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), Eric Johnson, Ph.D. (RTI), and Elizabeth Foley, B.A. (RTI), wrote the publication. Other significant contributors included Victoria Albright, M.A. (Project Director, RTI), Karol Krotki, Ph.D. (RTI), Francine Cannarozzi, M.Ed. (RTI), 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, M.A.
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, 2005: National Estimates of Drug-Related Emergency Department Visits. DAWN Series D-29, DHHS Publication No. (SMA) 07-4256, Rockville, MD, 2007.
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
1-877-SAMHSA-7 (1-877-726-4727) | 1-800-729-6686 | TDD: 1-800-487-4889
This publication can be accessed electronically through Internet World Wide Web connections:
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Substance Abuse and Mental Health Services Administration
Office of Applied Studies
1 Choke Cherry Road, Room 7-1044, Rockville, MD 20857
February 2007
Highlights
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
Nonmedical use of pharmaceuticals
Drug misuse and abuse: 2004 and 2005
Special types of drug-related ED visits
Suicide attempts
Seeking detox
Introduction
Major features of DAWN
What is a DAWN case?
What drugs are included in DAWN?
What is covered in this publication?
Estimates in this publication
Hospital participation in 2005
The margin of error
The margin of error and differences across time
Estimates adjusted for population size
Drug misuse and abuse in ED visits
Alcohol in ED visits
Alcohol in combination with other drugs (Tables 5-6, Figure 3)
Alcohol-related ED visits in patients under the age of 21 (Table 7)
ED visits for underage alcohol use (Tables 4, 8, Figure 4)
Nonmedical use of pharmaceuticals
Nonmedical use of pharmaceuticals (Tables 9-10, Figure 5)
Comparisons of ED visits in 2004 and 2005
Drug misuse and abuse in ED visits (Table 11)
Illicit drugs in ED visits (Table 12)
Alcohol in ED visits (Tables 13-14)
Nonmedical use of pharmaceuticals (Table 15)
Special types of drug-related ED visits
Suicide attempts (Tables 16-17, Figure 6)
Suicide attempt ED visits: 2004 and 2005 (Table 18)
Seeking detox (Tables 19-20, Figure 7)
Seeking detox ED visits: 2004 and 2005 (Table 21)
List of Tables
Table 1. Drug misuse and abuse in ED visits in the U.S., by type of drug involvement: 2005
Table 2. Illicit drugs in ED visits: 2005
Table 3. Illicit drugs, by patient characteristics: 2005
Table 4. Alcohol in drug-related ED visits: 2005
Table 5. Alcohol in combination, by patient and visit characteristics: 2005
Table 6. Drugs most frequently reported with alcohol: 2005
Table 7. Alcohol in drug-related ED visits in patients under age 21: 2005
Table 8. Alcohol only (age < 21), by patient and visit characteristics: 2005
Table 9. Nonmedical use of pharmaceuticals: 2005
Table 10. Nonmedical use of pharmaceuticals, by patient and visit characteristics: 2005
Table 11. Drug misuse and abuse in ED visits in the U.S., by type of drug involvement: 2004 and 2005
Table 12. Illicit drugs in ED visits: 2004 and 2005
Table 13. Alcohol in drug-related ED visits: 2004 and 2005
Table 14. Alcohol in drug-related ED visits in patients under age 21: 2004 and 2005
Table 15. Nonmedical use of pharmaceuticals ED visits: 2004 and 2005
Table 16. Suicide attempts: 2005
Table 17. Suicide attempts, by patient and visit characteristics: 2005
Table 18. Suicide attempts: 2004 and 2005
Table 19. Seeking detox: 2005
Table 20. Seeking detox, by patient and visit characteristics: 2005
Table 21. Seeking detox: 2004 and 2005
List of Figures
Figure 1. Rates of ED visits involving selected illicit drugs: 2005
Figure 2. Illicit drugs, ED visit rates by age and gender: 2005
Figure 3. Alcohol with other drugs, ED visit rates by age and gender: 2005
Figure 4. Alcohol only (age < 21), ED visit rates by age and gender: 2005
Figure 5. Nonmedical use of pharmaceuticals, ED visit rates by age and gender: 2005
Figure 6. Suicide attempts, ED visit rates by age and gender: 2005
Figure 7. Seeking detox, ED visit rates by age and gender: 2005
List of Appendices
Appendix A: Multum Lexicon End-User License Agreement
Appendix B: Glossary of Terms
Appendix C: DAWN Data Collection and Analytic Methods
Appendix D: DAWN Sampling and Estimation Methodology
Appendix E: Population Data
Appendix F: Race and Ethnicity in DAWN
This publication presents national estimates of drug-related visits to hospital emergency departments (EDs) for 2005, based on data from the Drug Abuse Warning Network (DAWN). DAWN is a public health surveillance system that monitors drug-related ED visits for the Nation and for selected metropolitan areas. DAWN estimates pertain to the entire United States, including Alaska, Hawaii, and the District of Columbia. The Substance Abuse and Mental Health Services Administration (SAMHSA) is the agency responsible for DAWN. SAMHSA is required to collect data on drug-related ED visits under section 505 of the Public Health Service Act.
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 2005 are based on data submitted by 355 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 (OTC) 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.
The 2005 estimates from DAWN provide the first opportunity since the redesign of DAWN to examine changes over time in drug-related ED visits. Thus, this publication also presents comparisons of estimates from 2004 and 2005. However, with only two years' estimates to compare, we urge caution in interpreting these as trends. No comparisons with prior years are possible, because of the redesign.
In 2005, hospitals in the United States delivered a total of 108 million ED visits, and DAWN estimates that 1,449,154 (CI: 1,206,622 to 1,691,880)1 ED visits were associated with drug misuse or abuse. Of those ED visits:
For 2005, DAWN estimates that 816,696 (CI: 666,947 to 966,446) ED visits involved an illicit drug. Thus, over half (56%) of all the drug misuse/abuse ED visits during the year involved an illicit drug either alone or in combination with another drug type. 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.
After taking population size and the margin of error into account:
For 2005, DAWN estimates that 492,655 (CI: 424,660 to 560,649) ED visits involved either alcohol in combination with another drug (all ages) or alcohol alone for patients under the age of 21. This is about one third (34%) of all drug misuse/abuse ED visits. 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 2005, DAWN estimates 394,224 (CI: 331,964 to 456,485) ED visits related to use of alcohol in combination with other drugs. Alcohol was most frequently combined with:
DAWN estimates 56,978 (CI: 45,810 to 68,146) alcohol-related ED visits for patients aged 12 to 17, and 88,781 (CI: 73,468 to 104,094) alcohol-related ED visits for patients aged 18 to 20. Alcohol is an illegal drug for both of these age groups.
About two thirds of the alcohol-related ED visits for minors involved alcohol and no other drug. DAWN estimates 98,430 (CI: 80,258 to 116,602) ED visits involved alcohol as the only drug.
Taking population size and the margin of error into account:
For 2005, DAWN estimates that 598,542 (CI: 486,771 to 710,314) ED visits involved nonmedical use of prescription or OTC pharmaceuticals or dietary supplements. The majority of these visits (55%) involved multiple drugs.
Central nervous system (CNS) agents (51% of nonmedical-use visits) and psychotherapeutic agents (46%) were the most frequent drugs reported in the nonmedical-use category of ED visits.
Among the CNS agents, the most frequent drugs were opiate/opioid analgesics (33% of nonmedical-use visits), including single-ingredient (e.g., oxycodone) and combination forms (e.g., hydrocodone with acetaminophen). Methadone, together with single-ingredient and combination forms of oxycodone and hydrocodone, were the most frequent opioids. Once the margin of error is taken into account, these three opioids appeared in similar numbers of visits:
It is not possible to know, based on the documentation available in ED medical records, the extent to which the source of these drugs is a legitimate prescription, as opposed to other sources, nor is it possible to distinguish methadone used for treatment of opiate addiction from the methadone in pill form, which is prescribed for pain. In fact, methadone may be one of the most ambiguous drugs to categorize in DAWN. When a patient on opioid replacement therapy presents to an ED, methadone may be routinely documented in the medical record, but without sufficient detail to distinguish whether the methadone specifically was related to the ED visit.
Among the psychotherapeutic agents, the anxiolytics (anti-anxiety agents), sedatives, and hypnotics were the most frequent, occurring in a third (34%) of visits associated with nonmedical use of pharmaceuticals. ED visits involving benzodiazepines clearly outnumber those involving any of the other types of psychotherapeutic agents. DAWN estimates that 172,388 (CI: 135,948 to 208,828) ED visits associated with nonmedical use of pharmaceuticals involved benzodiazepines in 2005. This is comparable to the number for prescription opiates/opioids.
Taking population size and the margin of error into account:
In 2005, hospitals in the United States delivered a total of 108 million ED visits, an increase of 2.3% over 2004. The population of the United States increased 0.9%, from 294 million to 296 million, over the same period.
According to DAWN, the total number of ED visits attributable to drug misuse and abuse was stable from 2004 to 2005. That is, the difference is not statistically significant. Likewise, no changes in ED visits from 2004 to 2005 were detected for any of the major illicit drugs or for alcohol.
ED visits related to nonmedical use of pharmaceuticals increased 21% from 2004 to 2005. Among the pharmaceuticals more frequently implicated in nonmedical use, the following changes are noted:
We cannot assess whether these changes may be related to changes in the quantity of these pharmaceuticals being prescribed for therapeutic uses. A decrease was observed in nonmedical-use visits involving Cox-2 inhibitors (e.g., Vioxx®, Bextra®, and Celebrex®). This may be associated with the decrease in medical use of Cox-2 inhibitors during the same period.
DAWN estimates 132,582 (CI: 113,283 to 151,882) ED visits for drug-related suicide attempts in 2005.3 Nearly two thirds (63%) of ED visits for drug-related suicide attempts involved multiple drugs.
In these ED visits for drug-related suicide attempts in 2005:
Overall there was no significant change in ED visits for drug-related suicide attempts from 2004 to 2005. Nor were significant changes found for any of the drugs frequently involved in these suicide attempts.
DAWN estimates 174,141 (CI: 59,348 to 288,933) drug-related ED visits for patients seeking detoxification or substance abuse treatment services during 2005. 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 within the hospital. Therefore, these visits do not encompass the full extent of the demand for these services.
Nearly two thirds (64%) of the seeking detox ED visits involved multiple drugs. Illicit drugs and alcohol were common in these visits:
Among the seeking detox ED visits, nearly 8 out of 10 (78%) 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, almost one fifth (18%) of seeking detox cases might not have received the care they sought, because they were discharged to home.
No changes in ED visits from 2004 to 2005 were detected for seeking detox ED visits overall, or for alcohol or the illicit drugs involved in these visits.
This publication presents final estimates of drug-related emergency department (ED) visits from the Drug Abuse Warning Network (DAWN) for 2005. DAWN is a public health surveillance system that monitors drug-related ED visits for the Nation and for selected metropolitan areas. 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.
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.
To be a DAWN case, the relationship between the ED visit and the drug use need not be causal; the drug needs only to be implicated in the visit. This approach accommodates cases where one or more drugs were involved but may or may not have directly caused the condition generating the ED visit, but at the same time avoids inclusion of current medications that are unrelated. Only recent drug use is included;4 the reason a patient used a drug need not be specified; and the criteria are broad enough to encompass all types of drug-related events, including explicit drug abuse. See Appendix C: DAWN Data Collection and Analytic Methods for a full description of DAWN cases and data collected on those cases.
DAWN collects data on all types of drugs, including:5
While the full array of drug-related ED visits covered by DAWN is very broad, this publication focuses primarily on ED visits involving drug misuse and abuse. The national estimates of ED visits associated with drug misuse and abuse are presented in terms of the following three categories:
The illicit drugs category covers ED visits involving the use of illegal substances. The alcohol category includes alcohol used in combination with other drugs and alcohol used alone in patients under 21, but excludes alcohol used alone in patients aged 21 and over. Nonmedical use of pharmaceuticals includes ED visits related to the misuse or abuse of prescription or OTC medications or dietary supplements. Nonmedical use includes taking a higher than prescribed or recommended dose of a pharmaceutical (i.e., contrary to directions or labeling), taking a pharmaceutical prescribed for another individual, malicious poisoning of the patient by another individual, and substance abuse involving pharmaceuticals.8
In addition, this report includes a separate section on two special types of ED visits: drug-related suicide attempts and patients "seeking detox." The latter includes patients who present to the ED seeking detoxification services or entry into a substance abuse treatment program. These visits tend to be concentrated in hospitals with administrative practices requiring medical clearance in the ED for admission to detox or substance abuse treatment units within the hospital. Drug-related ED visits involving suicide attempts or seeking detox are excluded from the category of nonmedical use of pharmaceuticals.
Estimates in this publication were calculated by applying sampling weights to data from a probability sample of hospitals and accounting for the survey design. Only national estimates pertaining to the entire United States—50 States and the District of Columbia—are provided in this publication.
Hospitals eligible for the DAWN sample are non-Federal, short-stay, general surgical and medical hospitals in the United States that operate 24-hour EDs. The American Hospital Association's (AHA) 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 B: Glossary of Terms.
The DAWN sample of hospitals includes an oversampling of hospitals in selected metropolitan areas (referred to as "Metropolitan Statistical Areas" or MSAs), supplemented with a sample of hospitals from the remainder of the United States, 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. National estimates are calculated as the sum of the estimates from 11 geographic areas (10 metropolitan areas, divisions, and subareas plus the sample from the remainder of the United States) after taking into account nonresponse, the volume of ED visits delivered by the universe of eligible hospitals in each area, and data quality factors. A more detailed discussion of the DAWN sample of hospitals and estimation procedures is provided in Appendix D: DAWN Sampling and Estimation Methodology.
For 2005, 355 hospitals submitted data that were used for estimation. The overall weighted response rate was 43.2%. For the 10 oversampled metropolitan areas and divisions, the individual response rates ranged from 59.0% in New Orleans to 78.5% in Denver. Additional detail on response rates is provided in Appendix C.
DAWN cases are found through a retrospective review of medical records in participating hospitals. Across the 355 participating hospitals, more than 11.8 million charts were reviewed to find the drug-related ED visits that met the DAWN case criteria. Based on the review of charts, 364,012 drug-related visits were found and submitted. On average, a DAWN member hospital submitted 1,025 DAWN cases. However, the number of submitted cases varied widely across hospitals, from 1 case to 9,012 cases (median 640) in a single hospital during 2005.
Since DAWN relies on a sample of hospitals, each estimate produced from the DAWN ED data is subject to sampling variability, referred to as the "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). 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 periods ("…") 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, drugs other than alcohol cannot be present in an "alcohol-only" category.
In this publication, confidence intervals (CIs) are included in many of the tables and are cited in the text along with the estimates. Technically, 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. As a practical matter, a CI, which is expressed as a range of values, does a better job of illustrating the true nature of the statistical estimates, because the interval reflects both the estimate and its particular margin of error.
For readers unfamiliar with these statistical concepts, additional descriptions and examples are provided in Appendix D.
In this publication, we assess differences between 2004 and 2005 estimates as the estimated percent change. However, the estimated percent change must exceed its margin of error in order to be considered a reliable difference between the estimates for the two years. That is, the difference must be statistically different from no change. We do this because a difference that is not statistically significant may be no difference at all. Therefore, the only differences shown in this publication as percentage changes are those that meet the standard for statistically significant differences. See Appendix D for additional details.
Major changes to DAWN were instituted at the beginning of 2003 as the result of a redesign that altered most of DAWN's core features. Changes included the design of the hospital sample, the drug-related cases eligible for DAWN, and the data items submitted on these cases. These improvements created a permanent disruption in trends. As a result, comparisons cannot be made between old DAWN (2002 and prior years) and the redesigned DAWN (2004 and forward).9
Standardized measures are needed to make valid comparisons of ED visits 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 United States 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.10 An example of how these rates are generated is provided in Appendix D, and the population estimates used for this publication are found in Appendix E: Population Data.
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 F: Race and Ethnicity in DAWN, describes the race and ethnicity data reported to DAWN.
For 2005, DAWN estimates that over 1.4 million ED visits were associated with drug misuse or abuse (Table 1). This estimate includes:
Of the 1.4 million drug misuse/abuse visits, about two thirds (65%) were associated with a single drug type. ED visits involving illicit drugs alone accounted for 31% of all visits related to drug misuse/abuse in 2005. ED visits involving nonmedical use of pharmaceuticals alone accounted for another 27%. In 2005, 7% of drug misuse/abuse visits were related to consumption of alcohol (and no other drug) by a minor.12 The remaining visits (35%) involved some combination of illicit drugs, alcohol, and/or pharmaceuticals.
This does not suggest that the majority of ED drug misuse/abuse visits involved a single drug. In fact, the typical drug-related ED visit involves multiple drugs, but these may be of a common type. For example, an ED visit involving illicit drugs alone may involve more than one illicit drug (e.g., cocaine and heroin).
ED visits in each of the three major categories—illicit drugs, alcohol, and nonmedical use of pharmaceuticals—are discussed in greater detail in separate sections of this publication.
| Drug involvement1 | Estimated visits2 |
Percent of visits | Relative standard error (RSE) |
95% Confidence interval | ||
|---|---|---|---|---|---|---|
| Lower bound |
- | Upper bound |
||||
| 1 The classification of drugs used in DAWN is derived from the Multum Lexicon, © 2005, Multum Information Services, Inc. The classification was modified to meet DAWN's unique requirements (2006). 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 United States. 3 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, 2005 (04/2006 update). |
||||||
| All types of drug misuse/abuse | 1,449,154 | 100% | 8.5 | 1,206,422 | - | 1,691,886 |
| Illicit drugs only | 450,296 | 31% | 11.9 | 345,526 | - | 555,066 |
| Alcohol only (age < 21) | 98,364 | 7% | 9.4 | 80,189 | - | 116,539 |
| Pharmaceuticals only | 395,617 | 27% | 10.1 | 317,048 | - | 474,186 |
| Combinations | ||||||
| Illicit drugs with alcohol3 | 199,008 | 14% | 7.9 | 168,009 | - | 230,007 |
| Illicit drugs with pharmaceuticals | 110,652 | 8% | 12.3 | 83,953 | - | 137,351 |
| Alcohol with pharmaceuticals | 138,477 | 10% | 11.0 | 108,710 | - | 168,244 |
| Illicit drugs with alcohol and pharmaceuticals | 56,740 | 4% | 11.1 | 44,427 | - | 69,053 |
To better understand the role of specific drugs and types of drugs in ED visits, this publication provides more detailed analysis of three drug categories: illicit drugs, alcohol, and nonmedical use of pharmaceuticals. This section focuses on ED visits involving illicit drugs.
For 2005, DAWN estimates that 816,696 (CI: 666,947 to 966,446) ED visits involved an illicit drug (Table 2). Thus, over half (56%) of all the drug misuse/abuse ED visits during the year involved an illicit drug, either alone or in combination with another drug type.
DAWN estimates that cocaine was involved in 448,481 (CI: 327,639 to 569,322) ED visits. In other words, close to one in three drug misuse/abuse ED visits (31%) involved cocaine.
Marijuana was involved in 242,200 (CI: 203,395 to 281,006) ED visits. Although it was associated with the second highest number of drug misuse/abuse ED visits for illicit drugs, marijuana was involved in approximately half as many ED visits as cocaine.
Heroin was involved in 164,572 (CI: 123,613 to 205,531) ED visits, or 11% of drug misuse/abuse ED visits overall. This is likely an underestimate, though, because some portion of heroin use has been unavoidably classified as an "unspecified opiate." Heroin is an opiate, and some drug screens test for opiates only as a class. About two thirds (69%) of reports of "opiates" submitted to DAWN for 2005 came from toxicology findings, so some unknown quantity of these may have been heroin. The number of ED visits involving unspecified opiates is estimated at 24,490 (CI: 18,634 to 30,446) visits.
Stimulants, including amphetamines and methamphetamine, were involved in 138,950 (CI: 86,163 to 191,737) ED visits, about 10% of drug misuse/abuse ED visits. Amphetamines and methamphetamine are combined for this analysis because some drug screens test for amphetamines only as a class. Consequently, an amphetamine-positive result could indicate amphetamine or methamphetamine. Nearly all the reports of amphetamines submitted to DAWN came simply as "amphetamine" and about three quarters (74%) of those were derived from toxicology findings.
Other illicit drugs appeared at much lower frequencies. For 2005, DAWN estimates:
| Drug category and selected drugs1 | Estimated visits2,3,4 |
Relative standard error (RSE) |
95% Confidence interval | ||
|---|---|---|---|---|---|
| Lower bound |
- | Upper bound |
|||
| 1 The classification of drugs used in DAWN is derived from the Multum Lexicon, © 2005, Multum Information Services, Inc. The classification was modified to meet DAWN's unique requirements (2006). 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 United States. 3 ED visits often involve multiple drugs. Such visits will appear multiple times in this table (e.g., a visit involving both cocaine and heroin will appear twice in this table). Summing ED visits as reported in this table will produce incorrect and inflated counts of ED 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, 2005 (04/2006 update). |
|||||
| Drug-related ED visits | |||||
| Total drug misuse/abuse ED visits | 1,449,154 | 8.5 | 1,206,422 | - | 1,691,886 |
| ED visits, illicit drugs | 816,696 | 9.4 | 666,947 | - | 966,446 |
| Cocaine | 448,481 | 13.7 | 327,639 | - | 569,322 |
| Heroin | 164,572 | 12.7 | 123,613 | - | 205,531 |
| Marijuana | 242,200 | 8.2 | 203,395 | - | 281,006 |
| Stimulants | 138,950 | 19.4 | 86,163 | - | 191,737 |
| Amphetamines | 35,827 | 13.3 | 26,491 | - | 45,163 |
| Methamphetamine | 108,905 | 23.6 | 58,469 | - | 159,340 |
| MDMA (Ecstasy) | 10,752 | 15.7 | 7,448 | - | 14,055 |
| GHB | 1,861 | 32.6 | 670 | - | 3,052 |
| Flunitrazepam (Rohypnol) | 596 | 45.0 | 70 | - | 1,121 |
| Ketamine | 275 | 22.6 | 153 | - | 397 |
| LSD | 1,864 | 21.3 | 1,085 | - | 2,644 |
| PCP | 7,535 | 16.8 | 5,056 | - | 10,013 |
| Miscellaneous hallucinogens | 3,792 | 18.2 | 2,438 | - | 5,145 |
| Inhalants | 4,312 | 15.2 | 3,030 | - | 5,594 |
| Combinations not tabulated above (NTA) | 1,755 | 21.0 | 1,033 | - | 2,477 |
| ED visits per 100,000 population | |||||
| Total drug misuse/abuse ED visits | 488.9 | 8.5 | 407.0 | - | 570.8 |
| ED visits, illicit drugs | 275.5 | 9.4 | 224.7 | - | 326.3 |
| Cocaine | 151.3 | 13.7 | 110.5 | - | 192.1 |
| Heroin | 55.5 | 12.7 | 41.7 | - | 69.3 |
| Marijuana | 81.7 | 8.2 | 68.6 | - | 94.8 |
| Stimulants | 46.9 | 19.4 | 29.1 | - | 64.7 |
| Amphetamines | 12.1 | 13.3 | 8.9 | - | 15.2 |
| Methamphetamine | 36.7 | 23.6 | 19.7 | - | 53.8 |
| MDMA (Ecstasy) | 3.6 | 15.7 | 2.5 | - | 4.7 |
| GHB | 0.6 | 32.6 | 0.2 | - | 1.0 |
| Flunitrazepam (Rohypnol) | 0.2 | 45.0 | 0.0 | - | 0.4 |
| Ketamine | 0.1 | 22.6 | 0.1 | - | 0.1 |
| LSD | 0.6 | 21.3 | 0.4 | - | 0.9 |
| PCP | 2.5 | 16.8 | 1.7 | - | 3.4 |
| Miscellaneous hallucinogens | 1.3 | 18.2 | 0.8 | - | 1.7 |
| Inhalants | 1.5 | 15.2 | 1.0 | - | 1.9 |
| Combinations NTA | 0.6 | 21.0 | 0.3 | - | 0.8 |
When considered in relation to the population of the United States, ED visits associated with illicit drugs vary across major drugs of abuse (Figure 1):
SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2005 (04/2006 update).
The rates of ED visits involving cocaine, marijuana, and heroin were higher for males than for females, after taking population size and the margin of error into account, but there was not a gender difference for stimulants (Figure 2). For cocaine the rates per 100,000 population were highest among patients aged 18 to 54, with lower rates for younger and older patients (Table 3, Figure 2). For heroin, the rates were highest for patients aged 21 to 44, while the rates for marijuana were highest for patients aged 18 to 24, and the rates for stimulants were highest for patients aged 18 to 44.
In terms of race/ethnicity, 46% of the visits related to any illicit drug use involved patients who were white. However, evaluating the relative frequencies across the race/ethnicity groups is impeded by missing data; race/ethnicity was unknown in 13% of illicit drug-related visits overall, and the percentage was higher for some drugs (e.g., 16% for heroin and 17% for MDMA).
| Patient characteristics | Selected drugs1 | ||||||||
|---|---|---|---|---|---|---|---|---|---|
| All illicits | Cocaine | Heroin | Marijuana | Stimulants | MDMA (Ecstasy) | GHB | LSD | PCP | |
| 1 The classification of drugs used in DAWN is derived from the Multum Lexicon, © 2005, Multum Information Services, Inc. The classification was modified to meet DAWN's unique requirements (2006). 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 United States. 3 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, 2005 (04/2006 update). |
|||||||||
| Drug-related ED visits2,3 | |||||||||
| ED visits, illicit drugs | 816,696 | 448,481 | 164,572 | 242,200 | 138,950 | 10,752 | 1,861 | 1,864 | 7,535 |
| Gender | |||||||||
| Male | 527,419 | 292,402 | 109,031 | 161,532 | 84,385 | 6,330 | 1,151 | 1,614 | 4,620 |
| Female | 288,960 | 155,985 | 55,503 | 80,597 | 54,419 | 4,419 | … | 251 | 2,913 |
| Unknown | 318 | 93 | 38 | 71 | … | … | … | … | … |
| Age | |||||||||
| 0-5 years | 720 | 212 | 42 | 129 | 287 | … | … | … | 33 |
| 6-11 years | 580 | … | … | … | … | … | … | … | … |
| 12-17 years | 50,457 | 9,295 | 992 | 37,790 | 7,542 | 2,068 | 63 | 330 | 684 |
| 18-20 years | 64,434 | 23,278 | 8,734 | 32,993 | 13,255 | 2,098 | … | 338 | 593 |
| 21-24 years | 98,017 | 41,117 | 19,926 | 38,812 | 20,992 | 3,355 | 365 | 447 | 1,567 |
| 25-29 years | 106,053 | 54,812 | 22,670 | 32,801 | 24,193 | 1,436 | 649 | 221 | 1,417 |
| 30-34 years | 98,567 | 55,964 | 22,350 | 25,337 | 20,043 | 959 | 271 | 174 | 1,012 |
| 35-44 years | 231,091 | 155,690 | 46,106 | 45,093 | 35,055 | 660 | 275 | 297 | 1,351 |
| 45-54 years | 137,374 | 90,558 | 35,665 | 23,716 | 14,563 | … | … | 43 | 576 |
| 55-64 years | 25,490 | 15,042 | 7,157 | 4,744 | 2,585 | … | … | … | 276 |
| 65 years and older | 3,236 | 1,821 | 825 | 403 | … | … | … | … | … |
| Unknown | 677 | 513 | 91 | 239 | 44 | … | … | … | … |
| Race/ethnicity | |||||||||
| White | 379,067 | 169,429 | 74,778 | 121,629 | 95,699 | 4,896 | 1,553 | 1,345 | 2,591 |
| Black | 224,084 | 166,496 | 35,671 | 59,288 | 7,224 | 3,235 | … | 183 | 2,038 |
| Hispanic | 94,291 | 51,639 | 25,869 | 26,543 | 14,997 | 655 | … | … | 1,386 |
| Race/ethnicity not tabulated above (NTA) | 9,932 | 4,644 | 1,722 | 2,740 | 2,951 | 171 | … | … | 72 |
| Unknown | 109,322 | 56,274 | 26,532 | 32,001 | 18,079 | 1,795 | 151 | 203 | … |
| ED visits per 100,000 population2,3 | |||||||||
| ED visits, illicit drugs | 275.5 | 151.3 | 55.5 | 81.7 | 46.9 | 3.6 | 0.6 | 0.6 | 2.5 |
| Gender | |||||||||
| Male | 361.2 | 200.3 | 74.7 | 110.6 | 57.8 | 4.3 | 0.8 | 1.1 | 3.2 |
| Female | 192.1 | 103.7 | 36.9 | 53.6 | 36.2 | 2.9 | … | 0.2 | 1.9 |
| Age | |||||||||
| 0-5 years | 3.0 | 0.9 | 0.2 | 0.5 | 1.2 | … | … | … | … |
| 6-11 years | 2.4 | … | … | … | … | … | … | … | … |
| 12-17 years | 197.9 | 36.5 | 3.9 | 148.3 | 29.6 | 8.1 | 0.2 | 1.3 | … |
| 18-20 years | 517.5 | 187.0 | 70.1 | 265.0 | 106.5 | 16.8 | … | 2.7 | 4.8 |
| 21-24 years | 581.5 | 243.9 | 118.2 | 230.2 | 124.5 | 19.9 | 2.2 | 2.6 | 9.3 |
| 25-29 years | 528.5 | 273.2 | 113.0 | 163.5 | 120.6 | 7.2 | 3.2 | 1.1 | 7.1 |
| 30-34 years | 490.9 | 278.7 | 111.3 | 126.2 | 99.8 | 4.8 | 1.4 | 0.9 | 5.0 |
| 35-44 years | 526.9 | 355.0 | 105.1 | 102.8 | 79.9 | 1.5 | 0.6 | … | 3.1 |
| 45-54 years | 323.4 | 213.2 | 84.0 | 55.8 | 34.3 | … | … | 0.1 | 1.4 |
| 55-64 years | 84.0 | 49.6 | 23.6 | 15.6 | 8.5 | … | … | … | 0.9 |
| 65 years and older | 8.8 | 4.9 | 2.2 | 1.1 | … | … | … | … | … |
SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2005 (04/2006 update).
Among all the drugs collected by DAWN, alcohol is unique. An ED visit related to alcohol use qualifies as a DAWN case under only two conditions: (1) the alcohol is found in combination with other drugs, regardless of patient age; or (2) the alcohol is found alone (i.e., not in combination with other drugs) in a patient under the age of 21. ED visits associated with alcohol use, particularly among underage patients, represent a significant public health and policy concern and are examined in detail in this chapter.
For 2005, DAWN estimates that 492,655 (CI: 424,660 to 560,649) ED visits involved either alcohol in combination with another drug (all ages), or alcohol alone for patients under the age of 21. This is about one third (34%) of all drug misuse/abuse ED visits (Table 4). Of all these ED visits involving alcohol, about one fifth (20%) involved patients under the age of 21 who used alcohol alone, that is, with no other drug.
| Drug category and selected drugs1 | Estimated visits2,3 |
Relative standard error (RSE) |
95% Confidence interval | |||
|---|---|---|---|---|---|---|
| Lower bound |
- | Upper bound |
||||
| 1 The classification of drugs used in DAWN is derived from the Multum Lexicon, © 2005, Multum Information Services, Inc. The classification was modified to meet DAWN's unique requirements (2006). 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 United States. 3 Estimates are all expressed in visits. SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2005 (04/2006 update). |
||||||
| Total drug misuse/abuse ED visits | 1,449,154 | 8.5 | 1,206,422 | - | 1,691,886 | |
| ED visits, alcohol | 492,655 | 7.0 | 424,660 | - | 560,649 | |
| Alcohol in combination | 394,224 | 8.1 | 331,964 | - | 456,485 | |
| Alcohol alone | 98,430 | 9.4 | 80,258 | - | 116,602 | |
DAWN estimates 394,224 (CI: 331,964 to 456,485) ED visits related to use of alcohol in combination with another drug(s) in 2005. Alcohol in combination with other drugs is reported to DAWN regardless of the patient's age. These are the only alcohol reports received for patients aged 21 and older. It is these adult patients who account for nearly 9 out of 10 ED visits (88%) implicating alcohol with another drug (Table 5).
Males accounted for 62% of visits involving alcohol in combination with other drugs (Table 5). Taking population size into account, males had higher rates of such visits than females (Figure 3). There was little variation in rates across the age groups from ages 18 to 44. However, the ED visit rates were lower for older and younger patients.
In terms of race/ethnicity, 54% of the visits with alcohol in combination involved patients who were white. Evaluating the relative frequencies across the race/ethnicity groups is impeded by missing data; in 11% of visits race/ethnicity was unknown.
| Patient characteristics | Estimated visits1,2 |
Visit characteristics | Estimated visits1,2 |
|---|---|---|---|
| 1 These are estimates of ED visits based on a representative sample of non-Federal, short-stay hospitals with 24-hour EDs in the United States. 2 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, 2005 (04/2006 update). |
|||
| ED visits, alcohol in combination | 394,224 | ||
| Gender | Number of drugs involved | ||
| Male | 244,892 | Single drug | |
| Female | 149,249 | Multiple drugs | 394,224 |
| Unknown | 83 | Alcohol involved | 394,224 |
| Age | Disposition | ||
| 0-5 years | 370 | Treated and released | 200,072 |
| 6-11 years | … | Discharged home | 150,338 |
| 12-17 years | 20,400 | Released to police/jail | 13,559 |
| 18-20 years | 27,278 | Referred to detox/treatment | 36,175 |
| 21-24 years | 44,049 | Admitted to this hospital | 132,008 |
| 25-29 years | 45,812 | ICU/critical care | 28,065 |
| 30-34 years | 45,062 | Surgery | 607 |
| 35-44 years | 117,423 | Chemical dependency/detox | … |
| 45-54 years | 73,705 | Psychiatric unit | 27,518 |
| 55-64 years | 15,365 | Other inpatient unit | 48,671 |
| 65 years and older | 4,379 | Other disposition | 62,144 |
| Unknown | 205 | Transferred | 41,696 |
| Race/ethnicity | Left against medical advice | 7,956 | |
| White | 214,413 | Died | 411 |
| Black | 84,104 | Other | 3,973 |
| Hispanic | 47,664 | Not documented | … |
| Race/ethnicity not tabulated above (NTA) | 4,821 | ||
| Unknown | 43,222 | ||
SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2005 (04/2006 update).
Alcohol was most frequently combined with (Table 6):
| Drugs reported with alcohol1 | Estimated visits2 |
|---|---|
| 1The classification of drugs used in DAWN is derived from the Multum Lexicon, © 2005, Multum Information Services, Inc. The classification was modified to meet DAWN's unique requirements (2006). 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 United States. SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2005 (04/2006 update). |
|
| No other drug | 98,430 |
| Cocaine only | 86,482 |
| Marijuana only | 33,643 |
| Cocaine and marijuana only | 22,377 |
| Heroin only | 12,797 |
| Stimulants only | 11,290 |
| Alprazolam only | 10,138 |
| Cocaine and heroin only | 9,692 |
For individuals under age 21, alcohol is an illegal drug, and ED visits related to both alcohol alone and alcohol in combination are reported to DAWN for this age group. Considering alcohol alone and alcohol in combination with other drugs, DAWN estimates:
Two thirds (67%) of the alcohol-related ED visits for minors involved alcohol alone, a finding that is similar for patients aged 12 to 17 and patients aged 18 to 20 (Table 7).
| Drug category and selected drugs1 | Estimated visits2 |
Relative standard error (RSE) |
95% Confidence interval | ||
|---|---|---|---|---|---|
| Lower bound |
- | Upper bound |
|||
| 1 The classification of drugs used in DAWN is derived from the Multum Lexicon, © 2005, Multum Information Services, Inc. The classification was modified to meet DAWN's unique requirements (2006). 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 United States. SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2005 (04/2006 update). |
|||||
| Patients aged 12-17 | |||||
| ED visits, alcohol | 56,978 | 10.0 | 45,810 | - | 68,146 |
| Alcohol in combination | 20,400 | 12.1 | 15,562 | - | 25,238 |
| Alcohol alone | 36,578 | 10.3 | 29,194 | - | 43,962 |
| Patients aged 18-20 | |||||
| ED visits, alcohol | 88,781 | 8.8 | 73,468 | - | 104,094 |
| Alcohol in combination | 27,278 | 8.3 | 22,840 | - | 31,716 |
| Alcohol alone | 61,503 | 10.9 | 48,363 | - | 74,643 |
For 2005, DAWN estimates 98,430 (CI: 80,258 to 116,602) ED visits related to use of alcohol alone (i.e., not in combination with another drug) by patients who were younger than age 21 (Table 4). Nearly all (98%, or 96,933 visits) of those visits involved underage drinking that was not related to either a suicide attempt or a request for admission to detox or substance abuse treatment program (Table 8).
Taking population size into account, the rate of these alcohol-only ED visits for patients aged 18 to 20 (487 visits per 100,000 population) was 3.5 times that for patients aged 12 to 17 (141 per 100,000). Males and females had similar rates (Figure 4).
In terms of race/ethnicity, 58% of these alcohol-only visits involved patients who were white. Evaluating the relative frequencies of the race/ethnicity groups is impeded by missing data; in 15% of visits, race/ethnicity was unknown (Table 8).
Most (86%) of the alcohol-only ED visits resulted in patients' being treated and released, usually to home; another 7% were admitted to inpatient units (Table 8).
| Patient characteristics | Estimated visits1,2 |
Visit characteristics | Estimated visits1,2 |
|---|---|---|---|
| 1 These are estimates of ED visits based on a representative sample of non-Federal, short-stay hospitals with 24-hour EDs in the United States. 2 Three dots (…) indicate that an estimate with an RSE greater than 50% or an estimate less than 30 has been suppressed. 3 This table is limited to ED visits classified as "alcohol only (age < 21)" and excludes visits classified as either "suicide attempt" or "seeking detox." Therefore, the estimate of total visits is slightly lower than that reported in Table 4. SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2005 (04/2006 update). |
|||
| ED visits, alcohol only (age < 21)3 | 96,933 | ||
| Gender | Number of drugs involved | ||
| Male | 55,558 | Single drug | 96,933 |
| Female | 41,365 | Multiple drugs | |
| Unknown | … | Alcohol involved | 96,933 |
| Age | Disposition | ||
| 0-5 years | 167 | Treated and released | 83,468 |
| 6-11 years | … | Discharged home | 74,766 |
| 12-17 years | 35,956 | Released to police/jail | 7,555 |
| 18-20 years | 60,694 | Referred to detox/treatment | 1,148 |
| 21-24 years | Admitted to this hospital | 7,082 | |
| 25-29 years | ICU/critical care | 2,078 | |
| 30-34 years | Surgery | 310 | |
| 35-44 years | Chemical dependency/detox | … | |
| 45-54 years | Psychiatric unit | 439 | |
| 55-64 years | Other inpatient unit | 4,075 | |
| 65 years and older | Other disposition | 6,383 | |
| Unknown | Transferred | 3,598 | |
| Race/ethnicity | Left against medical advice | 700 | |
| White | 57,603 | Died | … |
| Black | 7,051 | Other | … |
| Hispanic | 15,067 | Not documented | 1,068 |
| Race/ethnicity not tabulated above (NTA) | 2,200 | ||
| Unknown | 15,011 | ||
SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2005 (04/2006 update).
Use of illicit drugs is, by definition, substance abuse. For pharmaceuticals, however, distinguishing medical from nonmedical use is more complicated.13 In DAWN, "medical use" means taking a prescription or over-the-counter (OTC) pharmaceutical as prescribed or recommended, and "nonmedical use" is use that does not meet the definition of medical use. Thus, nonmedical use of pharmaceuticals includes taking more than the prescribed dose of a prescription pharmaceutical or more than the recommended dose of an OTC pharmaceutical or supplement; taking a pharmaceutical prescribed for another individual; deliberate poisoning with a pharmaceutical by another person; and documented misuse or abuse of a prescription or OTC pharmaceutical or dietary supplement. Nonmedical use of pharmaceuticals may involve pharmaceuticals alone or pharmaceuticals in combination with illicit drugs or alcohol.
A cautionary note: DAWN tries to capture only drugs that are related to the ED visit and actively discourages reporting of current medications that are unrelated to the visit. It is important to understand, however, that it is not possible, given the limitations of medical record documentation, to eliminate completely the reporting of current medications, and this should be considered when one interprets these findings.
For 2005, DAWN estimates that 598,542 (CI: 486,771 to 710,314) ED visits involved nonmedical use of prescription or OTC pharmaceuticals or dietary supplements (Table 9). The majority of these visits (55%) involved multiple drugs (Table 10):
Central nervous system (CNS) agents (51% of nonmedical-use visits) and psychotherapeutic agents (46%) were the most frequent drugs reported in the nonmedical-use category of ED visits (Table 9). Respiratory agents (4%), cardiovascular agents (5%), and all other types of pharmaceuticals were much less frequent.
Among the CNS agents, the most frequently reported drugs were opiate/opioid analgesics (33% of nonmedical-use visits), including single-ingredient (e.g., oxycodone) and combination forms (e.g., hydrocodone with acetaminophen). Methadone and single-ingredient and combination forms of hydrocodone and oxycodone were the most frequent opioids. Once the margin of error is taken into account, these three opioids appeared in similar numbers of visits:
| Selected drug categories and selected drugs1 | Estimated visits2,3,4 |
Relative standard error (RSE) |
95% Confidence interval | ||
|---|---|---|---|---|---|
| Lower bound |
- | Upper bound |
|||
| 1 The classification of drugs used in DAWN is derived from the Multum Lexicon, © 2005, Multum Information Services, Inc. The classification was modified to meet DAWN's unique requirements (2006). 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 United States. 3 ED visits often involve multiple drugs. Such visits will appear multiple times in this table (e.g., a visit involving two pharmaceuticals will appear twice in this table). Summing ED visits as reported in this table will produce incorrect and inflated count of ED 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, 2005 (04/2006 update). |
|||||
| ED visits, nonmedical use | 598,542 | 9.5 | 486,771 | - | 710,314 |
| PSYCHOTHERAPEUTIC AGENTS | 275,430 | 9.6 | 223,576 | - | 327,284 |
| Antidepressants | 61,023 | 8.6 | 50,726 | - | 71,320 |
| MAO inhibitors | … | 58.8 | … | - | … |
| SSRI antidepressants | 27,319 | 10.3 | 21,804 | - | 32,834 |
| Tricyclic antidepressants | 12,417 | 10.7 | 9,822 | - | 15,011 |
| Miscellaneous antidepressants | 25,577 | 9.9 | 20,593 | - | 30,562 |
| Antipsychotics | 37,327 | 11.6 | 28,812 | - | 45,843 |
| Anxiolytics, sedatives, and hypnotics | 204,711 | 10.4 | 162,841 | - | 246,580 |
| Barbiturates | 11,013 | 12.8 | 8,244 | - | 13,782 |
| Benzodiazepines | 172,388 | 10.8 | 135,948 | - | 208,828 |
| Alprazolam | 62,020 | 20.2 | 37,435 | - | 86,606 |
| Clonazepam | 30,608 | 14.5 | 21,896 | - | 39,320 |
| Diazepam | 18,567 | 10.8 | 14,633 | - | 22,502 |
| Lorazepam | 19,665 | 10.9 | 15,465 | - | 23,866 |
| Benzodiazepines NOS | 45,876 | 12.7 | 34,468 | - | 57,284 |
| Misc. anxiolytics, sedatives, and hypnotics | 31,553 | 11.0 | 24,741 | - | 38,365 |
| Diphenhydramine | 9,055 | 10.0 | 7,272 | - | 10,838 |
| Hydroxyzine | 3,153 | 17.3 | 2,084 | - | 4,223 |
| Zolpidem | 12,765 | 15.0 | 9,004 | - | 16,527 |
| Anxiolytics, sedatives and hypnotics NOS | 3,391 | 22.3 | 1,911 | - | 4,872 |
| CNS stimulants | 10,616 | 11.1 | 8,309 | - | 12,924 |
| Amphetamine-dextroamphetamine | 2,836 | 21.7 | 1,632 | - | 4,040 |
| Caffeine | 3,103 | 14.9 | 2,199 | - | 4,008 |
| Dextroamphetamine | … | 70.4 | … | - | … |
| Methylphenidate | 3,212 | 12.6 | 2,420 | - | 4,003 |
| CENTRAL NERVOUS SYSTEM AGENTS | 305,973 | 10.0 | 246,137 | - | 365,810 |
| Analgesics | 264,857 | 9.7 | 214,367 | - | 315,346 |
| Antimigraine agents | 914 | 21.5 | 530 | - | 1,298 |
| Cox-2 inhibitors | 1,201 | 24.3 | 629 | - | 1,774 |
| Opiates/opioids | 196,225 | 10.4 | 156,355 | - | 236,095 |
| Opiates/opioids, unspecified | 39,228 | 9.3 | 32,094 | - | 46,361 |
| Narcotic analgesics | 160,363 | 12.0 | 122,749 | - | 197,977 |
| Buprenorphine/combinations | … | 65.4 | … | - | … |
| Codeine/combinations | 5,550 | 12.0 | 4,242 | - | 6,857 |
| Fentanyl/combinations | 9,160 | 14.8 | 6,508 | - | 11,812 |
| Hydrocodone/combinations | 51,225 | 13.8 | 37,416 | - | 65,033 |
| Hydromorphone/combinations | 5,344 | 28.4 | 2,374 | - | 8,314 |
| Meperidine/combinations | 763 | 32.8 | 272 | - | 1,254 |
| Methadone | 41,216 | 14.8 | 29,249 | - | 53,184 |
| Morphine/combinations | 15,183 | 22.7 | 8,413 | - | 21,953 |
| Oxycodone/combinations | 42,810 | 14.5 | 30,672 | - | 54,948 |
| Propoxyphene/combinations | 6,813 | 11.6 | 5,265 | - | 8,360 |
| Nonsteroidal anti-inflammatory agents | 26,050 | 9.2 | 21,337 | - | 30,763 |
| Ibuprofen | 19,214 | 10.4 | 15,293 | - | 23,136 |
| Naproxen | 5,297 | 11.4 | 4,117 | - | 6,477 |
| Salicylates/combinations | 12,093 | 12.4 | 9,161 | - | 15,025 |
| Miscellaneous analgesics/combinations | 46,921 | 11.3 | 36,542 | -< | |
