Issue 23, 2006 |
In Brief |
According to the Drug Abuse Warning Network (DAWN) for 2004:
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Public concern has been increasing about the nonmedical use of pharmaceuticals.1-3 The problem involves both medications available only by prescription and other pharmaceuticals, such as dietary supplements, which are commonly available over the counter.4 Medications with a high potential for abuse are being more widely employed in the treatment of chronic medical conditions.5-8 Some evidence also shows that increased long-term exposure may be associated with a higher likelihood of abuse.9 Recent epidemiological data have shown dramatic increases in nonmedical use of pharmaceuticals among youth (12 to 17) and older adults (i.e., 55+).10
The Drug Abuse Warning Network (DAWN), which collects data from a national sample of short-term, general, non-Federal hospitals,11 offers valuable information on the scope of this problem and the burden it creates on one segment of the health care system. Data on drug-related emergency department (ED) visits provide both an indication of the physical harm that may result from drug misuse and abuse as well as information about the characteristics of patients involved. An ED visit associated with drug misuse or abuse also represents a unique opportunity for health care providers to identify and refer patients for appropriate follow-up care, including substance abuse treatment. DAWN data on the disposition of these visits provide some evidence of how frequently such interventions occur as a result of care sought in EDs and the relative frequency of visits that do not receive such follow-up care.
This DAWN report examines drug-related ED visits associated with nonmedical use involving three pharmaceuticals that are often used nonmedically: opiates/opioid analgesics (pain relievers), benzodiazepines, and muscle relaxants. Nonmedical use includes taking a higher-than-prescribed or recommended dose of a pharmaceutical, taking a pharmaceutical prescribed for another individual, malicious poisoning of the patient by another individual, as well as substance abuse involving pharmaceuticals.
According to DAWN data, there were nearly a half million ED visits involving nonmedical use of pharmaceuticals in 2004 (Table 1). Of these visits, 31.9 percent involved opiates/opioids, 29.1 percent involved benzodiazepines, and 5.7 percent involved muscle relaxants.
An estimated 158,281 ED visits involved opiates/opioids. The most frequently listed opiates/opioids were hydrocodone products (26.8% of opiates/opioids), oxycodone products (23.1%), and methadone (20.1%). An estimated 144,385 ED visits involved benzodiazepines. Alprazolam and clonazepam, respectively, accounted for 34.5 and 18.1 percent of such visits. Carisoprodol was the most frequently named muscle relaxant (61.2% of the visits involving muscle relaxants).
Drug | Estimated visits | 95% CI | |||||
---|---|---|---|---|---|---|---|
Number | Percentage | Lower bound | Upper bound | ||||
Opiates/opioids | 158,281 | 31.9 | 131,292 | 185,270 | |||
Hydrocodone/combinations | 42,491 | 31,831 | 53,151 | ||||
Oxycodone/combinations | 36,559 | 28,964 | 44,154 | ||||
Methadone | 31,874 | 23,752 | 39,996 | ||||
Benzodiazepines | 144,385 | 29.1 | 115,520 | 173,250 | |||
Alprazolam | 49,842 | 31,085 | 68,599 | ||||
Clonazepam | 26,238 | 20,581 | 31,895 | ||||
Muscle relaxants | 28,338 | 5.7 | 19,896 | 36,780 | |||
Carisoprodol | 17,366 | 11,170 | 23,562 | ||||
Cyclobenzaprine | 5,932 | 4,258 | 7,606 | ||||
All ED visits involving nonmedical use of pharmaceuticals | 495,732 | 100.0 | 408,285 | 583,179 | |||
Note: CI = confidence interval. Source: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2004 (September 2005 update). |
Typically, ED visits for nonmedical use of pharmaceuticals involve multiple drugs. Multiple drugs were involved in 67.0 percent of visits for opiates/opioids, 77.2 percent of visits for benzodiazepines, and 83.7 percent of ED visits for muscle relaxants (Figure 1). Often, alcohol is one of these other drugs. Alcohol was involved in 19.5 to 28.5 percent of visits involving opiates/opioids, benzodiazepines, or muscle relaxants.
Figure 1. Nonmedical use of pharmaceuticals alone and in combination |
Source: a) U.S. Census Bureau; b) Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2004 (September 2005 update). |
Patients aged 21 to 54 had the highest rates of ED visits for nonmedical use for all three drug classes (Figure 2). There was no statistically significant difference in the rates for individuals aged 21 to 34 and those aged 35 to 54. For opiates/opioids, there was no statistically significant difference in the rates between patients aged 12 to 20 and those aged 55 and older. For benzodiazepines and muscle relaxants, patients aged 12 to 20 had lower rates than those 21 to 54, but higher rates than those 55 and older.
Figure 2. Rates of ED visits for selected pharmaceuticals, by age |
Source: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2004 (September 2005 update). |
Overall, about half of ED visits involving nonmedical use of opiates/opioids, benzodiazepines, or muscle relaxants ended with no evidence of follow-up care: ranging from 54.7 percent for opiates/opioids to 46.3 percent for benzodiazepines (Figure 3). Follow-up care is defined broadly to include referrals to detoxification or substance abuse treatment services, admission to an inpatient unit in the hospital, or transfer to another health care facility.
As a disposition from the ED, deaths accounted for less than 1 percent of visits. However, these estimates do not account for patient deaths occurring before reaching the ED, after admission to an inpatient unit, or after transfer to another facility.
Figure 3. Discharge status of ED visits involving nonmedical use of selected pharmaceuticals |
Source: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2004 (September 2005 update). |
The Drug Abuse Warning Network (DAWN) is a public health surveillance system that monitors drug-related morbidity and mortality. DAWN uses a probability sample of hospitals to produce estimates of drug-related emergency department (ED) visits for the United States and selected metropolitan areas annually. DAWN also produces annual profiles of drug-related deaths reviewed by medical examiners or coroners in selected metropolitan areas and States. Any ED visit or death related to recent drug use is included in DAWN. All types of drugs-licit and illicit-are covered. Alcohol is included for adults when it occurs with another drug. Alcohol is always included for minors. DAWN's method of classifying drugs was derived from the Multum Lexicon, Copyright © 2005, Multum Information Services, Inc. The Multum Licensing Agreement can be found in DAWN annual publications and at http://www.multum.com/license.htm. DAWN is one of three major surveys conducted by the Substance Abuse and Mental Health Services Administration's Office of Applied Studies (SAMHSA/OAS). For information on other OAS surveys, go to http://www.oas.samhsa.gov. SAMHSA has contracts with Westat (Rockville, MD) and RTI International (Research Triangle Park, NC) to operate the DAWN system and produce publications. For publications and additional information about DAWN, go to http://DAWNinfo.samhsa.gov. |
The DAWN Report is published periodically by the Office of Applied Studies (OAS), Substance Abuse and Mental Health Services Administration (SAMHSA). This issue was written by Scott Novak, Ph.D. (RTI International, a trade name of Research Triangle Institute) and Judy K. Ball, Ph.D., M.P.A. (SAMHSA/OAS). All material in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Citation of the source is appreciated.