Issue 6, 2006R |
According to the Drug Abuse Warning Network (DAWN):
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In 2004, there were an estimated 21,584 ED visits associated with drug-related suicide attempts among persons aged 12 to 17 in the United States. These suicide attempts involved an average of 1.7 drugs, with more than half (57 percent) of the suicide attempts involving only one drug, and 5 percent involving four or more drugs. The majority of the adolescent patients received follow-up medical care in the same hospital or were transferred to another health care facility after discharge from the ED (Table 1).
Disposition | Estimated number of ED visits |
Percent of total visits |
---|---|---|
Treated and released | 6,358 | 29% |
Discharged home | 5,421 | |
Released to police/jail | … | |
Referred to detox/treatment | 929 | |
Admitted to same hospital | 8,595 | 40% |
ICU/critical care | 2,335 | |
Surgery | 126 | |
Chemical dependency/detox | 0 | |
Psychiatric unit | 3,424 | |
Other inpatient unit | 2,709 | |
All other dispositions | 6,631 | 31% |
Transferred | 6,560 | |
Left against medical advice | … | |
Died | … | |
Other | … | |
Total | 21,584 | 100% |
Note: 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 (03/2008 update). |
In 2004, DAWN received no reports of deaths in the ED for drug-related suicide attempts involving adolescents. However, this is based solely on ED records, which do not include patients who died before coming to the ED or after leaving the ED.
An estimated 6,358 (29 percent) of adolescents whose suicide attempt involved drugs were released after treatment in the ED (Table 1). Of these, 85 percent were discharged home, while 15 percent were referred to a detoxification/substance abuse treatment program.
On average, 1.7 drugs were involved in the suicide attempts of adolescent patients who were treated and released. Half of these suicide attempts involved at least one pain medication, most frequently a nonsteroidal anti-inflammatory drug (NSAID) (34 percent), such as ibuprofen, or a pain medication containing acetaminophen (24 percent) (Table 2).
Drug category | Percent of treated and released cases |
Percent of admitted to same hospital cases |
Percent of transferred to another facility cases |
---|---|---|---|
Any illicit substance (including alcohol) | 8% | 23% | 23% |
Alcohol | … | 18% | 16% |
Marijuana | … | … | … |
Any psychotherapeutic medication | 43% | 28% | 31% |
Antidepressants | 24% | 17% | 17% |
Antipsychotics | … | 7% | 5% |
Anti-anxiety agents, sedatives, and hypnotics | … | 5% | 8% |
Any pain medication | 54% | 59% | 51% |
Opioid analgesics | … | 1% | … |
Nonsteroidal anti-inflammatory drugs (NSAIDs) | 34% | 29% | 31% |
Aspirin/combinations | … | 10% | … |
Acetaminophen/combinations | 24% | 25% | 14% |
Note: 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 (03/2008 update). |
Psychotherapeutic medications were involved in 43 percent of cases that were treated and released. Antidepressants were the most frequent, involved in 24 percent of the visits. The DAWN data do not distinguish which of the patients had been prescribed antidepressants to treat preexisting depression and other mental health problems.
Additionally, 8 percent of the cases that were treated and released involved at least one illicit drug.
In an estimated 8,595 (40 percent) of the drug-related suicide attempts, the patient was admitted to the hospital upon discharge from the ED (Table 1). Approximately 40 percent of these patients were moved to a psychiatric unit.
The suicide attempts of adolescents who were admitted to the hospital involved an average of 1.7 drugs. Pain relievers were implicated in approximately 60 percent of these cases. These were primarily NSAIDs (29 percent) and pain medications containing acetaminophen (25 percent) (Table 2). Pain medications containing opioids are obtainable only by prescription. Pain medications containing acetaminophen or ibuprofen, while widely available, can be toxic if misused.
Psychotherapeutic drugs were implicated in 28 percent of the suicide attempts by adolescents who were admitted to the hospital. Antidepressants were the most frequently used psychotherapeutic, involved in 17 percent of these suicide attempts.
Approximately 23 percent of the suicide attempt cases that were admitted involved an illicit substance. Alcohol was involved in most of these visits, almost always used in combination with another drug. The interaction between alcohol and medications can increase the medication's toxicity, especially if it is a central nervous system depressant.3
Other dispositions accounted for an estimated 6,631 (31 percent) of the adolescent suicide-related ED visits that involved drugs. Almost all (99 percent) of these patients were transferred to another health care facility (Table 1).
Patients transferred to another facility. Thirty percent of adolescent drug-related suicide attempt cases were transferred to another health care facility after discharge from the ED. The suicide attempts of these patients involved, on average, 1.6 drugs. Pain medications were involved in half of these visits. The prevalence of pain medications among transferred patients was similar to the prevalence among patients with other dispositions. The most commonly involved pain medications were the NSAIDs (31 percent), followed by the acetaminophen/combination drugs (14 percent) (Table 2).
Psychotherapeutic drugs were involved in 31 percent of the suicide attempts by adolescent patients who were transferred to another medical facility. The anti-anxiety/sedative medications were involved in about half as many visits as the antidepressants (17 percent).
Approximately 23 percent of all the suicide-related ED visits that were transferred to another facility involved at least one illicit substance, primarily alcohol (16 percent).
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 © 2008, 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 Elizabeth Crane (SAMHSA/OAS) with assistance from Mindy Herman-Stahl (RTI International, a trade name of Research Triangle Institute). 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. |