May 24, 2012

Emergency Department Visits Involving Drug Misuse or Abuse by Children Aged 12 to 14

Children undergo dramatic physical, mental, and emotional changes and establish important health and behavior patterns as they transition between childhood and adolescence. Research findings indicate that early initiation of substance misuse or abuse is associated with changes in brain functioning, substance abuse or dependence in adolescence or adulthood, and numerous negative behaviors.^1,2,3 In 2009, public health surveillance measures showed that an estimated 627,000 children aged 12 to 14 reported past month alcohol use, and about 560,000 reported past month illicit drug use.⁴ The majority of young adolescent users report receiving alcohol and marijuana for free from friends or their own family members.^5,6 In 2009, approximately 23,760 substance abuse treatment admissions were young adolescents aged 12 to 14.⁷ This issue of The DAWN Report focuses on emergency department (ED) visits involving misuse or abuse by children aged 12 to 14.

The Drug Abuse Warning Network (DAWN) is a public health surveillance system that monitors drug-related ED visits in the United States. All DAWN cases involve an ED visit with a drug as either the direct cause of the visit or as a contributing factor. Misuse or abuse is broadly defined in DAWN to include all ED visits associated with nonmedical use of medications, illicit drug use, and any alcohol use among those aged 20 or younger. Data are collected on numerous illicit drugs, including cocaine, marijuana, heroin, amphetamines, and methamphetamines, as well as prescribed and over-the-counter medications. Data are also collected for visits involving alcohol only or in combination with other substances for persons aged 20 or younger.

In 2009, there were 58,663 drug-related ED visits involving children aged 12 to 14, and about half (28,068 visits, or 48 percent) involved misuse or abuse of drugs (Figure 1). Girls aged 12 to 14 made three fifths (58 percent) of the visits for misuse or abuse. In this age group, about one tenth (9 percent) of these ED visits involved patients aged 12, one quarter (26 percent) involved those aged 13, and nearly two thirds (65 percent) involved those aged 14.

Figure 1. Emergency Department (ED) Visits Involving Misuse or Abuse of Drugs by Children Aged 12 to 14, by Gender: 2009

Prescription and over-the-counter medications were involved in half (50 percent) of ED visits for misuse or abuse of drugs by children aged 12 to 14 (Table 1). Pain relievers were involved in 14 percent, including those containing acetaminophen (7 percent) or ibuprofen (5 percent). Anti-anxiety and insomnia drugs (e.g., Xanax^®, clonazepam) were involved in 11 percent of visits, and central nervous system stimulants (e.g., Adderall^®, Ritalin^®) were involved in 4 percent. Table 1 describes other drugs that contributed to ED visits in this age group. Medication involvement overall was more likely among girls than boys (55 vs. 42 percent) (Figure 2).

Figure 2. Emergency Department (ED) Visits Involving Misuse or Abuse of Selected Drugs by Children Aged 12 to 14, by Gender: 2009

Illicit drugs were involved in 28 percent of visits for misuse or abuse of drugs by children aged 12 to 14, much of which was accounted for by visits involving marijuana (22 percent). Visits by boys were more likely than visits by girls to involve illicit drugs (40 vs. 19 percent); 33 percent of visits by boys involved marijuana compared with 15 percent of visits by girls. Alcohol was involved in 37 percent of ED visits, with similar proportions for boys and girls (34 and 40 percent, respectively).

The majority of ED visits for misuse or abuse of drugs by children aged 12 to 14 (86 percent) involved a single drug type (alcohol only, illicit drugs only, or medications only). The remaining 14 percent of drug misuse or abuse ED visits by children aged 12 to 14 involved drugs in combination, much of which was accounted for by visits involving alcohol in combination (11 percent) (Figure 3).

Figure 3. Emergency Department (ED) Visits Involving Misuse or Abuse of Drugs by Children Aged 12 to 14, by Drug: 2009

Substance use, related ED visits, and admission to substance use treatment programs among children aged 12 to 14, although they occur on a relatively small scale, are disturbing occurrences. Despite legal restrictions, children can gain access to a variety of drugs and alcohol. Although there is ample research that supports the adverse effects of drugs on the developing child, youths frequently lack the developmental maturity to understand and act on knowledge about the risks involved. Parents and other adults should monitor and prevent access to these drugs in the home. Girls aged 12 to 14 are of particular concern because they made a higher proportion of visits overall. However, visits by boys were more likely to involve illicit drugs, especially marijuana; thus, prevention activities to reduce illicit drug use in this group are important.

Early education and prevention programs concerning substance use are important, and a number of approaches have been developed.^8,9 The findings in this report support the importance of addressing the dangers of nonmedical use of medications, in addition to alcohol and illicit drug use, as part of the drug use prevention curriculum.

Primary care providers can also play an important role in reducing the number of children aged 12 to 14 who are seen in the ED for drug-related medical emergencies. The American Academy of Pediatrics recommends that all adolescents be screened for alcohol, tobacco, and other drug use at every office visit, and practical and validated screening methods are available.^10,11 Resources have been developed to help parents and others have open and direct conversations about the dangers of drug and alcohol use with their children.^12,13 When appropriate, ED staff can refer patients to substance abuse treatment programs that are designed to meet the unique needs of these emerging young adolescents.¹⁴

This page was last updated on October 11, 2010.