Estimates for 2004 also cover a full 12-month period for the first time since the redesign of DAWN was introduced.1 Therefore, the estimates in this publication establish a new baseline against which subsequent years' estimates may be compared. No comparisons with prior years should be made.
DAWN relies on a national sample of general, non-Federal hospitals operating 24-hour EDs. The sample is national in scope, with oversampling of hospitals in selected metropolitan areas. Estimates for 2004 are based on data submitted by 417 hospitals. In each participating hospital, ED medical records are reviewed retrospectively to find the ED visits that were related to recent drug use. All types of drugs—illegal drugs, prescription and over-the-counter pharmaceuticals, dietary supplements, and nonpharmaceutical inhalants—are included. Alcohol, when it is the only drug implicated in a visit, is included for patients younger than age 21; alcohol, when it is present in combination with another drug, is included for patients of all ages.
Of an estimated 106 million ED visits in the U.S. during 2004, DAWN estimates that 1,997,993 (95% confidence interval (CI): 1,708,205 to 2,287,781) were drug-related.2
Out of a total of nearly 2 million drug-related ED visits in 2004, DAWN estimates that nearly 1.3 million ED visits were associated with drug misuse or abuse. Of those ED visits involving drug misuse or abuse:
For 2004, DAWN estimates 940,953 (CI: 773,124 to 1,108,782) drug-related ED visits involved a major substance of abuse. DAWN estimates that:
Taking the margin of error into account, the stimulants (amphetamines and methamphetamine) may be as frequent as heroin in drug-related ED visits, but the stimulants are less frequent than cocaine or marijuana. Since some drug screens test for amphetamines only as a class, an amphetamine-positive result could indicate amphetamine or methamphetamine.
After taking population size and the margin of error into account:
DAWN estimates that, for 2004, 461,809 (CI: 375,820 to 547,798) drug-related ED visits involved alcohol in combination with another drug or alcohol alone in a patient under the age of 21. Thus, nearly a quarter (23%) of all drug-related ED visits involved alcohol in one of these forms. Since DAWN does not account for ED visits involving alcohol alone in adults, the actual number of ED visits involving alcohol is higher. Alcohol is reported to DAWN when it is present in combination with other drugs, regardless of the patient's age.
In 2004, DAWN estimates that 363,641 (CI: 289,516 to 437,766) ED visits involved the use of alcohol in combination with another drug. Alcohol was most frequently combined with:
Considering ED visits only for patients under the age of 21, DAWN estimates 96,809 (CI: 76,127 to 117,491) drug-related ED visits involved alcohol and no other drug.
Injuries were diagnosed in 29% of the alcohol-only visits, and accidents involving falls or motor vehicles were diagnosed in 7%. Most (85%) of these visits resulted in patients being treated and released, usually to home; another 9% were admitted to inpatient units.
Taking population size and the margin of error into account:
Alcohol use by minors also occurs in combination with other drugs. Considering alcohol only and alcohol in combination with other drugs, DAWN estimates 60,118 (CI: 44,918 to 75,318) drug-related ED visits for patients aged 12 to 17 and 82,583 (CI: 67,853 to 97,313) drug-related ED visits for patients aged 18 to 20.
DAWN estimates 495,732 (CI: 408,285 to 583,179) ED visits in 2004 for non-medical use—i.e., misuse or abuse—of prescription or over-the-counter (OTC) pharmaceuticals. Multiple drugs were involved in more than half (57%) of these ED visits. The most frequent drugs in these visits were central nervous system (CNS) agents (53% of visits) and psychotherapeutic agents (48% of visits).
Among the CNS agents, the most frequent drugs were opiate/opioid analgesics (32% of visits involving non-medical use), including single-ingredient (e.g., oxycodone) and combination forms (e.g., hydrocodone with acetaminophen). Methadone and single-ingredient and combination forms of oxycodone and hydrocodone were the most frequent opioids, occurring in similar numbers of visits:
It is not possible to know the extent to which the source of these drugs is a legitimate prescription versus other sources nor is it possible to distinguish methadone used for treatment of opiate addiction from the methadone in pill form that is prescribed for pain.
Among the psychotherapeutic agents, the anxiolytics (anti-anxiety agents), sedatives, and hypnotics are the most frequent, occurring in more than a third (35%) of visits associated with pharmaceutical misuse/abuse. ED visits involving benzodiazepines clearly outnumber those involving any of the other types of psychotherapeutic agents. DAWN estimates that 144,385 (CI: 115,520 to 173,250) ED visits associated with pharmaceutical misuse/abuse involved benzodiazepines in 2004. This is comparable to the number for opiates/opioids.
Taking population size and the margin of error into account:
DAWN estimates 121,585 (CI: 108,955 to 134,215) drug-related ED visits associated with suicide attempts for 2004. The majority of suicide attempt ED visits involved multiple drugs (64%).
In these ED visits for drug-related suicide attempts in 2004:
DAWN estimates 177,879 (CI: 70,845 to 284,913) drug-related ED visits for patients seeking detox or substance abuse treatment services during 2004. However, these visits tend to be concentrated in hospitals with administrative policies that require medical clearance in the ED for admission to these specialized units.
More than 60% of ED visits for seeking detox involved multiple drugs. Both illicit and prescription drugs were common in these visits:
Among the seeking detox ED visits, 7 out of 10 received some type of follow-up care, either inpatient admission, referral elsewhere for detox or substance abuse treatment services, or transfer to another health care facility. However, a quarter of seeking detox cases may not have received the care they sought because they were discharged to home.
This publication presents final estimates of drug-related emergency department (ED) visits from the Drug Abuse Warning Network (DAWN) for 2004. DAWN is a public health surveillance system that monitors drug-related emergency department (ED) visits for the nation and for selected metropolitan areas. DAWN also collects data on drug-related deaths investigated by medical examiners and coroners in selected metropolitan areas and States. The Office of Applied Studies (OAS) of the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services, has been responsible for DAWN operations since 1992.
Major changes to DAWN were instituted at the beginning of 2003. These changes are the result of a redesign that, among other improvements, altered most of DAWN's core features, including the design of the hospital sample and the cases eligible for DAWN. These improvements create a permanent disruption in trends. As a result, comparisons cannot be made between old DAWN (2002 and prior years) and the new DAWN.
This publication presents national estimates of drug-related ED visits for 2004, based on data collected between January 1, 2004 and December 31, 2004. These are final estimates and the first full-year estimates from the new DAWN. Therefore, no trends are presented in this publication.
The findings based on the new DAWN hospital sample are representative of the entire United States, and, as such, they are generalizable to all 50 States and the District of Columbia.
One of the most important features of DAWN is its expansive definition of a case:
A DAWN case is any ED visit related to recent drug use.
DAWN includes ED visits associated with substance abuse/misuse, both intentional and accidental. DAWN also includes ED visits related to the use of drugs for legitimate therapeutic purposes. To be a DAWN case, the relation between the ED visit and the drug need not be causal; the drug needs only to be implicated in the visit.
The case criteria are intended to be broad and inclusive and to have few exceptions. DAWN cases are found through a retrospective review of medical records.3 Broad criteria take into account the fact that documentation in medical records varies in clarity and comprehensiveness across hospitals and among clinicians within hospitals. Broad criteria minimize the potential for judgments that could cause data to vary systematically and unexpectedly across reporters and hospitals. In addition, broad criteria are designed to capture a very diverse set of drug-related cases, which can be aggregated and disaggregated to serve a variety of analytical purposes and the interests of multiple audiences. In DAWN, only recent drug use is included;4 the reason a patient used a drug is irrelevant; and the criteria are broad enough to encompass all types of drug-related events, including, but not limited to, explicit drug abuse. There are a few clearly delineated exceptions to the DAWN case criteria. An ED visit is not a DAWN case if:
By design, the broad case criteria yield a diverse set of cases in DAWN. To bring order to this heterogeneous mix of DAWN cases, each case is assigned to one of eight case types, which may be analyzed separately or in purposeful combinations. The eight case types are:
Each DAWN case is assigned hierarchically into one and only one case type based on a series of questions and rules. To assign case type, DAWN reporters use a decision tree, a graphical depiction of the logic of the case type assignment rules (Figure 1). Cases are classified into the first case type that applies. Even if a case might fit into more than one type, it is assigned to the first one that applies. The case types were ordered with this in mind.
The final category, the case type called other, is reserved for DAWN cases that do not meet any of the rules for classification into one of the first seven types. By design, most cases of drug abuse are classified as case type other. This approach, which never directly identifies drug abuse, comes from the recognition that medical records frequently lack explicit documentation of substance abuse. This lack of documentation may occur for several reasons. First, the distinctions among use, misuse, and abuse of drugs are often subjective. Second, if there is a low index of suspicion for drug abuse in some types of patients, ED physicians may be unlikely to label those types of patients as drug abusers. Third, in many States, insurers may legally deny payment for ED visits related to substance abuse. Thus, financial incentives may be a factor to influence documentation practices.
With these eight case types DAWN includes some ED visits that are unrelated to drug abuse. However, using the hierarchical decision tree is a method for isolating a set of cases involving drug abuse or misuse.
DAWN includes all types of drugs.5 Drugs in DAWN include:
To be reportable, a non-pharmaceutical substance must be consumed by inhalation, sniffing, or snorting, and it must have a psychoactive effect when inhaled. An ED visit involving inhalation of a non-pharmaceutical, psychoactive substance and no other drug qualifies as a DAWN case. Carbon monoxide is excluded from the inhalants. Beginning in 2004, cases involving accidental exposures (e.g., exposure to paint fumes while painting a closet) are excluded as well.
Several methods are used to improve the quality and reliability of DAWN data. These include:
Estimates in this publication were calculated from a probability sample of hospitals by applying sampling weights to data from the sample and accounting for the survey design. Only national estimates pertaining to the U.S. are provided.
Estimates for 2004 are, for the first time, representative of the entire 50 States and the District of Columbia. Hospitals eligible for the DAWN sample are non-Federal, short-stay, general, surgical and medical hospitals in the U.S. that operate 24-hour EDs. The American Hospital Association's (AHA's) 2001 Annual Survey is the source of the sampling frame. (For a definition of sampling frame and other technical terms used in this publication, see Appendix C, Glossary of Terms.)
The DAWN sample of hospitals includes an oversampling of hospitals in selected metropolitan areas supplemented with a sample of hospitals from the remainder of the U.S., which includes other metropolitan areas as well as nonmetropolitan and rural areas. The metropolitan area boundaries correspond to the definitions issued by the Office of Management and Budget (OMB) in June 2003.
For 2004, the national estimates are calculated as the sum of the estimates from 16 geographic areas (15 metropolitan areas, divisions, and subareas and the remainder of the U.S.). The sampling weights consist of three components:
The nonresponse adjustment to the sampling weights is designed to account for data that are missing, but not for data that are incomplete. Therefore, the data used for this publication were subjected to an intense level of scrutiny. The procedures observed for 2004 differed somewhat from those applied in 2003 due to the increased volume of data. For 2004, DAWN case eligibility and assignment of type of case were subjected to a multi-stage review involving automated "expert system" processing with selective manual verification. First, each record submitted as a DAWN case was reviewed by an expert system, which assigned a probability that the record met DAWN case criteria. Records not meeting minimum probability thresholds, as well as a subsample of those that did, were reviewed by DAWN staff for final case eligibility determinations. Second, the expert system reviewed data items submitted on each DAWN case and assigned a probability for each case type. The case type with the highest probability was compared with the case type originally reported on the record. When these agreed, the case was flagged as final. When these disagreed or when the case type probability did not meet a minimum threshold, the case was reviewed manually to resolve the differences. An additional 10% of cases were reviewed manually as a quality control check. Third, all data were checked for internal consistency, out-of-range values, missing data, and adherence to skip patterns at data entry and during subsequent cleaning processes.
A fourth and final review focused explicitly on the issue of incomplete data, that is, DAWN cases missed due to incomplete chart review or inappropriate application of the case criteria. This review used statistical process control methods and information gained from on-site quality audits to identify and evaluate unexpected variability across months in the number of medical charts reviewed and the number of DAWN cases submitted for each hospital.
For 2004, 417 hospitals submitted data that were used for estimation. The weighted response rate varied from 47.4% in the San Francisco Division of the San Francisco Metropolitan Statistical Area (MSA) to 78.1% in the Buffalo, NY MSA. The weighted response rate for hospitals covering the U.S. outside of the 15 metropolitan areas, divisions, and subareas was 35.3%.
Across the 417 participating hospitals, more than 12 million charts were reviewed to find the drug-related visits that met the DAWN case criteria. Based on the review of charts, 279,564 drug-related visits were found and submitted. On average, a DAWN member hospital submitted 670 DAWN cases. However, the number of cases varied widely, from 4 cases to 7,485 (median 402) in a single hospital during 2004.
Since DAWN relies on a sample of hospitals, each estimate produced from the DAWN ED sample data is subject to sampling variability, the so-called "margin of error." This is the variation in the estimate that would be observed naturally if different samples were drawn from the same population using the same procedures. The sampling variability of an estimate in this publication is measured by its relative standard error (RSE), which is defined as the standard error of the estimate expressed as a percentage of the value of the estimate. The precision of an estimate is inversely related to its sampling variability as measured by the RSE. The greater the RSE, the lower the precision.
DAWN estimates with RSE values greater than 50% and estimates less than 30 are regarded as too imprecise for publication and are not shown. In the tables, three dots ("…") are shown in the place of estimates that have an RSE greater than 50% or estimates less than 30. Ratios (percentages or rates per 100,000 population) based on suppressed estimates are likewise suppressed. Gray shading in a cell indicates that the cell is not applicable. For example, no drugs other than alcohol can be present in the "alcohol only" case type category.
In this publication, confidence intervals (CIs) are included in many of the tables and are cited in the text along with the estimates. A CI, which is expressed as a range of values, does a better job of reflecting the true nature of the statistical estimates because it takes both the estimate and its margin of error into account. A 95% CI means that, if repeated samples were drawn from the same population of hospitals using the same sampling and data collection procedures, the true population value would fall within the confidence interval 95% of the time.
For readers unfamiliar with these concepts, a more detailed discussion and examples are provided in Appendix B.
| Geographic area | Total eligible hospitals1 | Eligible hospitals in sample | Responding hospitals in sample | Response rate for sample hospitals | Response rate for visits (weighted) |
|---|---|---|---|---|---|
| Total U.S.2 | 4,438 | 951 | 417 | 43.8 | 47.6 |
| Metropolitan Statistical Areas (MSAs)3 | |||||
| Atlanta-Sandy Springs-Marietta, GA MSA | 41 | 31 | 15 | 48.4 | 57.8 |
| Boston-Cambridge-Quincy, MA-NH MSA | 41 | 30 | 16 | 53.3 | 59.6 |
| Buffalo-Cheektowaga-Tonawanda, NY MSA | 14 | 14 | 8 | 57.1 | 78.1 |
| Chicago-Naperville-Joliet, IL-IN-WI MSA | 91 | 75 | 34 | 45.3 | 47.5 |
| Denver-Aurora, CO MSA | 14 | 14 | 8 | 57.1 | 65.0 |
| Detroit-Warren-Livonia, MI MSA | 38 | 26 | 20 | 76.9 | 72.6 |
| New Orleans-Metairie-Kenner, LA MSA | 21 | 21 | 10 | 47.6 | 68.9 |
| Phoenix-Mesa-Scottsdale, AZ MSA | 25 | 25 | 11 | 44.0 | 52.5 |
| St. Louis, MO-IL MSA | 37 | 37 | 17 | 45.9 | 49.1 |
| San Diego-Carlsbad-San Marcos, CA MSA | 17 | 17 | 10 | 58.8 | 61.4 |
| Seattle-Tacoma-Bellevue, WA MSA | 22 | 22 | 12 | 54.5 | 54.9 |
| Washington-Arlington-Alexandria, DC-VA-MD-WV MSA | 34 | 30 | 14 | 46.7 | 53.0 |
| Metropolitan Divisions and Subareas3 | |||||
| Miami-Miami Beach-Kendall, FL Metropolitan Division of Miami-Fort Lauderdale- Miami Beach, FL MSA |
21 | 17 | 11 | 64.7 | 68.9 |
| Bronx, Kings, New York, Queens, Richmond Counties of New York- Newark-Edison, NY-NJ-PA MSA |
52 | 40 | 26 | 65.0 | 75.1 |
| San Francisco-San Mateo-Redwood City, CA Metropolitan Division of San Francisco- Oakland-Fremont, CA MSA |
18 | 18 | 9 | 50.0 | 47.4 |
| 1 Short-term, general, non-Federal hospitals with 24-hour emergency departments, based on the American Hospital Association (AHA) Annual Survey, are eligible for DAWN. 2 Total eligible hospitals in the U.S. include eligible hospitals from metropolitan areas shown and the remainder of the U.S. Therefore, components shown do not sum to the total. 3 Metropolitan Statistical Areas (MSAs) and Metropolitan Divisions follow the standard definitions issued by the Office of Management and Budget in June 2003 (available at http://www.whitehouse.gov/omb/bulletins/b03-04.html), with one exception: For New York, geographic coverage is limited to the subarea comprising the five Boroughs of New York City. SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2004 (09/2005 update). |
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Standardized measures are needed to make valid comparisons of ED visits and drugs across age and gender categories that differ in population size. For age in particular, the size of the underlying population differs considerably across age groups; for example, the number of individuals aged 18 to 20 in the U.S. is much lower than the number of individuals aged 35 to 44.
To take the size of the underlying population into account, rates of ED visits per 100,000 people are generated using population data from the U.S. Bureau of the Census.6 An example is provided in Appendix B, and the population estimates used for this publication can be found in Appendix D.
Standardized rates are not calculated for race and ethnicity subgroups because the race and ethnicity categories available to DAWN are much less detailed and contain considerably more missing data than the race and ethnicity categories in the Census data. Appendix E describes the race and ethnicity data reported to DAWN.
On average, a drug-related ED visit involved 1.6 drugs.
Among the nearly 2 million ED visits that were drug-related in 2004, DAWN estimates nearly 1.3 million were associated with drug misuse or abuse. This figure includes 940,953 (CI: 773,124 to 1,108,782) drug-related ED visits that involved illicit drugs or alcohol, and 495,732 (CI: 408,285 to 583,179) ED visits associated with non-medical use of pharmaceuticals.
ED visits involving illicit drugs alone accounted for 30% of all visits related to drug misuse/abuse in 2004. ED visits involving non-medical use of pharmaceuticals alone accounted for another 25%. Only 8% of drug misuse/abuse visits were related to consumption of alcohol by a minor. The remaining visits (37%) involved some combination of illicit drugs, alcohol, and/or pharmaceuticals.
ED visits in each of the three major categories—illicit drugs, alcohol, and non-medical use of pharmaceuticals—are discussed in greater detail in separate sections in the remainder of this publication.
| Drug-related ED visits | ||||||
|---|---|---|---|---|---|---|
| Type of case | Unweighted sample data | Weighted estimates1 | Relative standard error (RSE) |
95% Confidence interval | ||
| Lower bound |
- | Upper bound |
||||
| Suicide attempt | 16,169 | 121,585 | 5.3 | 108,955 | - | 134,215 |
| Seeking detox | 28,800 | 177,879 | 30.7 | 70,845 | - | 284,913 |
| Alcohol only (age < 21) | 11,315 | 96,809 | 10.9 | 76,127 | - | 117,491 |
| Adverse reaction | 71,175 | 592,044 | 8.9 | 488,768 | - | 695,320 |
| Overmedication | 28,707 | 244,330 | 10.5 | 194,046 | - | 294,614 |
| Malicious poisoning | 747 | 6,026 | 16.6 | 4,066 | - | 7,986 |
| Accidental ingestion | 5,796 | 57,940 | 7.0 | 49,990 | - | 65,890 |
| Other | 116,855 | 701,381 | 10.6 | 555,663 | - | 847,099 |
| 279,564 | 1,997,993 | 7.4 | 1,708,205 | - | 2,287,781 | |
| 15,568,029 | 105,978,433 | 7.5 | 90,399,603 | - | 121,557,263 | |
| Drugs | ||||||
| Type of case | Unweighted sample data | Weighted estimates2 | Relative standard error (RSE) |
95% Confidence interval | ||
| Lower bound | - | Upper bound | ||||
| Suicide attempt | 34,009 | 266,459 | 6.1 | 234,601 | - | 298,317 |
| Seeking detox | 56,272 | 357,467 | 32.9 | 126,957 | - | 587,977 |
| Alcohol only (age < 21) | 11,315 | 96,809 | 10.9 | 76,127 | - | 117,491 |
| Adverse reaction | 92,571 | 742,916 | 9.1 | 610,410 | - | 875,422 |
| Overmedication | 49,893 | 447,466 | 11.1 | 350,115 | - | 544,817 |
| Malicious poisoning | 1,320 | 10,416 | 17.0 | 6,945 | - | 13,887 |
| Accidental ingestion | 7,398 | 73,992 | 6.6 | 64,421 | - | 83,563 |
| Other | 202,018 | 1,291,276 | 9.8 | 1,019,010 | - | 1,503,542 |
| 454,796 | 3,256,802 | 7.4 | 2,784,436 | - | 3,729,168 | |
| 1 These are estimates of ED visits based on a representative sample of non-Federal, short-stay hospitals with 24-hour EDs in the U.S. 2 These are estimates of drugs. A single ED visit may involve multiple drugs. SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2004 (09/2005 update). |
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SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2004 (09/2005 update).
| Drug involvement1 | Estimated visits2,3 |
Percent |
|---|---|---|
| All types of drug misuse/abuse | 1,254,078 | 100% |
| Illicit drugs only | 379,609 | 30% |
| Alcohol only (age < 21) | 98,174 | 8% |
| Pharmaceuticals only | 313,125 | 25% |
| Combinations | ||
| Illicit drugs with alcohol4 | 190,747 | 15% |
| Illicit drugs with pharmaceuticals | 99,535 | 8% |
| Alcohol with pharmaceuticals | 125,374 | 10% |
| Illicit drugs with alcohol and pharmaceuticals | 47,515 | 4% |
| 1 This classification of drugs is derived from the Multum Lexicon, Copyright 2005, Multum Information Services, Inc. The classification has been modified to meet DAWN's unique requirements (2005). The Multum Licensing Agreement governing use of the Lexicon is provided in Appendix A and can be found on the Internet at http://www.multum.com. 2 These are estimates of ED visits based on a representative sample of non-Federal, short-stay hospitals with 24-hour EDs in the U.S. 3 Estimates are all expressed in visits. 4 DAWN excludes alcohol-only visits for adults. Alcohol, when present with other drugs, is included for all ages. SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2004 (09/2005 update). |
||
The first method for assessing drug abuse in new DAWN focuses on illicit drugs, regardless of case type.
For 2004, DAWN estimates 940,953 (CI: 773,124 to 1,108,782) drug-related ED visits that involved a major substance of abuse (Table 4). This means that nearly half (47%) of all the drug-related ED visits during the year involved alcohol or an illicit drug.
DAWN estimates that cocaine was involved in 383,350 (CI: 284,170 to 482,530) ED visits. In other words, approximately one in five drug-related ED visits (19%) involved cocaine.
Marijuana was involved in 215,665 (CI: 175,930 to 255,400) ED visits. Thus, marijuana may be only slightly less common than cocaine in drug-related ED visits.
Heroin was involved in 162,137 (CI: 122,414 to 201,860) drug-related ED visits or 8% of drug-related ED visits overall. This could, however, be an underestimate. Heroin is an opiate, and some drug screens test for opiates only as a class. About three-quarters (74%) of reports of "opiates" submitted to DAWN for 2004 came from toxicology findings, so some unknown quantity of these may have been heroin. The number of unspecified opiates in drug-related ED visits is estimated at 37,007 (CI: 28,738 to 45,276) visits, or 2% of all drug-related ED visits.
Stimulants, including amphetamines and methamphetamine, were involved in 102,843 (CI: 61,520 to 144,166) ED visits, about 5% of drug-related ED visits overall. Amphetamines and methamphetamine are combined for this analysis because more than 8 out of 10 (86%) amphetamine reports are derived from toxicology findings.7 Since some drug screens test for amphetamines only as a class, an amphetamine-positive result could indicate amphetamine or methamphetamine.
Other illicit drugs appeared at much lower frequencies. For 2004, DAWN estimates:
By design, DAWN excludes illicit drugs from all case types except suicide attempt, seeking detox, malicious poisoning, and other. Also by design, most illicit drug use will be classified in case type other, with most of the remainder in suicide attempts and seeking detox cases (Table 5). For example:
| Drug category and selected drugs1 | Estimated visits2,3,4 | Relative standard error (RSE) |
95% Confidence interval | ||
|---|---|---|---|---|---|
| Lower bound |
- | Upper bound |
|||
| Total drug-related ED visits | 1,997,993 | 7.4 | 1,708,205 | - | 2,287,781 |
| Major substances of abuse (includes alcohol) | 940,953 | 9.1 | 773,124 | - | 1,108,782 |
| Alcohol | 461,809 | 9.5 | 375,820 | - | 547,798 |
| Alcohol-in-combination | 363,641 | 10.4 | 289,516 | - | 437,766 |
| Alcohol alone (age < 21 only) | 98,168 | 10.9 | 77,196 | - | 119,140 |
| Cocaine | 383,350 | 13.2 | 284,170 | - | 482,530 |
| Heroin | 162,137 | 12.5 | 122,414 | - | 201,860 |
| Marijuana | 215,665 | 9.4 | 175,930 | - | 255,400 |
| Stimulants | 102,843 | 20.5 | 61,520 | - | 144,166 |
| Amphetamines | 32,686 | 15.5 | 22,757 | - | 42,615 |
| Methamphetamine | 73,400 | 22.7 | 40,742 | - | 106,058 |
| MDMA (Ecstasy) | 8,621 | 15.6 | 5,985 | - | 11,257 |
| GHB | 2,340 | 48.3 | 125 | - | 4,555 |
| Flunitrazepam (Rohypnol) | 473 | 49.3 | 16 | - | 930 |
| Ketamine | 227 | 26.5 | 109 | - | 345 |
| LSD | 1,953 | 20.2 | 1,179 | - | 2,727 |
| PCP | 8,928 | 22.9 | 4,920 | - | 12,936 |
| Miscellaneous hallucinogens | 3,445 | 18.4 | 2,202 | - | 4,688 |
| Inhalants | 9,275 | 15.5 | 6,457 | - | 12,093 |
| 1,524 | 16.5 | 1,032 | - | 2,016 | |
| 1 This classification of drugs is derived from the Multum Lexicon, Copyright 2005, Multum Information Services, Inc. The classification has been modified to meet DAWN's unique requirements (2005). The Multum Licensing Agreement governing use of the Lexicon is provided in Appendix A and can be found on the Internet at http://www.multum.com. 2 These are estimates of ED visits based on a representative sample of non-Federal, short-stay hospitals with 24-hour EDs in the U.S. 3 Estimates are all expressed in visits. For example, 383,350 visits involved cocaine, and 162,137 visits involved heroin. Visits cannot be summed across drugs because drug-related ED visits often involve multiple drugs (e.g., visits involving both cocaine and heroin would be double counted). 4 Three dots (…) indicate that an estimate with an RSE greater than 50% or an estimate less than 30 has been suppressed. SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2004 (09/2005 update). |
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| Drug category and selected drugs1 | All case types | Type of case | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Suicide attempt | Seeking detox | Alcohol only (age < 21) |
Adverse reaction | Over-medication | Malicious poisoning | Accidental ingestion | Other | ||
| Drug-related ED Visits2,3,4 | |||||||||
| Total drug-related ED visits | 1,997,993 | 121,585 | 177,879 | 96,809 | 592,044 | 244,330 | 6,026 | 57,940 | 701,381 |
| Cocaine | 383,350 | 13,940 | 81,439 | … | … | 995 | … | 286,648 | |
| Heroin | 162,137 | 2,986 | 53,088 | … | … | 111 | 46 | 105,906 | |
| Marijuana | 215,665 | 9,747 | 27,259 | … | … | 879 | 148 | 177,380 | |
| Stimulants | 102,843 | 4,218 | 12,151 | … | 345 | 810 | … | 84,926 | |
| Amphetamines | 32,686 | 1,894 | 1,829 | … | 341 | 532 | 88 | 27,861 | |
| Methamphetamine | 73,400 | 2,391 | 10,518 | … | … | 281 | … | 60,042 | |
| MDMA (Ecstasy) | 8,621 | 278 | … | … | … | … | … | 7,107 | |
| GHB | 2,340 | … | … | … | … | 231 | … | 1,751 | |
| Flunitrazepam (Rohypnol) | 473 | … | … | … | … | … | … | … | |
| Ketamine | 227 | … | … | … | … | … | … | 144 | |
| LSD | 1,953 | … | 60 | … | … | … | … | 1,784 | |
| PCP | 8,928 | 418 | 410 | … | … | … | … | 7,779 | |
| Miscellaneous halluicinogens | 3,445 | … | 90 | … | … | … | … | 3,214 | |
| Inhalants | 9,275 | 187 | … | 1,165 | … | … | 3,338 | 4,376 | |
| Combinations NTA | 1,524 | … | 222 | … | … | … | … | 1,282 | |
| Percent of visits | |||||||||
| Cocaine | 19% | 11% | 46% | … | … | 17% | … | 41% | |
| Heroin | 8% | 2% | 30% | … | … | 2% | 0% | 15% | |
| Marijuana | 11% | 8% | 15% | … | … | 15% | 0% | 25% | |
| Stimulants | 5% | 3% | 7% | … | 0% | 13% | … | 12% | |
| Amphetamines | 2% | 2% | 1% | … | … | 9% | … | 4% | |
| Methamphetamine | 4% | 2% | 6% | … | … | 5% | … | 9% | |
| MDMA (Ecstasy) | 0% | 0% | … | … | … | … | … | 1% | |
| GHB | 0% | 0% | … | … | … | 4% | … | 0% | |
| Flunitrazepam (Rohypnol) | 0% | … | … | … | … | … | … | … | |
| Ketamine | 0% | … | … | … | … | … | … | 0% | |
| LSD | 0% | … | 0% | … | … | … | 0% | 0% | |
| PCP | 0% | 0% | 0% | … | … | … | … | 1% | |
| Miscellaneous hallucinogens | 0% | … | 0% | … | … | … | … | 0% | |
| Inhalants | 0% | 0% | … | 0% | … | … | 6% | 1% | |
| Combinations NTA | 0% | … | 0% | … | … | … | … | 0% | |
| ED Visits per 100,000 population2,3,4 | |||||||||
| Total drug-related ED visits | 680 | 41 | 61 | 113 | 202 | 83 | 2 | 20 | 239 |
| Cocaine | 131 | 5 | 28 | … | … | 0 | … | 98 | |
| Heroin | 55 | 1 | 18 | … | … | 0 | 0 | 36 | |
| Marijuana | 73 | 3 | 9 | … | … | 0 | 0 | 60 | |
| Stimulants | 35 | 1 | 4 | … | 0 | 0 | … | 29 | |
| Amphetamines | 11 | 1 | 1 | … | 0 | 0 | 0 | 9 | |
| Methamphetamine | 25 | 1 | 4 | … | … | 0 | … | 20 | |
| MDMA (Ecstasy) | 3 | 0 | … | … | … | … | … | 2 | |
| GHB | 1 | … | … | … | … | 0 | … | 1 | |
| Flunitrazepam (Rohypnol) | 0 | … | … | … | … | … | … | … | |
| Ketamine | 0 | … | … | … | … | … | … | 0 | |
| LSD | 1 | … | 0 | … | … | … | … | 1 | |
| PCP | 3 | 0 | 0 | … | … | … | … | 3 | |
| Miscellaneous halluicinogens | 1 | … | 0 | … | … | … | … | 1 | |
| Inhalants | 3 | 0 | … | 0 | … | … | 1 | 1 | |
| Combinations NTA | 1 | … | 0 | … | … | … | … | 0 | |
| 1 This classification of drugs is derived from the Multum Lexicon, Copyright 2005, Multum Information Services, Inc. The classification has been modified to meet DAWN's unique requirements (2005). The Multum Licensing Agreement governing use of the Lexicon is provided in Appendix A and can be found on the Internet at http://www.multum.com. 2 These are estimates of ED visits based on a representative sample of non-Federal, short-stay hospitals with 24-hour EDs in the U.S. 3 Estimates are all expressed in visits. For example, 383,350 visits involved cocaine, and 162,137 visits involved heroin. Visits cannot be summed across drugs because drug-related ED visits often involve multiple drugs (e.g., visits involving both cocaine and heroin would be double counted). 4 Three dots (…) indicate that an estimate with an RSE greater than 50% or an estimate less than 30 has been suppressed. SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2004 (09/2005 update). |
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When considered in relation to the population of the U.S., ED visits associated with illicit drugs are relatively infrequent, but vary across the major drugs (Figure 4):
The rates of ED visits involving cocaine, marijuana, heroin, and stimulants did not differ between males and females after taking population size and the margin of error into account (Figure 5). The rates for patients aged 21 to 54 tended to be similar for cocaine and heroin, with lower rates for younger and older patients (Table 6 and Figure 5). For marijuana, the rates were highest for patients aged 18 to 24. For stimulants, the rates were highest for patients aged 18 to 44.
SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2004 (09/2005 update).
| Patient characteristics | Selected drugs1 | |||||||
|---|---|---|---|---|---|---|---|---|
| Cocaine | Heroin | Marijuana | Stimulants | MDMA (Ecstasy) | GHB | LSD | PCP | |
| Drug-related ED visits2,3,4 | ||||||||
| Total drug-related ED visits | 383,350 | 162,137 | 215,665 | 102,843 | 8,621 | 2,340 | 1,953 | 8,928 |
| Gender | ||||||||
| Male | 249,942 | 108,768 | 141,871 | 58,700 | 4,916 | 1,316 | 1,786 | 5,783 |
| Female | 133,296 | 53,319 | 73,716 | 44,138 | 3,704 | … | 167 | 3,131 |
| Unknown | 112 | 50 | 78 | … | … | … | … | … |
| Age | ||||||||
| 0-5 years | 253 | … | … | … | … | … | … | … |
| 6-11 years | … | … | 380 | … | … | … | … | … |
| 12-17 years | 11,539 | 1,400 | 39,035 | 6,402 | 1,429 | … | 451 | 806 |
| 18-20 years | 18,404 | 8,801 | 27,742 | 10,028 | 2,374 | 423 | 551 | 853 |
| 21-24 years | 34,564 | 18,256 | 32,154 | 15,542 | 2,179 | … | 339 | 1,543 |
| 25-29 years | 49,153 | 25,037 | 28,645 | 18,340 | 1,357 | 404 | 157 | 1,246 |
| 30-34 years | 55,142 | 22,474 | 24,716 | 14,484 | 611 | 308 | 133 | 1,670 |
| 35-44 years | 127,662 | 44,864 | 40,639 | 24,405 | 513 | 326 | 201 | 1,724 |
| 45-54 years | 73,807 | 34,383 | 19,389 | 11,663 | … | … | … | 895 |
| 55-64 years | 10,790 | 5,933 | 2,311 | 1,430 | … | … | … | … |
| 65 years and older | 1,503 | 653 | 403 | 49 | … | … | … | … |
| Unknown | 518 | 188 | 136 | 35 | … | … | … | … |
| Race/ethnicity | ||||||||
| White | 145,216 | 68,297 | 111,685 | 60,469 | 4,108 | … | 1,326 | 4,734 |
| Black | 152,732 | 41,831 | 53,955 | 4,323 | 2,140 | 37 | 268 | 2,133 |
| Hispanic | 36,888 | 18,595 | 18,677 | 8,904 | … | 50 | 104 | 861 |
| Race/ethnicity NTA | 4,589 | 1,607 | 2,706 | 1,910 | 191 | … | … | 34 |
| Unknown | 43,925 | 31,807 | 28,642 | 27,238 | 1,370 | 291 | 233 | 1,165 |
| ED visits per 100,000 population2,3,4 | ||||||||
| Total drug-related ED visits | 131 | 55 | 73 | 35 | 3 | 1 | 1 | 3 |
| Gender | ||||||||
| Male | 173 | 75 | 98 | 41 | 3 | 1 | 1 | 4 |
| Female | 89 | 36 | 49 | … | … | … | 0 | … |
| Age | ||||||||
| 0-5 years | 1 | … | … | … | … | … | … | … |
| 6-11 years | … | … | 2 | … | … | … | … | … |
| 12-17 years | 45 | 6 | 154 | 25 | 6 | … | 2 | 3 |
| 18-20 years | 149 | 71 | 225 | 81 | 19 | 3 | 4 | 7 |
| 21-24 years | 205 | 108 | 190 | 92 | 13 | … | 2 | 9 |
| 25-29 years | 251 | 128 | 146 | 94 | 7 | 2 | 1 | 6 |
| 30-34 years | 269 | 110 | 121 | 71 | 3 | 2 | 1 | 8 |
| 35-44 years | 289 | 102 | 92 | 55 | 1 | 1 | 0 | 4 |
| 45-54 years | 177 | 83 | 47 | 28 | … | … | … | 2 |
| 55-64 years | 37 | 20 | 8 | 5 | … | … | … | … |
| 65 years and older | 4 | 2 | 1 | 0 | … | … | … | … |
| 1 This classification of drugs is derived from the Multum Lexicon, Copyright 2005, Multum Information Services, Inc. The classification has been modified to meet DAWN's unique requirements (2005). The Multum Licensing Agreement governing use of the Lexicon is provided in Appendix A and can be found on the Internet at http://www.multum.com. 2 These are estimates of ED visits based on a representative sample of non-Federal, short-stay hospitals with 24-hour EDs in the U.S. 3 Estimates are all expressed in visits. 4 Three dots (…) indicate that an estimate with an RSE greater than 50% or an estimate less than 30 has been suppressed. SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2004 (09/2005 update). |
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SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2004 (09/2005 update).
The second method of assessing drug misuse and abuse in DAWN focuses on alcohol:
For 2004, DAWN estimates 461,809 (CI: 375,820 to 547,798) drug-related ED visits involved alcohol in combination with another drug or alcohol alone in a patient under the age of 21. Thus, nearly a quarter (23%) of all drug-related ED visits involved alcohol in one of these forms (Table 7).
| Estimated visits2,3 | Relative standard error (RSE) |
95% Confidence interval | |||
|---|---|---|---|---|---|
| Lower bound |
- | Upper bound |
|||
| Total drug-related ED visits | 1,997,993 | 7.4 | 1,708,205 | - | 2,287,781 |
| Alcohol | 461,809 | 9.5 | 375,820 | - | 547,798 |
| Alcohol-in-combination | 363,641 | 10.4 | 289,516 | - | 437,766 |
| Alcohol alone | 98,168 | 10.9 | 77,196 | - | 119,140 |
| 1 This classification of drugs is derived from the Multum Lexicon, Copyright 2005, Multum Information Services, Inc. The classification has been modified to meet DAWN's unique requirements (2005). The Multum Licensing Agreement governing use of the Lexicon is provided in Appendix A and can be found on the Internet at http://www.multum.com. 2 These are estimates of ED visits based on a representative sample of non-Federal, short-stay hospitals with 24-hour EDs in the U.S. 3 Estimates are all expressed in visits. SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2004 (09/2005 update). |
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DAWN estimates 363,641 (CI: 289,516 to 437,766) ED visits related to use of alcohol in combination with another drug in 2004. Alcohol is reported to DAWN in combination with other drugs, regardless of the patient's age. These are the only alcohol reports received for patients aged 21 and older. Nearly 9 out of 10 (87%) ED visits implicating alcohol with another drug were for adult patients. Alcohol in combination appeared in substantial numbers in most case types (Table 8):
Alcohol was involved with other drugs in about a quarter (27%) of ED visits involving misuse or abuse of drugs—i.e., overmedication, malicious poisoning, and case type other, considered as a group. Alcohol appeared rarely in adverse reactions (1% of visits).
| Drug category and selected drugs1 | All case types | Type of case | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Suicide attempt | Seeking detox | Alcohol only (age<21) | Adverse reaction | Over-medication | Malicious poisoning | Accidental ingestion | Other | ||
| Drug-related ED visits2,3,4 | |||||||||
| Total drug-related ED visits | 1,997,993 | 121,585 | 177,879 | 96,809 | 592,044 | 244,330 | 6,026 | 57,940 | 701,381 |
| Alcohol | 461,809 | 37,414 | 60,022 | 96,809 | 8,212 | 47,915 | 2,935 | 603 | 207,897 |
| Alcohol-in- combination |
363,641 | 36,702 | 59,599 | 8,200 | 47,915 | 2,935 | 601 | 207,689 | |
| Alcohol alone | 98,168 | 712 | 424 | 96,809 | … | … | … | … | … |
| Percent of visits | |||||||||
| Alcohol | 23% | 31% | 34% | 100% | 1% | 20% | 49% | 1% | 30% |
| Alcohol-in- combination |
18% | 30% | 34% | 1% | 20% | 49% | 1% | 30% | |
| Alcohol alone | 5% | 1% | 0% | 100% | … | … | … | … | … |
| 1 This classification of drugs is derived from the Multum Lexicon, Copyright 2005, Multum Information Services, Inc. The classification has been modified to meet DAWN's unique requirements (2005). The Multum Licensing Agreement governing use of the Lexicon is provided in Appendix A and can be found on the Internet at http://www.multum.com. 2 These are estimates of ED visits based on a representative sample of non-Federal, short-stay hospitals with 24-hour EDs in the U.S. 3 Estimates are all expressed in visits. 4 Three dots (…) indicate that an estimate with an RSE greater than 50% or an estimate less than 30 has been suppressed. SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2004 (09/2005 update). |
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Alcohol was most frequently combined with (Table 9):
Among cases involving misuse or abuse of drugs, DAWN estimates 258,539 (CI: 189,623 to 327,455) ED visits involving alcohol in combination with other drugs in 2004. Males accounted for 62% of these visits involving alcohol and other drugs, but taking population size into account, males and females had similar rates of such visits. There was little variation in rates across the age groups from ages 18 to 44. However, rates of such visits were lower for older and younger patients.
In terms of race and ethnicity, 51% of the visits with alcohol in combination involved patients who were white. Evaluating the relative frequencies of the other race/ethnicity groups is impeded by missing data; in 14% of visits race/ethnicity was unknown.
SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2004 (09/2005 update).
| Drugs reported with alcohol1 | All case types | Type of case | |||||||
|---|---|---|---|---|---|---|---|---|---|
| Suicide attempt | Seeking detox | Alcohol only (age < 21) |
Adverse reaction | Over-medication | Malicious poisoning | Accidental ingestion | Other | ||
| Drug-related ED visits2,3,4 | |||||||||
| No other drug | 98,168 | 712 | 424 | 96,809 | … | … | … | … | … |
| Cocaine only | 83,816 | 1,566 | 20,234 | … | … | 324 | … | 61,686 | |
| Marijuana only | 33,963 | 506 | 2,333 | … | … | … | … | 31,099 | |
| Cocaine and marijuana only | 19,697 | 437 | 4,973 | … | … | 94 | … | 14,193 | |
| Heroin only | 14,669 | 349 | 4,565 | … | … | … | … | 9,751 | |
| Cocaine and heroin only | 9,992 | 167 | 4,181 | … | … | … | … | 5,641 | |
| Stimulants only | 9,525 | 204 | 949 | … | … | 87 | … | 8,269 | |
| Alprazolam only | 9,035 | 1,371 | 717 | 253 | 4,097 | … | … | 2,590 | |
| 1 This classification of drugs is derived from the Multum Lexicon, Copyright 2005, Multum Information Services, Inc. The classification has been modified to meet DAWN's unique requirements (2005). The Multum Licensing Agreement governing use of the Lexicon is provided in Appendix A and can be found on the Internet at http://www.multum.com. 2 These are estimates of ED visits based on a representative sample of non-Federal, short-stay hospitals with 24-hour EDs in the U.S. 3 Estimates are all expressed in visits. 4 Three dots (…) indicate that an estimate with an RSE greater than 50% or an estimate less than 30 has been suppressed. SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2004 (09/2005 update). |
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| Patient characteristics | All case types1,2,3,4 | Overmedication, malicious poisoning, and case type other1,2,3,4 |
||
|---|---|---|---|---|
| All alcohol | Alcohol-in- combination |
Alcohol alone | Alcohol-in-combination | |
| Total drug-related ED visits | 461,809 | 363,641 | 98,168 | 258,539 |
| Gender | ||||
| Male | 281,019 | 224,217 | 56,802 | 161,412 |
| Female | 180,675 | 139,322 | 41,353 | 97,037 |
| Unknown | 114 | 102 | … | 90 |
| Age | ||||
| 0-5 years | 701 | 335 | 366 | … |
| 6-11 years | 283 | … | 267 | … |
| 12-17 years | 60,118 | 19,605 | 40,512 | 16,835 |
| 18-20 years | 82,583 | 25,676 | 56,907 | 21,004 |
| 21-24 years | 37,437 | 37,436 | … | 28,070 |
| 25-29 years | 41,592 | 41,584 | … | 29,309 |
| 30-34 years | 44,946 | 44,935 | … | 29,931 |
| 35-44 years | 106,723 | 106,720 | … | 74,182 |
| 45-54 years | 70,440 | 70,362 | … | 47,537 |
| 55-64 years | 13,319 | 13,314 | … | 9,006 |
| 65 years and older | 3,298 | 3,289 | … | 2,186 |
| Unknown | 369 | 369 | … | 284 |
| Race/ethnicity | ||||
| White | 250,706 | 191,860 | 58,846 | 130,865 |
| Black | 94,014 | 86,541 | 7,473 | 63,102 |
| Hispanic | 44,747 | 32,773 | 11,974 | 24,509 |
| Race/ethnicity NTA | 6,727 | 4,570 | 2,157 | 3,613 |
| Unknown | 65,614 | 47,896 | 17,718 | 36,451 |
| 1 This classification of drugs is derived from the Multum Lexicon, Copyright 2005, Multum Information Services, Inc. The classification has been modified to meet DAWN's unique requirements (2005). The Multum Licensing Agreement governing use of the Lexicon is provided in Appendix A and can be found on the Internet at http://www.multum.com. 2 These are estimates of ED visits based on a representative sample of non-Federal, short-stay hospitals with 24-hour EDs in the U.S. 3 Estimates are all expressed in visits. 4 Three dots (…) indicate that an estimate with an RSE greater than 50% or an estimate less than 30 has been suppressed. SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2004 (09/2005 update). |
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DAWN estimates 96,809 (CI: 76,127 to 117,491) ED visits related to use of alcohol by patients who were younger than age 21 in 2004 (Table 4). These numbers increase very little if instances of underage alcohol use in suicide attempts and seeking detox cases are also included (Table 11).
Alcohol was specifically indicated in a diagnosis in about two out of three (68%) alcohol-only visits, with toxic effects (e.g., "intoxication") in slightly fewer (57%) visits. Injuries were diagnosed in 29% of alcohol-only visits, and accidents, involving falls or motor vehicles, were indicated by diagnosis in 7% (Table 11).
Most (85%) of such visits resulted in patients being treated and released, usually to home; another 9% were admitted to inpatient units.
Taking population size into account, the rate of alcohol-only ED visits for ages 18 to 20 (456 visits per 100,000 population) was 2.9 times that for patients aged 12 to 17 (157 per 100,000). The rates for males and females were equivalent.
In terms of race and ethnicity, 60% of the alcohol-only visits involved patients who were white. Evaluating the relative frequencies of the other race/ethnicity groups is impeded by missing data; in 18% of visits race/ethnicity was unknown.
SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2004 (09/2005 update).
| Patient characteristics | Estimated visits1,2 |
Visit characteristics | Estimated visits1,2 |
|---|---|---|---|
| Total drug-related ED visits | 96,809 | ||
| Gender | Number of drugs involved | ||
| Male | 56,223 | Single drug | 96,809 |
| Female | 40,573 | Multiple drugs | |
| Unknown | … | Alcohol involved | 96,809 |
| Age | Disposition | ||
| 0-5 years | 366 | Treated and released | 82,486 |
| 6-11 years | 267 | Discharged home | 71,324</ |
