Marijuana- & Cocaine-Related Emergency Department Visits Up

Emergency department mentions of cocaine increased 10 percent and marijuana increased 15 percent from 2000 to 2001, according to new data from SAMHSA's Drug Abuse Warning Network (DAWN).

The 2001 DAWN data show 638,484 drug-related hospital emergency department visits in the continental United States in 2001, an increase of 6 percent over the year 2000 for emergency department visits involving drugs and mentions of drugs. In DAWN, a single drug abuse episode may have multiple drug mentions.

Marijuana mentions, which rose to the same level as heroin mentions in 1997, continued to increase. Marijuana mentions increased 15 percent from 96,426 to 110,512 between 2000 and 2001 and were concentrated in patients age 12 to 34. Increases for marijuana were reported in Minneapolis, San Diego, Seattle, San Francisco, and Baltimore. Decreases were recorded only in New Orleans.

"This report shows one more cost of drug abuse to our society," said U.S. Health and Human Services Secretary Tommy G. Thompson. "We must continue to strengthen our prevention programs and build substance abuse treatment capacity so that people don't abuse drugs and end up in costly emergency departments, taking resources away from other urgent care needs."

"Marijuana-related medical emergencies are increasing at an alarming rate, exceeding even those for heroin. This report helps dispel the pervasive myth that marijuana is harmless," said White House Drug Czar John Walters. "In reality, marijuana is a dangerous drug, and adults and youth alike should be aware of the serious consequences that can come from smoking it."

Although marijuana is most often present with other drugs, about a quarter of drug abuse-related emergency department visits involving marijuana (a total of 27,061 in 2001) involved marijuana as the only drug.

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Cocaine mentions increased 10 percent, from 174,881 to 193,034 from 2000 to 2001, with 24 percent of these mentions attributed to crack. Increases for cocaine were noted in Atlanta, Minneapolis, San Francisco, and Boston. Decreases in cocaine reports occurred in New Orleans, San Diego, and Dallas.

"Eight of every 10 drug mentions come from seven substances—alcohol-in-combination with other drugs, cocaine, marijuana, heroin, benzodiazepines, antidepressants, and analgesics," said SAMHSA Administrator Charles G. Curie, M.A., A.C.S.W. "Dependence and suicide were the most frequently cited motives for taking substances. People need to know help is available, treatment is effective, and recovery is possible."

Heroin mentions (93,064) were statistically unchanged from 2000 to 2001. Increases in heroin mentions in emergency departments were evident in Atlanta, Minneapolis, Detroit, Denver, Miami, and Boston. Decreases occurred in New Orleans, San Diego, Seattle, Baltimore, Newark, and Los Angeles.

Methamphetamine showed no significant nationwide change in the number of mentions between 2000 and 2001. Emergency department mentions of methamphetamine in 2001 were concentrated in five western cities: Los Angeles, San Diego, San Francisco, Phoenix, and Seattle. Among these cities, methamphetamine mentions increased 10 percent in Los Angeles and decreased 27 percent in Seattle. Amphetamine mentions did not change significantly between 2000 and 2001, and were also concentrated in the same western cities.

There were no significant changes in reports of club drugs between 2000 and 2001. However, emergency department mentions of MDMA (Ecstasy) were nearly double the levels from 1999 (5,542 versus 2,850 in 1999). In 2001, DAWN estimates 3,340 episodes involved GHB, and 679 involved Ketamine. Other club drugs like flunitrazepam, known as Rohypnol, had estimates too imprecise for publication from 1995 through 2001. Ecstasy increased in emergency department mentions in Atlanta, Miami, Philadelphia, and San Francisco. Decreases were seen in Chicago, Los Angeles, and Seattle. Ecstasy mentions were highest in persons age 18 to 25, at 10 mentions per 100,000 population. There were no significant increases in GHB, but decreases were evident in Los Angeles, Atlanta, and Chicago.

DAWN estimates indicate that alcohol-in-combination with other drugs was statistically unchanged from 2000 to 2001, but mentions increased 36 percent, from 160,798 to 218,005, between 1994 and 2001. Increases in mentions of alcohol-in-combination with other drugs were found in Minneapolis, San Francisco, Boston, Miami, Phoenix, Baltimore, and Washington, DC. A decrease in mentions of alcohol-in-combination with other drugs was found in New Orleans.

Mentions of hallucinogens such as LSD and PCP remained stable from 2000 to 2001. PCP incidences rose in Philadelphia and Washington, DC. There were no significant increases seen for LSD, but there were decreases evident in Phoenix, Seattle, Chicago, and Los Angeles.

Mentions of inhalants in emergency departments decreased 56 percent from 2000 to 2001 from 1,522 to 676.

DAWN estimates that 43 percent of the 1.1 million emergency department drug mentions in 2001 were primarily for the non-medical use of legal prescription or non-prescription medications. There were 220,289 mentions of psychotherapeutic agents (19 percent) and 210,685 mentions of central nervous system agents (18 percent).

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Among the psychotherapeutic agents, anxiolytics (anti-anxiety drugs), sedatives, and hypnotics comprised 12 percent of total drug-related emergency department mentions (135,949). This includes abuse of benzodiazepines (103,972 mentions). There were 61,012 mentions of antidepressants. From 2000 to 2001, mentions of benzodiazepines rose 14 percent from 91,078 to 103,972. Among the benzodiazepines with significant increases from 2000 to 2001, alprazolam (drugs such as, but not limited to, Xanax) mentions were up 16 percent from 22,105 to 25,644. Benzodiazepines not identified by name were up 35 percent, from 22,376 to 30,302.

Among the central nervous system agents, narcotic analgesics and combinations were the most frequently mentioned in drug-related emergency department visits in 2001, constituting 9 percent of all emergency department mentions (99,317). Mentions of these narcotic analgesics and combinations rose 44 percent from 1999 to 2001 and 21 percent from 2000 to 2001.

Significant long-term increases between 1994 and 2001 in emergency department mentions of narcotic analgesics and combinations were found for hydrocodone and its combinations (up 131 percent since 1994), methadone (up 230 percent), morphine and its combinations (up 210 percent), oxycodone and its combinations (up 352 percent), and narcotic analgesics that were not identified by name (up 288 percent).

In 1 year, from 2000 to 2001, methadone mentions increased by 37 percent, and oxycodone and its combinations rose 70 percent. Unspecified narcotic analgesics rose 24 percent. Mentions of analgesics containing hydrocodone were statistically unchanged from 2000 to 2001, but were 41 percent higher than in 1999.

The DAWN system also captures the non-medical uses of new drugs approved by the Food and Drug Administration. During the period between 1994 and 2001, there were over 1,000 mentions each for seven new drugs including citalopram, mirtazapine, and nefazodone, which are antidepressants; olanzapine and quetiapine, which are antipsychotics; and tramadol and Cox-2 inhibitors, which are analgesics.

DAWN is a nationally representative survey of hospitals with emergency departments conducted annually by SAMHSA's Office of Applied Studies. In 2001, 458 hospitals participated in DAWN. The survey is designed to provide information about emergency department visits that are induced by or related to the use of an illegal drug or the non-medical use of a legal drug. Because up to four drugs can be reported for each emergency department visit, there are more "mentions" than "visits." The survey also provides estimates for 21 metropolitan areas. DAWN does not measure the frequency or prevalence of drug use in the population, but rather the health consequences of drug use that are reflected in visits to hospital emergency departments.

To obtain a printed copy of the report, Emergency Department Trends from the Drug Abuse Warning Network, Final Estimates 1994-2001, contact SAMHSA's National Clearinghouse for Alcohol and Drug Information at P.O. Box 2345, Rockville, MD 20847-2345. Telephone: 1 (800) 729-6686 (English and Spanish) or 1 (800) 487-4889 (TDD). The complete report (text and tables) is available online at www.oas.samhsa.gov.

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