HomeMy WebLinkAboutCOM 0639.016 2008-2010
BRENDA J. FORD
Council Member
District 7 - Central Kona
Phone:
Fax:
E-Mail :
(808) 326- 5684
(808) 329- 4786
bford@co.hawaii.hi. us
HA W AI'I COUNTY COUNCIL
County of Hawai 'i
Kailua Trade Center
75-5706 Hanama Place, Suite 109
Kailua-Kona, Hawai'i 96740
l"'3
=>
<::::::>
<:::::>
o
00
C(:)
z;c::.
~ "-.....,
:? :,~:~
C--
::0
Z
:0
m
"........,
\ .~;
~~"-r":;
........
c...,)
\!l
:3
DATE:
January 8, 2010
Q
:?
IT!
~,
\....,.1
TO:
J Yoshimoto, Chairperson,
and Members of the Hawai'i County Council
Brenda J. Ford, Council Member ~~ ':J~
J:
o
FROM:
SUBJECT:
A report on "Drug Abuse Warning Network, 2006: National Estimates of Drug-
related Emergency Department Visits" from the U.S. Department of Health and
Human Services, Substance Abuse and Mental Health Services Administration in
reference to Resolution 281-09 encouraging the decriminalization of the use of
marIJuana.
The attached 2006 report provides statistics on emergency department visits based on alcohol,
marijuana, and other drugs compiled by the Drug Abuse Warning Network (DAWN). Please
provide a copy of this report to each council member for review prior to the council meeting
scheduled for the January 22, 2010. The council members will need as much time as possible to
review the document.
BJF/
Comm. No. &: 1; q ./ fa
Ref. TO:-=p{~r
Ref. Date. JAN 2' 2.
Serving tile IlIterests (~ftlle People (~f Our Island
Hawai'i COUlltv Is An Er/llal O/J/Jortullitv Provider And EI1l/Jlover
\)
~.
OFFICE OF APPLIED STUDIES
Drug Abuse Warning Network, 2006:
National Estimates of Drug=Related
Emergency Department Visits
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Substance Abuse and Mental Health Services Administration
http://DAWNinfo.samhsa.gov/
o
'I>
831'v'1'I1183 03 1'v'NOI1'v'N :900<: 'NM'v'O
(':
900i:lsn6nv
L990i: OV\l 'aIlIMpOCJ 'PPO~-L WOOCJ 'p80CJ NJa4J a~04J ~
Sa!pnlS pa!lddV!O a:J!HO
UO!jeJ1S!U!WPV Sa:J!fUas 4118aH 181uaV\l PU8 asnqv a:Ju81sqns
381:1:10 8NIl V'NI81~0
'(10\J8ds3 PU8 4S!16U3)
(LGL P-9GL- Ug-~) L-VSHV\lVS- Ug- ~
:je ~JOMlaN UO!18WJO!UI 4118aH S,VSHV\lVS 118:J aS8ald JO
'Lujysa!do:J/MB8S4weSS80/rdu4 WOJ! paU!81qo aq A8W saldo:J PJ8H
^06eS4W8S'S80/rdn4 WOJ! JO ^068S4W8S0!U!NM\io/rdn4 WOJ! pap8oluMOp aq A8W UO!j8::>!Iqnd S!41
N011V'81l8nd :10 S31d08 lV'NOI1IOOV' 8NINIV'180
'800i: 'OV\l 'all!^~:JOCJ '6SSP-90 (VV\lS) 'ON UO!18::>!lqnd
SHHO 'OS-O sapas NMVO 'sJ!S!/\ JuawJ.ledao A::>ue6JeW3 pe)eleCl-6nJO}0 se)ew!Js3 feuo!leN :900Z '>fJOMJeN
6u!UJeM esnqv 6nJO 'Sa!pnlS pa!lddV!o a:J!HO 'UO!j8J1S!U!WPV sa:J!fUas 4118aH 181uaV\l PU8 asnqv a::>u81sqns
:UO!lBl!:J p8lsa66ns 'pal8!:J8JddB S! a:JJnos a4l!O UO!l81!J 'VSHV\lVS 'SUO!18:J!UnwwoJ
!O a:J!HO a41 !O UO!18Zp041n8 UaWJM ':J!!!:Jads a411no41!M aa! 8 JO! palnq!JIS!P JO pa:JnpoJdaJ aq IOU A8W UO!18:J!IQnd
S!41 'Ja^aMOH '(VSHV\lVS) UO!18J1S!U!WPV sa:J!fUas 4118aH 181uaV\l PU8 asnqv a:Ju81sqns a41 WOJ! UO!ss!wJad
ln041!M pa!do::> JO pa:JnpoJdaJ aq A8W PU8 U!8WOP :J!lqnd a41 U! S! uO!j8:J!lqnd S!41 U! 6U!J8add8 18pal8W IIV
38110N NIV'~OO 81lSnd
YV\I 'U8JOV\l 8U!!aSOr !O uo!paJ!p
a41 Japun 9G06-i:0-Sgi: 'ON P8J1UOJ Japun 181saM Aq papnpuo:J S8M UO!pallo:J 818P NMVO a41 '(11CJ 'U8P!IS!181S)
YV\I 'laI4:JaJ::J Jalad PU8 '(11CJ 'lsAI8UV) 'O'4d '46n8qw81S 81Aal '(11CJ 'U8P!IS!181S) 'O'4d '!~IOJ)lIOJ8)1 '(11CJ 'lsAI8UV)
'S'V\I 'aaUOIl8V\1 uP3 '(SVOI\fSHV\lVS) 'H'd'V\I 'l!a\aUOd 'V\I A418)11dVJ papnl:JU! SJOlnqpluo:J lU8:J!!!u6!s Ja410
'UO!j8:J!lqnd a41 aloJM (11CJ 'JopaJ!O parOJd) YV\I '146pq1V 8POP!^ PU8 (SVOI\fSHV\lVS 'JopaJ!O parOJd NMVO)
Yd'V\I "O'4d '1188 ')I Apnr 'G09i:-SO-Ogi: 'oN P8J1UOJ Japun 18UO!18uJalU111CJ 41!M (SVO) Sa!pnlS pa!lddv !O a::>~!o
'(VSHV\lVS) UO!jeJ1S!U!WPV sa:J!fUas 4l18aH 18luaV\l PU8 asnqv a:Ju81sqns a41 Aq paJ8daJd S8M UO!18:J!lqnd S!41
SlN3 V\J 80 3lMO N >18 V'
"tJ>
\:)
',-'.1;'
CONTENTS
Page
Acknowledg ments............................................................................................................................ 2
High lights............................................................................................................................. ............. 7
ED visits involving drug misuse/abuse ......................................................................................... 7
Illicit drugs in ED visits.................................................................................................................. 8
Alcohol and drug-related ED visits................................................................................................8
Alcohol in combination with other drugs.................................................................................... 8
Alcohol in patients under age 21............................................................................................... 9
Nonmedical use of pharmaceuticals ............................................................................................. 9
Comparisons in drug misuse and abuse: 2004, 2005, and 2006................................................ 10
Special types of drug-related ED visits....................................................................................... 10
Suicide attempts ... ....................... ................. ..................... ........... ...... ..... ......... ..... ...... ........... 10
Seeking detox ...... ........ ...... ..... ..... .................... ................................. ...... ..... .............. ...... ....... 11
Introduction......................................................................................................................... ........... 13
Major features of DAWN .............................................................................................................13
What is a DAWN case? .......................................................................................................... 13
What drugs are included in DAWN? ...................................................................................... 13
What is covered in this publication?........................................................................................14
Hospital participation in 2006 .....................................................................................................14
Estimates in this publication .......................................................................................................15
Margin of error for estimates ...................................................................................................... 15
Comparisons across years ......................................................................................................... 16
Margin of error for comparisons across years ............................................................................16
Estimates adjusted for population size .......................................................................................16
Drug Misuse and Abuse in ED Visits ............................................................................................ 17
Illicit Drugs in ED Visits ................................................................................................................. 19
Alcohol in ED Visits .......................................................................................................................27
Alcohol in combination with other drugs (Tables 5-6, Figure 3) .................................................. 27
Alcohol-related ED visits in patients under the age of 21 (Table 7) ............................................ 30
ED visits for underage alcohol use (Tables 4,8, Figure 4) ......................................................... 30
Nonmedical Use of Pharmaceuticals ............................................................................................ 33
Nonmedical use of pharmaceuticals (Tables 9-10, Figure 5)......................................................33
DAWN, 2006: NATIONAL ED ESTIMATES
3
S31Vv.lllS3 03 lVNOIIVN :900(: 'NMVO
CI
,~~
v
G9 ....................................................................... 900G pue '900G 'VOOG :xOlap 5u!~aas
09.......................................... 900G :S:J!IS!JapeJe4:J I!S!^ pue lua!led Aq 'xolap 5u!~aas
69.................................................................................................. 900G :xolap 5u!~aas
99.................................................................. 900G pue '900G 'vOOG :sldwane ap!:J!ns
t9 .......................................900G :S:J!IS!JapeJe4:J I!S!^ pue jUa!led Aq 'sldwane apP!ns
09 ................. ........... ............ ................ .............. ........ ................ 900G :sldwane apP!ns
9v...................... 900G pue '900G 'vOOG :SI!S!^ 03 sle:J!jna:JewJe4d!0 asn le:J!pawuoN
W'" 900G pue '900G 'vOOG : ~G aBe Japun slua!jed U! SI!S!^ 03 palejaJ-5nJp U! 1040:J11f
W.......................................... 900G pue '900G 'vOOG :SI!S!^ 03 palejaJ-BnJp U! 1040:J11f
tv..........................................................900G pue '900G 'vOOG :SI!S!^ 03 U! s5nJp Pili
GV'" ............ ....... ...... ......................... .............. ...... ........... ........... '900G pue '900G 'vOOG
:jUawa^IO^U! BnJP!o adAI Aq "s'n a41 U! SI!S!^ 03 U! asnqe pue asns!w BnJO
Lt.........900G :S:J!IS!JapeJe4:J I!S!^ pue lua!jed Aq 'sle:J!lna:JeWJe4d!0 asn le:J!pawuoN
Vt ................................................................ 900G :sle:J!jna:JeWJe4d!0 asn le:J!pawuoN
~t'''''''''''''''''''''''''''' 900G :s:J!jspapeJe4:J I!S!^ pue lua!jed Aq '(~G > aBe) AIUO 1040:J11f
Ot...............................900G :~G aBe Japun slua!jed U! SI!S!^ 03 palelaJ-BnJp U! 1040:J11f
6G....................................................900G :1040:Jle 41!M pajJodaJ AlluanbaJ! ISOW sBnJO
aG............................. 900G :s:J!jspapeJe4:J I!S!^ pue lua!led Aq 'uo!jeu!qwo:J U! 1040:J11f
a......................................................................900G :SI!S!^ 03 palelaJ-5nJp U! 1040:J11f
tG .............................................................. 900G :S:J!jspal:JeJe4:J jUa!led Aq 'sBnJp IP!l1I
OG.....................................................................................900G :sl!S!^ 03 U! sBnJp 1!:J!11I
8 ~ . .............. .................. ....... ............................. ................. ................ .......... .......... 900G
:luawa^lo^u! BnJP!o adAI Aq "s'n a41 U! SIIS!^ 03 U! asnqe pue asns!w BnJO ~ alqel
salqel !O lS!l
~G alqel
OG alqel
6 ~ alqel
8 ~ alqel
n alqel
9 ~ alqel
9 ~ alqel
v~ alqel
t ~ alqel
G~ alqel
~ ~ alqel
o ~ alqel
6 alqe 1
8 alqel
L alqel
9 alqe 1
9 alqel
valqel
t alqel
G alqe 1
G9 ........................................................ (~G alqel) 900G pue '900G 'VOOZ :SI!S!^ 03 xOlap 5u!~aas
89 .................................................................................... (L amB!.:l 'OZ-6~ salqel) xOlap 5u!~aas
v9 ...................................................... (8 ~ alqel) 900Z pue '900Z 'VOOZ :SI!S!^ 03 ldwane apP!ns
6v ..................................................................................(9 am5!.:l 'n -9~ salqel) sldwane apP!ns
6v ..................................................................................... Sl!S!^ 03 palela~-6nJO lO sadAlle!:>ads
9v ..........................................................................(9 ~ a/qel) sle:J!jna:JeWJe4d!o asn le:J!pawuoN
VV .............................................................................................(v~ -t ~ salqel) SI!S!^ 03 U! I04o:J11f
tV ............................................................................................. (Z ~ alqel) SI!S!^ 03 U! s5nJp IP!11I
W......................................................................... (~~ alqel) SI!S!^ 03 U! asnqe pue asns!w 5nJO
~v ....................................................................... 900l pue '900l'vOOl :Sl!S!^ 03lo suos!Jedwo:::l
aBed
SlN31N08
-------_._---,._------,.._-----,~,~~------_.._.__._----------..---....-----------------------
"
CONTENTS
Page
List of Figures
Figure 1 Rates of ED visits involving selected illicit drugs: 2006 .............................................22
Figure 2 Illicit drugs, ED visit rates by age and gender: 2006..................................................25
Figure 3 Alcohol with other drugs, ED visit rates by age and gender: 2006.............................29
Figure 4 Alcohol only (age < 21), ED visit rates by age and gender: 2006..............................32
Figure 5 Nonmedical use of pharmaceuticals, ED visit rates by age and gender: 2006 .......... 39
Figure 6 Suicide attempts, ED visit rates by age and gender: 2006 ........................................54
Figure 7 Seeking detox, ED visit rates by age and gender: 2006............................................61
List of Appendixes
Appendix A: Multum Lexicon End-User License Agreement ........................................................ 65
Appendix B: Glossary of Terms .................................................................................................... 69
Appendix C: DAWN Data Collection and Statistical Methods ....................................................... 77
Appendix 0: Race and Ethnicity in DAWN ................................................................................... 99
DAWN, 2006: NATIONAL ED ESTIMATES
5
S31lfr/IlS3 03 llfNOlllfN :900Z 'NMlfO
..
9
"
HIGHLIGHTS
his publication presents national estimates of drug-related visits to hospital emergency departments (EDs) for
2006, based on data from the Drug Abuse Warning Network (DAWN). Also presented are comparisons of 2006
estimates with those for 2004 and 2005. 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. 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 2006 estimates introduce several improvements made to the DAWN sampling and estimation methodology.
In order to ensure comparability between estimates for 2004, 2005, and 2006, the improvements were applied
retrospectively to 2004 and 2005 data, resulting in small changes as compared to early published estimates.
ED visits involving drug misuse/abuse
In 2006, hospitals in the United States delivered a total of 113 million ED visits, and DAWN estimates that
1,742,887 (confidence interval [CI]: 1,451,086 to 2,034,688)1 ED visits were associated with drug misuse or abuse. Of
those ED visits:
Iill 31% involved illicit drugs only,
iii 28% involved pharmaceuticals only,
III 7% involved alcohol only in patients under the age of 21,
III 13% involved illicit drugs with alcohol,
III 10% involved alcohol with pharmaceuticals,
III 8% involved illicit drugs with pharmaceuticals, and
III 3% involved illicit drugs with pharmaceuticals and alcohol.
1 The 95% confidence interval (el) accounts for the margin of error of the estimate. It indicates. with a high degree of confidence, that
the true population value was between 1,451,086 and 2,034,688 drug-related ED visits.
DAWN, 2006: NATIONAL ED ESTIMATES
7
"
S31'v'V'JIlS3 03 l'v'NOIl'v'N :900l 'NMVO
8
'jU8J8jjlp ^IIUe~!j!u5!s JOU 8J8M v9 OJ 9v pue 'vv OJ 9f: 'vf: OJ Of: '6~ OJ 9~ 'v~ OJ ~~ 'O~ OJ tn s8!J058)e~ 85e 84) JOj S8)eJ 84) 'S! )e41 Z
'(Sl!S!^ Sg6'P~) 8uole U!OJ8H ill
pue '(Sl!S!^ ~ pne) euenfiJew pue 8u!e:J08 III
'(Sl!S!^ Sgg' ~ p) 8uole euenfpeVII III
'(Sl!S!^ SSg' ~O~) 8uole 8u!e:J08 I!.'l
:4l!M P8U!qWO:J AIlU8nb8JJ lSOW seM 1040:JIV 's6nJp J84l0 4l!M
UO!leu!qwo:J U! 1040:Jle JO 8sn Ol p8lel8J SlIS!^ 03 (9~S'L~g Ol S~S'SSS D) LWOgp S8WW!lS8 NMVO '900e ul
s6nJp JaLllO L1l!M UOneu!qwo::> u! 10Llo::>I'v'
'86e S.lU8!led 84l JO SS81PJeB8J 'sBnJp J8410 4l!M UOneu!qwo:J
U! lU8S8Jd S! l! u84M NMVO Ol p8lJod8J S! 1040:JIV 'J84B!4 S! 1040:Jle 6u!^10^u! Sl!S!^ 03 JO J8qwnu lenpe 84l 'sllnpe
U! 8uole 1040:Jle BU!^IO^U! Sl!S!^ 03 JOJ luno:J:Je lOU S80p NMVO 8:JU!S 'Sl!S!^ 03 8snqej8SnS!W BnJp lie JO (%W
PJ!4l 8UO lnoqe S! S!41 '~e JO 8Be 84l J8pUn SlU8!Wd JOJ 8uole 1040:Jle JO (s8Be lie) BnJp J84l0ue 4l!M UO!leu!qwo:J
U! 1040:Jle J84l!8 P8^10^U! Sl!S!^ 03 (SVO'Sgg Ol PP6'~Og :18) ~eg'LLg le4l S8lew!ls8 NMVO '900e JO,j
Sl!S!^ 03 palE?la.l-6n.lp put? 1040:>1'9'
'pp Ol s~ p8Be SlU8!led JOJ lS84B!4 8J8M S8leJ 84l 'slUelnW!lS JO,j III
pue 'PC Ol S ~ p8Be SlU8ned JOJ lS84B!4 8J8M S8leJ 84l 'euenfpew JO,j III
'pg Ol ~e p8Be SlU8ned JOJ lS84B!4 8J8M S8leJ 84l 'U!OJ84 JO,j III
'SlU8ned
J8PI0 pue J8BunOA JOJ S8WJ J8MOI 41!Mz'Jel!W!S 8J8M pg Ol S ~ p8Be SlU8!led JOJ S8leJ 84l '8U!e:J0:J JO,j III
'J8pU8B Aq J8U!P lOU PIP sluelnw!lS JOJ S8WJ
84llnq 'S81ew8J ue4l s81eW JOJ J84B!4 8J8M U!OJ84 pue 'euen[pew '8U!e:J0:J BU!^IO^U! Sl!S!^ 03 JO S8WJ 841 III
:lunO:J:Je OlU! JOJJ8 JO u!BJew 84l pue 82!S uO!lelndod Bu!~el JalN
'U!OJ84 se lU8nb8JJ se pue euenf!Jew ue4llUanb8JJ ss81 8J8M (8U!wel84dwe4law pue S8U!Wel84dwe) slUelnwns
841 'sBnJp l!:l!11! J84l0 a4l JO Aue ue4llU8nbaJJ aJOW seM au!e:Jo:J 'lUno:J:Je OlUl JOJJ8 JO u!BJew a4lBu!~e1
'8Mqe 84l JO Aue ue4llUanb8JJ ss81 4:Jnw 8J8M 'SH8 pue 'Asels:J3 'd8d se 4:Jns 'sBnJp lP!II! J84l0 III
pue '(9PO'6P~ Ol
gO~'gg :18) Sl!S!^ 03 gLg'LO~ U! P8^10^UI 8JaM 'aU!Wel84dwe4l8w pue S8U!Wel84dwe Bu!pnpu! 'sluelnW!lS III
'(gSO'Oge Ol geg'6~ ~ D) Sl!S!^ 03 OS1'6S ~ U! P8^10^U! seM U!OJ8H ill
'(SSS'ePS Ol LS1'SSe :18) Sl!S!^ 03 S9g'06e U! P8^10^U! seM euen[peVII ill
'(9Sg'eU Ol6LnLS :18) Sl!S!^ 03 SOg'Spg U! P8^10^U! seM 8u!e:J08 ill
:le4l S8lew!ls8 NMVO 'sBnJp JO s8dAl J84l0 4l!M
UOneu!qwo:l U! JO 8uole J84l!8 BnJp lP!lI! ue P8^10^U! Je8A 84lBupnp Sl!S!^ 03 8snqej8SnS!W 6nJp 84llle JO (%gg) Jle4
Ja^o 'sn41 'BnJp lP!l1! ue P8^10^U! S)!S!^ 03 (0 ~ ~ 'get ~ 01 S ~t069 :18) pg ~'S% le4l S8lewnS8 NMVO '900e JO,j
Sl!S!^ 03 u! s6n.lp l!:>!111
..
Alcohol in patients under age 21
DAWN estimates 76,760 (CI: 60,318 to 93,202) alcohol-related ED visits for patients aged 12 to 17, and 105,675
(CI: 82,757 to 128,593) alcohol-related ED visits for patients aged 18 to 20. Alcohol is an illegal drug for both of these
age groups.
About two thirds (69%) of the alcohol-related ED visits for minors involved alcohol and no other drug. Taking
population size and the margin of error into account:
III The rate of alcohol-only ED visits for patients aged 18 to 20 (581 visits per 100,000 population) was 2.8 times
that for patients aged 12 to 17 (204 per 100,000), and
III Males and females had similar rates.
Nonmedical use of pharmaceuticals
For 2006, DAWN estimates that 741,425 (CI: 674,198 to 808,652) ED visits involved nonmedical use of
prescription or OTC pharmaceuticals or dietary supplements. The majority of these visits (54%) involved multiple
drugs.
Central nervous system (CNS) agents (present in 50% of nonmedical-use visits) and psychotherapeutic agents
(44%) were the most frequent drugs reported in the nonmedical-use category of ED visits.
Among the CNS agents, the most frequent drugs were opiatelopioid analgesics (present in 33% of nonmedical-
use visits), including single-ingredient formulations (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:
III Hydrocodone/combinations in 57,550 ED visits (CI: 43,701 to 71,398),
III Oxycodone/combinations in 64,888 ED visits (CI: 49,746 to 80,030), and
III Methadone in 45,130 ED visits (CI: 35,870 to 54,389).
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 almost a third (32%) 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 195,625 (CI: 167,789 to 223,461) ED visits associated with nonmedical use of
pharmaceuticals involved benzodiazepines in 2006.
DAWN, 2006: NATIONAL ED ESTIMATES
9
S31'v'I'IIlS3 03 1'v'NOI1'v'N :900l 'NM'v'O
o ~
'S8S0pJ8^0 5nJp OJ P8j!W!ljOU 8Je SjdW8ne 8S84j 'jIS!^ 4:>e8 U! peje:>!ldw! seM 5nJp e 45n041 0
's5nJp ald!llnw pa^IO^U! sldwane apP!nS palelaJ-5nJp JOJ SI!S!^ 03 JO (%S9) SPJ!41 OMl
AlleaN o'900G U! sldwane apP!ns pa)ew5nJp JOJ SIIS!^ 03 (VGV' ~ ~G OISB nS~ :IJ) SOB'GB ~ sa)ew!ISa NM'v'O
sldwane ap!::l!ns
Sl!S!^ 03 palelaJ-6nJp lO sadJ\llepads
'sasn
:J!lnadeJa41 JOJ paqp:JsaJd 5u!aq sle:J!lna:JeWJe4d asa41 JO Al!luenb a41 U! sa5ue4:J 01 palelaJ aJe sle:J!lna:JeWJe4d
:J!Jpads 41!M paleposse SI!S!^ 03 U! saseaJ:Jap JO saseaJ:Ju! Ja41a4M ssasse 01 alqe IOU S! NM'v'O
'%9S paseaJ:Ju! SUO!leu!qwo:J/auopo:JAxo
5u!^10^u! SI!S!^ pue '%vv paseaJ:Ju! SUO!leu!qwo:J/auopo:JOJPA4 5u!^10^u! SI!S!^ 'sP!o!do/sale!do
a41 5uow'v' '%€v paseaJ:Ju! s:J!sa5IeUe p!o!do/a)e!do 5u!^10^u! SI!S!^ pue '%9€ paseaJ:Ju! sau!daze!pozuaq
5ul^10^U! SI!S!^ 'sap05ale:J OMl asa41 U!41!M ,(%W sjUa5e SNJ pue (%~€) slua5e :J!lnadeJa4104:JAsd
JOJ paJJn:J:Jo 900G 01 vOOG WOJJ sa5ue4:J alqelou 'asn le:J!pawuou U! pale:J!ldw! AI1UanbaJJ ISOW s5nJp a41
5uow'v' '900G 01 vOOG WOJJ pOp ad a4j U! %B€ paseaJ:Ju! sle:J!lna:JeWJe4d JO asn le:J!pawuou 01 palelaJ SI!S!^ 03
'1040:Jle JOJ JO (sluelnw!IS pue 'euen[pew 'U!OJa4 'au!e:Jo:J) s5nJp lP!II!
Jo[ew a41 JO Aue JOJ papalap aJaM '900G 01 SOOG WOJJ JO '900G OJ vOOG WOJJ SI!S!^ 03 U! sa5ue4:J lue:J!J!u5!s oN
'900G pue vOOG uaaMlaq
asn 03 U! JO UO!lelndod a41 U! saseaJ:Jul a4jlUno:J:Je ojU! a~ej Salew!lsa NM'v'O op JON 'lunO:J:Je OIU! saseaJ:Ju! 4:Jns
a~el 01 palsn[pe IOU aJe salew!lsa NM'v'O pue 'aw!l Ja^o 5u!seaJ:Ju! aq Aew sasn :J!lnadeJa41 aleW!l!5al JOJ pasuads!p
sle:J!lna:JewJe4d JO Jaqwnu a411e41 Jap!suo:J 01 a1!4M4)JoM S! I! 'papalap saseaJ:Ju! lue:J!J!u5!s a41 5u!pJe5atl
'900G OISOOG WOJJ %U paseaJ:Ju! 4:J!4M '1040:Jle 41!M UO!leulqwo:J U! pasn sle:J!lna:JeWJe4d II
pue :900G 01 vOOG WOJJ %9€ paseaJ:Ju! 4:J!4M '(s)5nJp lP!II! 41!M uO!leu!qwo:J U! pasn sle:J!lna:JeWJe4d IIi1I
:900G 01 vOOG WOJJ %vv paseaJ:Ju! 4:J!4M '(5nJp JO adAl Ja410 ou 41!M "a'!) auole sle:J!lna:JeWJe4d l1li
:5U!^10^U! Sj!S!^ JOJ papalap aJaM sa5ue4:J 'IUawa^IO^U!
5nJp JO sadAllUaJaH!p a41 ssoJ:J'v' 'JOJJa JO u!5Jew a41 U!41!M S! a:JuaJaH!p luaJedde a41 'S! le41 '900G pue 'SOOG
'vOOG SSOJ:Je alqels seM asnqe pue asns!w 5nJp 01 alqelnq!llle SI!S!^ 03 JO Jaqwnu lelol a4j 'NM'v'O 015u!pJo:J:J'v'
'po!Jad awes a41 JaM 'UO!IIIW GO€ OJ UO!ll!w v6G WOJJ '%6'G paseaJ:Ju! SajelS pal!Un a41 JO UO!lelndod a41
'vOOG Ja^o %6't JO aseaJ:Ju! ue 'Sj!S!^ 03 UO!II!W € ~ ~ JO lelol e paJa^!Iap sa)elS pal!Un a41 U! Slel!ds04 '900G ul
900Z pue '900Z 'POOZ :asnqe pue aSns!w 6nJp U! suospedwo:)
'vv OJ B ~ pa5e SIUa!)ed JOJ Isa4514 aJaM sa)eJ I!S!^ 03 II
pue 'salew pue sa\ewaJ uaaMlaq JaH!p IOU PIP sle:J!lna:JeWJe4d JO asn le:J!pawuou JOJ sajeJ I!S!^ 03 E'l
:jUno:J:Je OIU! JOJJa JO u!5Jew a41 pue az!s UO!lelndod 5u!~e1
In these ED visits for drug-related suicide attempts in 2006:
III The large majority of drug-related suicide attempts (92%) involved pharmaceuticals,
Iil More than half (58%) included psychotherapeutic agents, such as benzodiazepines or antidepressants,
11II Slightly less than half (45%) involved CNS agents, primarily analgesics (pain relievers), including both
prescription and OTC formulations,
I'JI Nearly one third (30%) involved alcohol (but DAWN data exclude visits for adults when alcohol is the only
drug), and
11II About one quarter (23%) involved an illicit drug.
Overall, there was no significant change in ED visits for drug-related suicide attempts during the time period from
2004 to 2006, but an increase was detected from 2005 to 2006. Increases were evident from 2004 to 2006, as well as
2005 to 2006, for some of the pharmaceuticals frequently involved in suicide attempts, such as benzodiazepines and
opiate/opioid pain relievers.
Seeking detox
DAWN estimates 118,355 (CI: 90,171 to 146,540) drug-related ED visits for patients seeking detoxification or
substance abuse treatment services during 2006. 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 (65%) of the seeking detox ED visits involved multiple drugs. Illicit drugs and alcohol were
common in these visits:
11II Cocaine (49% of visits) and heroin (29%) were followed in frequency by marijuana (19%) and amphetamine
or methamphetamine stimulants (7%), and
III Alcohol in combination with another drug was implicated in 40% of seeking detox ED visits.
Among the seeking detox ED visits, nearly 7 out of 10 (69%) 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, more than one quarter (27%) of seeking detox cases might not have received the care they
sought, because they were discharged to home.
No significant changes in ED visits from 2004 to 2006, or from 2005 to 2006, were detected for seeking detox ED
visits overall, or for alcohol or the illicit drugs involved in these visits.
DAWN, 2006: NATIONAL ED ESTIMATES
11
S31\fV>lllS3 03 l\fNOIl\fN :900Z 'NM\fO
z ~
"
INTRODUCTION
This publication presents estimates of drug-related emergency department (ED) visits from the Drug Abuse
Warning Network (DAWN) for 2006, with comparison of estimates for 2004 and 2005. DAWN is a public health
. . surveillance system that monitors drug-related ED 'Islls 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.
Major features of DAWN
What is a DAWN case?
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
mayor 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;4the 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 Statistical Methods for a full description of DAWN cases and
data collected on those cases.
What drugs are included in DAWN?
DAWN collects data on all types of drugs, including:5
II Illegal drugs, such as heroin, cocaine, marijuana, and Ecstasy,
II! Prescription drugs, such as Prozac"', Vicodin"', OxyContin"', alprazolam, and methylphenidate,
11II Over-the-counter (OTC) medications, such as aspirin, acetaminophen, ibuprofen, and multi-ingredient cough
and cold remedies,
IIIl Dietary supplements, such as vitamins, herbal remedies, and nutritional products,
11II Psychoactive, nonpharmaceutical inhalants,6
III Alcohol in combination with other drugs, and
II Alcohol alone, in patients aged less than 21 years.?
4 That is, patients with a history of drug use (and no recent use) are excluded.
5 The classification of drugs used in DAWN is derived from the Multum Lexicon, @ 2007, Multum Information Services, Inc. The
classification was modified to meet DAWN's unique requirements (2007). The Multum Licensing Agreement governing use of the
Lexicon is provided in Appendix A.
6 To be reportable, a nonpharmaceutical substance must be consumed by inhalation, sniffing, or snorting and must have a psychoactive
effect when inhaled. An ED visit involving inhalation of a nonpharmaceutical, psychoactive substance qualifies as a DAWN case even if
no other drug was present. Carbon monoxide is excluded from the inhalants. Since 2004, cases involving accidental exposures (e.g.,
exposure to paint fumes while painting a closet) have been excluded as well.
7 ED visits related to alcohol use alone are excluded for patients aged 21 and over.
DAWN, 2006: NATIONAL ED ESTIMATES
1 3
S31V~IlS3 03 lVNOllVN :900Z 'NMVO
v.
"Sle:l!Ina8eWJe4d )0 asn 8!jnadeJa4j a4j 4j!M pajeposse Sj!S!^ pue 'weJ60Jd jUaWjeaJj asnqe a8Uejsqns e OlU! AJjUa
JO Sa8!AJaS UO!)e8!I!XOjap 6u!~aas sjua!)ed JO) Sj!S!^ 'suo!)sa6u! lejUapp8e 'Sle8ljna8eWJe4d 6U!^10^U! sjdwane apP!nS aJe papnl8x3 S
e 'a6eJa^e uo 'pa)l!wqns pue punot aJaM SI!S!^ palelaJ-6nJp 9v6'9Vt 'SjJe4::> to Ma!^aJ a41 uo pases 'epa)!J::> ase::>
NM\fO a411aw je41 SI!S!^ 03 pajelaJ-6nJp a41 PU!t 01 paMal^aJ aJaM sjJe4::> UO!II!W 9'6 '9001: U! Slel!ds04 6u!ledp!jJed
lie SSOJ::>\f 'Slel!ds04 6u!led!::>!jJed U! spJo::>aJ le::>lpaw to Ma!MJ a^!padsOJlaJ e 46noJ41 punot aJe sase::> NM\fO
':::J x!puadd\f U! pap!^oJd
S! saleJ asuodsaJ uo I!elap leuo!l!pp\f "eaJe Uel!IOdoJlaw I!OJlao a41 U! %1:' ~L 01 eaJe Uel!IOdoJlaW uOlsnoH a41
U! %g'Ot WOJt pa6ueJ SaleJ asuodsaJ lenp!^!pu! a41 'SUO!S!^!P pue seaJe uel!lodoJlaw paldwesJaM I: ~ a41 JO::l '% ~ '91:
seM aleJ asuodsaJ pal46!aM lIeJaM a41 'UO!lew!jsa JOt pasn aJaM le41 elep pa)l!wqns Slel!ds04 901: '9001: JO::l
9002: U! uO!led!:)!l..led lel!dsOH
'sle::>!lna::>eWJe4d to asn le::>!paWUOU to N06ale::>
a41 WOJt papnpxa aJe xOlap 6u!~aas JO SId wane apP!ns 6u!^10^u! SI!S!^ 03 palelaJ-6nJO 'lel!ds04 a41 U!41!M Sl!un
luaWleaJl asnqe a::>uelsqns JO xOlap 01 UO!ss!wpe JOt 03 a41 U! a::>ueJeap le::>!paW 6up!nbaJ sa::>!peJd a^!leJlS!U!Wpe
41!M Slel!ds04 U! pajeJlua::>uo::> aq 01 pual SI!S!^ asa41 'weJ60Jd jUawleaJl asnqe a::>uelsqns e OIU! NjUa JO sa::>!NaS
uO!je::>lt!XOlap 6u!~aas 03 a41 olluasaJd 04M SIUa!led sapnpu! Janej a41 ,,'xolap 6u!~aas" Slua!led pue sldwane
apP!ns palejaJ-6nJp :SI!S!^ 03 to sadAlle!::>ads OMl uo uo!pas aleJedas e sapnl::>u! jJodaJ S!41 'uo!j!ppe Uj
s'sle::>!jna::>eWJe4d 6u!^10^u! asnqe a::>uelsqns
pue 'Ienp!^!pu! Ja410ue Aq lua!jed a41 to 6u!uos!od snop!lew 'lenpl^!pU! Ja410ue JOt paq!J::>saJd le::>!lna::>eWJe4d e 6u!~el
'(6u!laqel JO suo!paJIP 01 NeJluo::> "a'!) le::>!lna::>ewJe4d e to asop papuawwo::>aJ JO paqp::>saJd ue41 Ja46!4 e 6u!~el
sapnpu! asn le::>!pawuoN 'sluawalddns AJela!p JO SUO!le::>!paw :::J10 JO uO!jdp::>saJd to asnqe JO asns!w a41 01 palelaJ
SI!S!^ 03 sapnpu! sle::>!lna::>eWJe4d to asn le::>!pawuoN 'Ja^o pue ~I: pa6e slua!jed U! auole pasn 1040::>le sapnl::>xa
lnq '~I: Japun slua!jed U! auole pasn j040::>le pue s6nJp Ja410 41!M UO!jeU!qwo::> U! pasn j040::>le sapnl::>u! AJ06ale::>
1040::>le a41 'le6all! AlleJaua6 aJe le41 sa::>uelsqns to asn a41 6u!^10^u! SI!S!^ 03 SJa^o::> N06aje::> s6nJp lP!II! a41
'sle::>!lna::>eWJe4d to asn le::>!pawuoN 111I
pue '1040::>1\f III
's6nJp lP!1I1 III
:sa!J06ale::> aaJ41 6u!MOIIOJ a41 to SWJal U! palUasaJd eJe esnqe
pue esns!w 6nJp 41!M pale posse SI!S!^ 03 to salew!jse leuO!leu e41 'esnqe pue esns!w 6nJp 6Ul^10^U! SI!S!^ 03 uo
Alpewpd sesn::>ot UO!le::>!Iqnd S!41 'peoJq Ne^ S! NM\fO Aq paJa^o::> SI!S!^ 03 paleleJ-6nJp to AeJJe lint e41 el!4M
G.uO!le~!lqnd sllIJ U! paJ,MOO SI JellM
,,'eMq\f pelelnqe110N" JO "\f1N,, uO!je!^aJqqe e41 41!M ajqel e U!
01 peJJetaJ eq Aew s6nJp to dnoJ6 lenp!SaJ e 'suo!jenl!S esa41 ul 'UO!le::>!jqnd S!41 U! s6nJp to sedAllle ue^e JO s6nJp lie
M04s 01 elq!ssod IOU S! I! 'Nelnqe::>O^ 6nJp NM\fO e41 U! pepnpu! s6nJp to epnl!llnw e41 01 enp 'uo!l!Ppe ul ,,'peltpeds
eS!MJa410 ION" JO "SON" UO!le!^eJqqe e41 41!M SUO!le::>!Iqnd NM\fO U! pelou eJe SUO!lenl!S ese41 'C.sele!do"
JO "sau!deze!pozuaq" 'a::>uelSU! JOt) sep06ele::> 6nJp ::>!tpedsuou AIUO sepnpu! pJo::>aJ le::>!pew e41 'sase::> ewos ul
DAWN member hospital submitted 1,077 DAWN cases. However, the number of submitted cases varied widely
across hospitals, from 7 cases to 6,782 cases (median 820) in a single hospital during 2006.
Estimates in this publication
Estimates in this publication were calculated by applying sampling weights, non response adjustments, and
poststratification adjustments to data from the probability sample of hospitals. 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 medical and surgical 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. Subsequent AHA surveys are used annually to refresh the sample. 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 oversample areas), supplemented with a sample of hospitals from the remainder of the United States, which
includes other metropolitan areas, as well as non metropolitan 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 oversample areas plus the estimate for the remainder of
the United States after taking into account non response, 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 C.
Margin of error for estimates
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 quantities less than 30 are regarded as too imprecise
for publication and are not shown. Three periods ("...") are displayed in the place of suppressed estimates. Ratios
(percentages or rates per 1 00,000 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, 95% confidence intervals (Cis) are included in many of the tables and are cited in the text
along with the estimates. 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. A CI, which is expressed as a range of values, is useful because the interval reflects both
the estimate and its particular margin of error.
DAWN, 2006: NATIONAL ED ESTIMATES
1 5
S31'v'VlIlS3 03 l'v'NOIl'v'N :900l 'NM'v'O
9 ~
'^s:)'v~al!.::J-t1-\fl\fOllV-LOOllS3-JN :all.::J 'llul~'sjaSejePIlS8dod/^06'snSua8MMM/rdll~ :~u!l 'sajew!js3 UO!jelndod AI~jUOV'J
'u!6PO :J!ueds!H pue 'a88J PU8 xas 'a68 )0 maA al6u!s - s:J!lSpap8J8~:J :JI~d8J60wap Aq Saj8W!jSa 18UO!j8N 'jaS8j80 UO!l81ndod
18UO!j8N UO!j8lndod juaPIsatll8sua:JjSOd snsuaJ)o n8aJns 's'n a~j WOJ) '900l/6/9)0 S8 'aJ8 900l JO) Saj8W!jSa UO!l81ndod O~
'SJ8aA juanbasqns JO Jopd WOJ) aso~j OJ alq8J8dwo:J JOU aJ8
pa~S!lqnd aJaM j8~j Saj8W!jSa a~j PU8 tOOl JO) pa~S!lqnd JOU aJaM Saj8w!lsa J8aA-lIn.::J '(SI8j!dso~)0 aldw8s Plo a~j "6'a) Plo a~j)o
awos OSl8 jnq (8paj!J:J aS8:J papu8dxa a~j "6'a) SaJnj8a) Mau a~j)o awos papaliaJ 8j8p COOl :J8aA UOlj!SU8Jj 8 S8M COOl 'NM\fO JO.::J 6
'NMVO 01 paj.JodaJ elep
A1P1ULlla pue a::JeJ aLll saqp::Jsap 'NMVO U! A1P!ULl13 pue a::JeC:l :0 x!puaddv 'elep snsuaJ aLll U! sap06ale::J A1P!ULlla
pue a::JeJ aLll ueLll elep 6u!ss!w aJOW AlqeJap!suo::J u!eluO::J pue pal!elap ssal Ll::Jnw aJe NMVO 01 alqel!e^e sap06ale::J
Al!::J!ULlla pue a::JeJ aLll asne::>aq 'sdnoJ6qns A1P!ULlla pue a::>eJ JOl paleln::>le::J IOU aJe saleJ paz!pJepUelS
'J x!puaddv U! punol aJe UO!le::J!lqnd S!Lll JOl pasn SaleW!ISa uO!lelndod 900Z
aLll pue paleJaua6 aJe saleJ asaLll MOll 10 aldwexa uv o~'snsuaJ aLlllo neaJng 's'n aLll WOJl elep uO!lelndod 6u!sn
paleJaua6 aJe saleC:l 'sajew!lsa passaJddnsun JOl suosJad 000'00 ~ Jad SI!S!^ 03 ~o SaleJ sj.JodaJ uO!le::>!Iqnd S!Ll1
'1717 01 9€ pa6e slenp!^!pu! 10
Jaqwnu aLll ueLll JaMol Ll::>nw S! salelS pal!Un aLll U! OZ 01 B ~ pa6e slenp!^!pu! 10 Jaqwnu aLll 'aldwexa JOl :sdnoJ6 a6e
SSOJ::>e AlqeJap!suo::> sJamp UO!lelndod 6U!ApapUn aLlllo az!s aLll 'Jeln::>!j.Jed U! a6e JO::l 'az!s UO!lelndod U! JaWP leLll
sap06ale::> Japua6 pue a6e SSOJ::>e SI!S!^ 0310 suospedwo::> P!le^ a~ew 01 papaau aJe saJnseaw paz!pJepuelS
az!s UO!~elndod JOJ pa~snfpe sa~eW!lS3
'SJeaA lUaJawp JO~ salew!lsa uaaMlaq sa::JuaJamp jUe::J!~!u6!s JOl 6u!ISal 10 pOLllaw
aLll uo I!elap leuO!I!ppe sap!AOJd J xlpuaddv 'SJeaA OMl aLll uaaMlaq a6ueLl::J leaJ ou seM aJaLllleLll ale::J!pU! lue::>!I!u6!s
Alle::>!IS!lelS IOU aJe leLll sa::>uaJawo 'JOJJa 10 u!6Jew aLll paa::>xa lsnw a::>uaJawp aLll 'S! leLll 'lue::J!I!u6!s Alle::J!lS!lelS aq
lsnw SJeaA OMl JO~ SaleW!ISa uaaMlaq a:JuaJawp aLll 'a6ueLl::> e se UO!le:J!lqnd S!Lll U! pajJodaJ aq 01 'JOJJa JO u!6Jew
Sl! papaa::>xa a::>uaJawp aLll~! ulej.Ja:Jse 01 SJeaA OMl uaaMlaq SaleW!ISa 10 las Ll::Jea palsal slsAleue NMVO
SJeaA SSOJ~e suos!Jedwo~ JOJ. JO.ua JO u!6JelJ\l
6'(pJeMJO~ pue POOZ) NMVO pau6!sapaJ aLll pue (SJeaA JO!Jd pue WOZ) NMVO
Plo uaaMlaq apew aq louue::> suos!Jedwo::> '11nSaJ e sV 'SpUaJl U! UO!ldnJs!p lUaUewJad e paleaJ::J slUawaAOJdw!
asaLl1 'a::>ueJnsse Al!lenb pue 6u!pu!J ase::> JO~ 10::J010Jd aLll pue 'sase::J asaLll uo pall!wqns Swal! elep aLll 'NMVO
JOl alq!6!1a sase::> palelaJ-6nJp aLll 'aldwes lel!dsOLl aLll 10 u61sap aLll papnpu! sa6ueLlJ 'SaJnleal aJo::J s,NMVO
10 ISOW paJalle leLll u6!sapaJ e 10 l[nSaJ aLll se €OOZ 10 6U1Uu!6aq aLllle palnl!lsu! aJaM NMVO 01 sa6ueLl::J Jofev.J
'900Z JOl asoLll 01
pue POOZ JOJ asoLll 01 900Z JOJ sajew!lsa 6upedwo:J Aq passasse aJe sa6ueLl::> JeaA-UaaMlaq 'UO!le::>!Iqnd S!Lll ul
SJeaA SSOJ~e suospedwo:)
'J x!puaddv
U! pap!^oJd aJe saldwexa pue suo!ldlJ::>sap leuo!l!ppe 'slda::Juo::> le::>!IS!lelS asaLll Lll!M Je!l!welun sJapeaJ JO::l
..
DRUG MISUSE AND ABUSE IN ED VISITS
or 2006, DAWN estimates that over 1.7 million ED visits were associated with drug misuse or abuse (Table 1).
This estimate includes:
III 958,164 ED visits (CI: 690,218 to 1,226,11 O) that involved illicit drugs alone or in combination with other
drugs,
II 577,521 ED visits (CI: 501,994 to 653,048) that involved the use of alcohol alone or in combination with other
drugs, and
II 860,108 ED visits (CI: 787,298 to 932,918) associated with nonmedical use of pharmaceuticals alone or in
combination with other drugs.11
Of the 1.7 million drug misuse/abuse visits, about two thirds (66%) were associated with a single drug type (illicit
drugs, alcohol, or nonmedical use of pharmaceuticals). ED visits involving illicit drugs alone accounted for 31 % of all
visits related to drug misuse/abuse in 2006. ED visits involving nonmedical use of pharmaceuticals alone accounted
for another 28%. About 7% of drug misuse/abuse visits were related to consumption of alcohol (and no other drug) by
a minor.12 The remaining visits (34%) involved some combination of illicit drugs, alcohol, and/or nonmedical use of
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 often involves 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.
11 These three categories of ED visits are not mutually exclusive, and the sum of the estimates is greater than the total number of drug
misuse/abuse visits. See Appendix C for additional detail on the type of ED visits included in each category.
12 ED patients over the age of 21 for whom alcohol was the only drug associated with their ED visits are not considered DAWN cases.
DAWN, 2006: NATIONAL ED ESTIMATES
17
4
S31lfV'lllS3 03 llfNOlllfN :900Z 'NMlfO
9 ~
'(alepdn Baal/So) gOal '~JOMlaN 6UIUJeM asnqlf 6nJO 'lfSHV'JlfS 'salpnlS pa!lddlf )0 aOI))O :3~l:lnOS
'sa6e lie JO) papnpuI S! 's6nJp Ja~IO ~IIM lUasaJd ua~M 'IO~OOIIf 'sllnpe JO) SI!SI^ "IUO-Io~oole sapnpxa NMlfO t
'salelS pal!Un
a~l UI s03 mO~-vl ~IIM Slel!dso~ "els-)Jo~s 'leJapa::l-uoU)O aldwes a^llelUaSaJdaJ e uo paseq SIIS!^ 03 )0 SaleW!ISa aJe asa~l G
'woownllmllMMM/rdn~ Ie laUJalul a~l uo puno) aq ueo pue If xIPuaddlf U! papI^oJd sl UOO!xa7
a~l)o asn 6UIUJa^061uawaaJ61f 6UISUaO!1 wnllnV'J a~l '(LOOl) SluawaJ!nbaJ anblun s,NMlfO laaw 01 pa!IIPow seM uO!leo!llssep
a~l 'oul 'SaOIAJas uOllewJolul wnllnV'J 'LOOl cr> 'UOO!xa7 wnllnV'J a~l WOJI pa^pap sl NMlfO uI pasn s6nJp 10 UOlleo!)ISSep a~l
8GO' ~L - 6LO'8v 8'6 %S SIjIj'61j sle:mnaOeWJe4d pue 10400le 41lM s6nJp l!:l!lll
9vn6~ - Ovti:lj~ B'Ij %O~ f;VL'W sleollnaoeWJe4d 41lM 1040011f
O~Ij'W - ~91j'W 17'0 ~ %B 1jf;Ij'm sleollnaoeWJe4d 41lM s6nJp 1!:l!1I1
i:~8'LLG - Of;n 9 ~ Ij't~ %U ~i:9'6 ~i: sl0400le ~IIM s6nJp l!:l!lll
suolleulqwoJ
i:S8' ~ 179 - ~i:L'Of;V 8'9 %8i: 9Lt98v "IUO sleollnaoewJe4d
i:v9'm - 99L'96 9D %L VOL'9i: ~ (~i: > 86e) "IUO 104001\1
68 ~ '6GL - 0i:6'tvf; f;'8~ %~f; v99'9f;9 "IUO s6nJp l!:lllll
889'v80'i: - 980' ~9P' ~ 9'8 %OO~ L8S'i:vH asnqe{8SnS!W 6nJp 10 sad"IIlV
punoq - punoq (3Stj) JOJJ8
Jaddn JaMol pJepuels S)!S!^ 10 lSIIS!^ ~lu8Wa^10^UI 6nJa
a^!leI8tj lU80Jad palewns3
le^J81u! 80uapl1uoJ %96
900~ :}UaWaAIOAU! 6nJp JO €IdA} Aq I's'n alH U! S}!S!A 03 U! asnqe pue asns!w 6nJO
~ alqel
I)
ILLICIT DRUGS IN ED VISITS
o 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 2006, DAWN estimates that 958,164 (CI: 690,218 to 1,226,110) ED visits involved an illicit drug (Table 2).
Thus, over half (55%) of all the drug misuse/abuse ED visits during the year involved illicit drugs, either alone or in
combination with another drug type.
DAWN estimates that cocaine was involved in 548,608 (CI: 374,579 to 722,636) ED visits. In other words, close
to one in three drug misuse/abuse ED visits (31 %) involved cocaine.
Marijuana was involved in 290,563 (CI: 238.737 to 342,388) 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 189.780 (CI: 119,525 to 260,035) ED visits, or approximately 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.
Nearly two thirds (64%) of reports of "opiates" submitted to DAWN for 2006 came from toxicology findings, so some
unknown quantity of these may have been heroin. The number of drug misuse/abuse ED visits involving unspecified
opiates is estimated at 55,674 (CI: 42,590 to 68.757) visits.
Stimulants, including amphetamines and methamphetamine, were involved in 107,575 (CI: 66,105 to 149,046)
ED visits, about 6% 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 (99%) of the reports of amphetamines submitted
to DAWN came simply as "amphetamine" and 65% of those were derived from toxicology findings.
Other illicit drugs appeared at much lower frequencies. For 2006, DAWN estimates:
ill MDMA (Ecstasy) in 16.749 ED visits (CI: 11,470 to 22,028),
IIlI PCP in 21,960 ED visits (CI: 5,518 to 38,403),
m Miscellaneous hallucinogens in 3,898 ED visits (CI: 2,591 to 5,205),
Il.I LSD in 4,002 ED visits (CI: 1,945 to 6,059),
I!I GHB in 1,084 ED visits (CI: 517 to 1,652), and
!lI Ketamine in 270 ED visits (CI: 29 to 511).
DAWN, 2006: NATIONAL ED ESTIMATES
1 9
o
S31VVolllS3 a3 lVNOIlVN :900l 'NMVa
0<:
EO ~ 't - LOO'~ 0'9(; 9S0'(; (V1N) a^oq8 paj81nq8jjOU SUOlj8U!qwOJ
OOV'L - 988'E 6'9~ Ev9'9 SjU8184U\
90tS - ~69'(; ~"H 868'E sUa60U!8n\l84 snoau8\1a8S!lAJ
EOV' 8E - 8~9'9 (;'8E 096' ~(; dJd
690'9 - 9v6' ~ (;9(; GOO'v OSl
~~S - 6(; 9'9v OLG aUIW8ja)j
.., - .., ,., (loudA40tj) w8daZ8Jj!Unl:J
(;S9' ~ - H9 L'9(; v80' ~ 8H8
6GO'(;(; - OLv' ~ ~ ~ '9 ~ 6v L'9 ~ (AS8jS8:3) VlAJOlAJ
v6~'6~~ - E99'Ov ~ 'S(; v(;6'6L aU!W8ja4dw84jalAJ
9W6E - vto'9(; n~ Ovt(;E SaUlW8ja4dwv
9VO'6V~ - 90 ~ '99 L'6~ SLS'LO~ SjU8\nWljS
88nvE - L EL' 8E(; ~'6 E99'06(; 8u8n[IJ8lAJ
Sto'09(; - 9(;9'6 ~ ~ 6'8~ 08L'68 ~ U!OJaH
9E9'(;GL - 6L9'v LE (;'9~ 809'8VS aU!880J
0~~'9(;n - 8~t069 n~ v9 ~ '896 s6nJp jP!l1! 'Sj!SI^ 0:3
889'vEO'l - 980' ~9V' ~ 9"8 L88'lvn SI!S!^ 0:3 asnq8/asns!w flnJp IBj01
Sj!S!^ 0:3 paj8\8J-6nJO
punoq punoq
Jaddn JaMol
18mjU! a8uap!lu08 %96
(:3Stj) JOJJa
pJ8pU8jS
a^!j8Iatj
V'€'lSI!S!^
pajBW!lS:3
~ sflnJp papalas PU8 ,{JOflajB8 flnJO
900Z :Sl!S!^ 03 u! sBnJp l!:>!I11
Z 81qel
().
Table 2 (continued)
Illicit drugs in ED visits: 2006
Drug category and selected drugs 1
ED visits Relative
per 100,000 standard
population2,3,4 error (RSE)
ED visits per 100,000 population
95% Confidence interval
Lower Upper
bound bound
Total drug misuse/abuse ED visits 576.7 8.5 480.1 - 673.2
ED visits, illicit drugs 317.0 14.3 228.4 - 405.7
Cocaine 181.5 16.2 123.9 - 239.1
Heroin 62.8 18.9 39.5 - 86.0
Marijuana 96.1 9.1 79.0 - 113.3
Stimulants 35.6 19.7 21.9 - 49.3
Amphetamines 10.7 11.4 8.3 - 13.1
Methamphetamine 26.4 25.1 13.5 - 39.4
MDMA (Ecstasy) 5.5 16.1 3.8 - 7.3
GHB 0.4 26.7 0.2 - 0.5
Flunitrazepam (Rohypnol) ... ... ... - ...
Ketamine 0.1 45.6 0.0 - 0.2
LSD 1.3 26.2 0.6 - 2.0
PCP 7.3 38.2 1.8 - 12.7
Miscellaneous hallucinogens 1.3 17.1 0.9 - 1.7
Inhalants 1.9 15.9 1.3 - 2.4
Combinations not tabulated above (NTA) 0.7 26.0 0.3 - 1.0
The classification of drugs used in DAWN is derived from the Multum Lexicon, @ 2007, Multum Information Services, Inc. The
classification was modified to meet DAWN's unique requirements (2007). The Multum Licensing Agreement governing use of the
Lexicon is provided in Appendix A and can be found on the Internet at httpl/wwwmultum.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.
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 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, 2006 (03/2008 update).
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):
III 182 visits per 100,000 population for cocaine,
III 96 visits per 100,000 population for marijuana,
ill 63 visits per 100,000 population for heroin, and
III 36 visits per 100,000 population for stimulants.
DAWN, 2006: NATIONAL ED ESTIMATES
21
<J
S31lfWI1S3 03 llfNOl1lfN :900Z 'NMlfO
zz
'(SjUelnW!IS JOt %OZ pue U!OJ84 JOt %8 "6'8)
s6nJp 8WOS JOt J84614 seM 86elu8~J8d 841 pue '1IeJ8AO SI!S!A p81e18J-6nJp !P!II! to % ~ ~ UI uMou~un seM ^IP!U418/8~eJ
:elep 6u!SS!w ^q P8P8dw! SI sdnoJ6 ^lPIU418/8~eJ 841 SSOJ~e S8pU8nb8Jt 8Aljel8J 841 6u!lenleA8 'J8A8MOH
'8114M 8J8M 04M SIU8!led P8AloAUI 8sn 6nJp lPIlIl ^ue 01 P8jel8J Sl!S!^ 841 to %PP '^lPIU418/8~eJ to SWJ81 UI
'pp 01 8 ~ p86e
SIU8!led JOt IS846!4 8J8M sluelnw!lS JOt S8jeJ 841 pue 'PZ 018 ~ p86e Slu8!led JOt IS846!4 8J8M euenfpew JOt S81eJ 841
8114M 'pg 01 ~Z p86e SIU8!led JOt IS84614 8J8M S81eJ 841 'U!OJ84 JO:l ,(Z 8Jn6!:I '€ 81qe1) SIU8!led J8PI0 pue J86uno^ JOt
S81eJ J8MOI 41!M 'pg 018 ~ p86e SIU8!led 6uowe IS846!4 8J8M UO!lelndod 000'00 ~ J8d S81eJ 841 8U!e~0~ JO:l ,(Z 8Jn61:1)
slUelnW!lS JOt 8~U8J8JJ!P J8pU86 e IOU seM 8J8411nq 'luno~~e OIU! JOJJ8 to u!6Jew 841 pue 8Z!S UO!lelndod 6ul~el
J8ye 'S81eW8t JOt ue41 S81eW JOt J84614 8J8M UIOJ84 pue 'euen[uew '8U!e~0~ 6U!AIOAU! SlIS!^ 03 to S81eJ 841
'(al8pdn 800<:/\:0) 900<: '~JOMlaN 6U!UJ8M asnqlf 5nJO 'lfSH~VS 'Sa!pnIS pallddV )0 a:JIJJO :3:)cInOS
sluelnwI1S
U!OJaH
euen!ueV\l
au!eJO)
o
os ~
'"
<:J
~
o
o
OOL C,
o
o
<:J
o
<:J
C
~
OSL 0'
:::>
laL
OOl
900Z :s6nJp lP!1I! pal::lalaS 6U!^IO^U! Sl!S!^ G3l0 Sale~
~ 8m6!:l
11
Table 3
Illicit drugs, by patient characteristics: 2006
Patient
characteristics All
illicits
Selected drugs 1
PCP
Drug-related ED visits2,3
ED visits, illicit 958,164 548,608 189,780 290,563 107,575 16,749 1,084 4,002 21,960
drugs
Gender
Male 631,052 354,268 129,914 195,063 68,638 10,835 824 3,297 15,298
Female 326,846 194,121 59,7 44 95,478 38,930 5,915 261 705 6,661
Unknown 266 ... ... ... ... ... ... ... ...
Age
0-5 years 855 585 ... ... ... ... ... ... ...
6-11 years ... ... ... ... ... ... ... ... ...
12-17 years 58,428 10,984 1,661 44,088 7,740 4,524 ... 1,045 1,242
18-20 years 71,973 26,802 8,299 44,146 8,487 3,997 ... 1,075 1,718
21-24 years 105,043 47,515 17,119 46,388 16,453 4,217 ... 611 5,118
25-29 years 126,699 63,945 26,607 42,626 20,489 1,928 121 ... 5,637
30-34 years 107,718 67,820 23,657 28,904 15,000 1,124 175 ... 2,714
35-44 years 264,430 181,912 57,155 49,571 26,170 417 ... ... 3,088
45-54 years 176,026 122,028 42,662 26,367 10,068 ... ... ... 2,271
55-64 years 39,767 23,177 11,049 6,947 2,680 ... ... ... ...
65 years and 5,929 3,499 1,456 1,071
older ... ... ... ... ...
Unknown 388 300 ... 68 ... ... ... ... ...
Race/ethnicity
White 421,775 215,718 78,470 154,081 57,582 8,140 720 2,898 6,087
Black 295,041 213,797 49,522 75,835 6,638 4,392 ... ... ...
Hispanic 126,529 63,692 35,781 31,528 ... 1,528 ... ... ...
Racelethnicity
not tabulated 7,830 3,206 1,656 1,871 1,893 90 ... ... ...
above (NT A)
Unknown 106,990 52,194 24,351 27,248 21,658 ... 130 ... 1,625
DAWN, 2006: NATIONAL ED ESTIMATES
23
t[
S3111V'JIlS3 03 lllNOI111N :9001: 'NMIIO
vi:
'(818pdn 900l1EO) gOal '~JOMI8N 6UIUJ8M 8snqll 6nJO 'IISHVIJIJS 'S8ipnlS p8!1ddll )0 801))0 :3~~nos
'p8SS8Jddns U88q S84 OE U841 SS81818W!lS8 U8 JO %Og U841 J8188J6 3Sl:l U8 41iM 818W!lS8 U8 18418180lPUI (..,) SlOP 88J41 t
'S8181S p81!Un
841 uI s03 Jn04-vl 41!M SI81idS04 A81S-jJ04S '18J8p8j-UOU )0 81dw8S 8^i181U8S8Jd8J 8 UO p8S8q SIIS!^ 03)0 S818W!lS8 8J8 8S841
'wonW1111l11.lMMM/rd1l418 18UJ81UI841 uo puno) 8q U80 PU8 II XiPU8ddv uI P8P!^oJd sl UOO!X87
841)0 8sn 6UiUJ8^061U8W88J6v 6U!SU80il wnllnV\j 841 '(LOOl) S1U8W8Jlnb8J 8nb!un s,NMVO 188W 01 P81)!POW S8M UO!180!)ISS8P
841 'oul 'S80!fU8S UOI18WJO)UI wnllnV\j 'LOOl @ 'UOO!X87 wnllnV\j 841 WOJ) P8^P8P SI NMVO ui p8sn s6nJp)0 UO!180I)!SS8P 841 ~
.., .., ,.. .., .., In: 9'f: l'6 g~ J8PIO
PU8 SJ88^ gg
.., ,.. ,.. .., {9 nl Ht: S'OL ~nl~ SJe8^ v9-gg
l'g .., .., .., 6'll 0'09 ~L6 S'LLl L'OOv SJe8^ vg-gv
~L .., .., 0' ~ v09 g'v~ ~ om ~'Olv L'O~9 SJe8^ vv-gt:
sn ,.. 60 g t:'9L ~m v'Ol~ O'gvt: O'Svg SJe8^ Vt:-Ot:
9'9l .., 9'0 ~ '6 g'96 600l vgl~ t: ~Ot: O'L6g SJe8^ 6l-gl
~ 'ot: 9't: .., 8'Vl 6'96 l'Ul S'OO~ 6'6Ll L'S~9 SJe8^ vl- ~l
9't:~ g'S .., g' ~t: OL9 t:SVt: g'g9 n~l 6'L9g SJe8^ Ol-S ~
6'17 ~'v '" S'H vot: nH g'9 l't:v 9'6ll SJe8^ L~-l~
,.. .., .., .., ,.. ,.. .., .., .., SJe8^ ~ ~-9
.., .., .., .., .., .., ,.. vl g't: SJe8^ g-O
85V
€'V g'O (O 6t: v'gl €'l9 O'6t: L'9l ~ n~l 81ew8,j
t:'O ~ l'l 9'0 €'L ~'9v 6'Ot:~ l'LS S'Lt:l g't:lv 81eV\j
J8pU88
'?,'L n v'o g'g 9'g'?, r96 8'l9 9'~8~ O'H'?, s5nJp
liO!!I! 'SI!S!^ 03
d~d
SI!O!II!
IIV
SO!ISp810eJB40
IU8nBd
900l :s:>nSpalOBJBl(:) luanBd Aq 's6nJp ~!O!lll
(panU!+UOJ) € elqel
Figure 2
Illicit drugs, ED visit rates by age and gender: 2006
Cocaine
500 c 500
c 420
0 .9
'p ;0
'" 400 400
:; :;
Q. Q.
0 0
Q. Q.
0 300 0 300 238
0 0
0 0
6 0'
~ 200 ~ 200
Q; Q; 127
Q. Q. r--,
~ 100 ~ 100
'" '"
'" '"
0 0
""' 0 """ '" """ """ """ "" + Male Female
6 N ":" N M "" ""' <0 ""'
..0 N cO J., 6 J., J., J., <0
N N M M """ ""'
Marijuana
500 500
c c
0 ,g
'p
'" 400 '" 400
:; 348 :;
Q. Q.
0 0
Q. Q.
0 300 0 300
0 0
0 0
6 6
~ 200 ~ 200 131
Q; Q;
Q. 100 Q. 100
~ ~
'" m
'" '"
0 0
""' r-- 0 """ '" """ "" """ """ + Male Female
6 ":" ":" N M "" ""' <0 ""'
..0 N ~ J., 6 J., J., J., <0
N N M M """ ""'
Heroin
500 c 500
c
0 0
.~ 'p
400 '" 400
:; :;
Q. Q.
0 0
Q. Q.
0 300 0 300
0 0
0 0
6 6
~ 200 ~ 200
Q; Q;
Q. Q. 87
~ 100 ~ 100
'" m 39
'" 4 '"
0 0 r~~~"J
u;' r-- 0 "" '" """ """ "" """ + Male Female
N ":" N M """ ""' ~ ""'
0 ..0 N cO J., 6 J., J., <0
N N M M """ ""'
Stimulants
500 500
c c
.9 .9
;0 400 ~ 400
:;
Q. Q.
0 0
Q. Q.
0 300 0 300
0 0
0 0
6 0'
~ 200 ~ 200
Q; 97 97 Q;
Q. Q.
~ 100 ~ 100 46
'" '" 25
'" '"
0 0 ~'."'1
""' r-- 0 """ '" """ """ """ """ + Male Female
6 '" N ":" N M """ ""' <0 ""'
N cO J., 6 J., J., J., <0
N N M M """ ""'
SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2006 (03/2008 update).
DAWN, 2006: NATIONAL ED ESTIMATES 25
o
26
DAWN, 2006: NATIONAL ED ESTIMATES
o
o
o
'l-
ALCOHOL IN ED VISITS
mong 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 section.
For 2006, DAWN estimates that 577,521 (CI: 501,994 to 653,048) 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
(33%) of all drug misuse/abuse ED visits (Table 4). Of all these ED visits involving alcohol, about one fifth (22%)
involved patients under the age of 21 who used alcohol alone, that is, with no other drug.
Table 4
Alcohol in drug-related ED visits: 2006
Relative 95% Confidence interval
Drug category and selected drugs 1 Estimated standard
visits2,3 Lower Upper
error (RSE) bound - bound
Total drug misuse/abuse ED visits 1,742,887 8.5 1,451,086 - 2,034,688
ED visits, alcohol 577,521 6.7 501,994 - 653,048
Alcohol in combination 450,817 7.6 383,818 - 517,816
Alcohol alone 126,704 12.5 95,766 - 157,642
1 The classification of drugs used in DAWN is derived from the Multum Lexicon, @2007, Multum Information Services, Inc. The
classification was modified to meet DAWN's unique requirements (2007). 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. 2006 (03/2008 update).
Alcohol in combination with other drugs (Tables 5-6, Figure 3)
DAWN estimates 450,817 (CI: 383,818 to 517,816) ED visits related to use of alcohol in combination with
another drug(s) in 2006. 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 (87%) implicating alcohol with another drug (Table 5).
Males accounted for 63% of visits involving alcohol in combination with other drugs (Table 5). Taking population
size and the margin of error 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 54. ED visit rates were lower for older and younger
patients.
DAWN, 2006: NATIONAL ED ESTIMATES
27
II
S31lfv.l11S3 03 llfNOlllfN :900l 'NMlfO
8Z
'(ajepdn 900llEO) 900G '~JoMjaN 6u!UJeM asnqlf 6nJO 'lfSHV<JlfS 'sa!pnjS pa!lddlf )0 a:J!JJO :3::>~(10S
'passaJddns uaaq se4 OE ue4j ssal ajewljsa ue JO %Og ue4j JajeaJ6 3S~ ue 4j!M ajew!jsa ue je4j aje:J!pu! (..,) SjOp aaJ41 l
'sajejS paj!u(1
a4j U! s03 m04-vG 4j!M Slej!ds04 AejS-jJ04S 'l8Japa:l-UOU )0 aldwes aA!jejuasaJdaJ e uo paseq Sj!S!A 03 )0 sajew!jsa aJe asa41 ~
v6E'\7\7 UMOU~U(1
~6L'l
LL6'9
g~6'Ov
gvO'~9
~WLg
SgS' 617
m'l~
6lv
v L j7'gt:
SOL'gg ~
m'gl
vgg'g~
v~~'m
~90'vEl
L~S'Ogv
LWOgv
nSI!S!A
pajBWnS3
017tv
('V1N)
aAoqB p8jBlnqBjjOU Aj!0!U4j8/80B~
o!uBds!H
~oB18
8j!4M
Aj!0!U4ja/aoB~
UMOU~U (1
J8PI0 pUB SJe8A gg
SJB8A vg-gg
SJB8A 17g-g17
SJB8A v17-gt:
SJB8A Vt:-Ot:
SJB8A 6l-gl
SJeaA 17l- ~l
SJB8A Ol-S ~
SJB8A n-l~
SJB8A ~ ~-g
SJeaA g-O
a6'V
p81U8wnoop ION
J8410
P810
80lApB leolp8W jsu!e5e U8l
p8JJ8)SUeJl
uOIj!sods!p J8410
Ilun lua!ledu! J8410
I!un 0IJIB!40ASd
XOI8P/AOU8PU8d8P leo!W84J
AJ85ms
8JeO leO!I!Jof(1JI
lel!ds04 S!41 01 p8ll!wp'V
IU8WIB8JI/XOI8P 01 p8JJ8)8tj
I!Bf/80!IOd 01 p8SB818tj
8w04 pa5JB40S!0
9LO'~g
t:OO'g6
170 ~ '9gl
gn
t:g\7'L
g ~6' ~l
SLO'SS
6SV't:t: ~
170t:'\7V
9t:6't:g
v~6'17v
wL'~t:
SW17l
p8SB81aJ pUB palBaJl
UO!I!sods!O
PSAIOAU! 104001'1
s5nJp 8Id!llnV<J
5nJp SI5u!S
paAlo^u! s5nJP!0 J8qwnN
SLt99 ~
glV'VSl
UMOU~U(1
81Bw8::!
81BV<J
JSPUS8
UO!jBU!qwoo U! 10400lB 'Sj!S!^ 03
L~B'Og17
sonSpSjOBJB40 j!S!^
nSj!S!^
pajBw!jS3
SO!jSpapBJB40 juanBd
900(; :s:mSp9l0BJB40 l!S!^ pUB lU9nBd Aq 'UOnBU!qWOO U! I0400lV
g 91qel
'UMou~un seM A1P!U41a/80eJ
SI!S!^ JO %0 ~ U! :elep 5u!ss!w Aq P8P8dw! S! sdnoJ5 A1P!U418/80eJ 841 SSOJoe S8!OU8nb8JJ 8^!leI8J 841 5u!lenle^3
'81!4M 8J8M 04M SIU8!led P8^10^U! UO!leU!qwoo U! 10400le 41!M SI!S!^ 841 JO %L9 'A1P!U418/8oeJ JO SWJ81 ul
Figure 3
Alcohol with other drugs, ED visit rates by age and gender: 2006
350
300
c
o
'" 250
-s
Cl.
o
::; 200
o
o
~ 150
Q:;
Cl.
2! 100
'"
ex:
50
350
308
1.,1
1200
jil
, i
I
167
i
300
o
o
c
o
.~ 250
-S
Cl.
o
::; 200
o
o
~ 150
01
Cl.
2! 100
'"
ex:
50
Lf"'l r--. 0 '<::j" en "T ~ oe::t' 'O;;j'" +
6 ~ N ~ ~ ~ 6 ~ ~ ~ ~
NNMM~lJ"'l
Male
Female
SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2006 (03/2008 update).
Alcohol was most frequently combined with (Table 6):
li Cocaine alone (101,588 visits),
II Marijuana alone (41,653 visits),
lIil Cocaine and marijuana (21,241 visits), and
II Heroin alone (14,958 visits)
Table 6
Drugs most frequently reported with alcohol: 2006
Drugs reported with alcohol1
No other drug
Cocaine only
Marijuana only
Cocaine and marijuana only
Heroin only
Stimulants only
Alprazolam only
Cocaine and heroin only
1
Estimated visits2
126,704
101,588
41,653
21,241
14,958
7,895
8,007
10,628
The classification of drugs used in DAWN is derived from the Multum Lexicon, @ 2007, Multum Information Services, Inc. The
classification was modified to meet DAWN's unique requirements (2007). The Multum Licensing Agreement governing use of the
Lexicon is provided in Appendix A and can be found on the Internet at http://www.multulllcom.
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, 2006 (03/2008 update),
DAWN, 2006: NATIONAL ED ESTIMATES
29
#
S31V~IlS3 a3 lVNOl1VN :900Z 'NMVa
08
'(v aJn6!.:!) sajeJ Jellwls
pe4 sajewaJ pue saleVlj '(000'00 ~ Jad vOZ) L ~ OJ Z ~ pa6e sjuaned JOJ je4j saWn B'G seM (uO!jelndod 000'00 ~ Jad
Sj!S!^ ~ gg) OZ OJ 9 ~ pa6e sjua!jed JOJ Sj!S!^ 03 AIUO-1040:)le asa4j JO ajeJ a4j 'juno::l::le OjU! az!s UO!lelndod 6u!~el
'(g alqel) weJ60Jd juawjeaJj asnqe a::luejsqns JO xOjap OJ UO!ss!wpe
JOJ jsanbaJ e JO jdwalle apP!ns e Ja4j!a OJ pajelaJ JOU seM je4j 6u!~upp a6eJapun juasaJdaJ Sj!S!^ aS04j JO (Sj!S!^
ggg'9Z ~ JO '%66) lie ApeaN '(v alqel) ~Z a6e ue4j Ja6UnOA aJaM 04M sjua!jed Aq (6nJp Ja4jOUe 4j!M uO!jeu!qwo::l
U! JOU "a'!) auole 1040::lle JO asn OJ pajelaJ Sj!S!^ 03 (Zv9'L9~ OJ 99L'96 :18) VOL'9U sajew!jsa NM\fO '900Z JO:!
(17 amG!.:l 'g '17 salQel) asn IOllO:>le aGeJapun JOl Sl!S!^ 03
vvt7v6 Z09'f:9 ~ 'v ~ tL6'f:L
~ ~tLf: f:6~'9Z 6'B ZOnf:
f:69'm L9L'ZB ~ ' ~ ~ 9L9'90~
OZ-B ~ peBe slueqed
09f:'L9 f:Zf:'Lf: 9'17 ~ ZVf:'Z9
f:OL'BZ Vf:~'OZ 0'6 B ~ t7VZ
ZOtf:6 B~f:'09 6'O~ 09L'9L
L~-U peBe SIUe!led
punoq punoq (3SCl) JOJJa
Jaddn JaMol pJepuejs zSj!S!^
a^!lelaCl pajew!ls3
le^JajU! aouap!Juo:) %96
'(81epdn BOOl/to) 900l '~JOMI8N OUIUJeM 8snQlf onJO 'IfSH\^JlfS 'S8!pnlS p8!1ddlf JO 80!JJO :3::JClnOS
's81elS pal!Un
841 U! s03 Jn04-vl 41!M Slel!ds04 AelS-jJ04S 'leJ8p8::J-UOu )0 81dwes 8^!lelu8SaJd8J e uo paseq SI!S!^ 03 JO s81ew!ISa 8Je 8sa41 1:
'WOO uII11lnw MMM/ld1l4 Ie 18UJ8jUI 841 uo punoJ 8q ueo pue V XIPuaddlf U! pap!^oJd S! UOO!X87
841)0 8sn OUIUJ8^OOluawa8JOIf OU!SU80!l wnlln\^J 841 '(LOOl) SIU8W8J!nb8J anb!un S,NMlfO 188W 01 P8!J!POW seM UO!leO!J!ssep
841 'oul 'SaO!AJ8S uOllewJoJul wnlln\^J 'LOOl @ 'UOO!Xi37 wnlln\^J a41 WOJJ pa^p8p S! NMlfO UI p8sn SonJp JO UOlleo!J!ssep 841 ~
auole 104001\7'
uO!jeu!qwoo uI 104001\7'
10400le 'Sj!S!^ 03
8uole 104001\7'
uO!jeu!qwo::l U! 104001\7'
10400le 'SI!S!^ 03
~ sBnJp papelas pue AJoBejeo BnJO
900l : ~l a6e J8pUn SIU8!led U! SI!S!^ 03 p8lel8J-6nJp U! IOLlO:>I'v'
L 81qel
'(L alqel) OZ OJ g~ pa6e sjUaned pue U OJ U pa6e sjua!jed
JOJ Jel!w!s S! je4j 6u!pu!J e 'auole 1040::lle pa^lo^u! SJOU!W JOJ Sj!S!^ 03 pajelaJ-1040::lle a4j JO (%69) 0 ~ U! L ApeaN
'OZ OJ 9 ~ pa6e Sjuaned JOJ Sj!S!^ 03 pajeWl040::lle (f:69'9U OJ L9L'G9 :18) 9L9'90 ~ 11II
pue 'L ~ OJ Z ~ pa6e sjUaned JOJ Sj!S!^ 03 pajeWl040::lle (ZOn6 OJ 9 ~ f:'09 :18) 09L'9L III
:sajeW!jsa NM\fO 's6nJp Ja4jO
4j!M UOneu!qwO::l U! 1040::lle pue auole 1040::lle 6upap!SU08 'dnoJ6 a6e S!4j JOJ NM \f0 OJ pajJodaJ aJe uOljeu!qwo::l
U! 1040:)/e pue auole 1040::l/e 4joq OJ pajelaJ Sj!S!^ 03 pue '6nJp le6all! ue sl 1040::lle '~Z a6e Japun slenp!^!pu! JO.:l
(L alqel) ~Z lO aGe alll Japun swaned U! Sl!S!^ 03 palelaJ-lollo:>I'v'
In terms of racelethnicity, 58% of these alcohol-only visits involved patients who were white. Evaluating the
relative frequencies of the racelethnicity groups is impeded by missing data; in 16% of visits, racelethnicity was
unknown (Table 8).
Most (90%) of the alcohol-only ED visits resulted in patients' being treated and released, usually to home;
another 6% were admitted to inpatient units (Table 8).
Table 8
Alcohol only (age < 21), by patient and visit characteristics: 2006
Patient characteristics Estimated Visit characteristics Estimated
visits1,2 visits1,2
ED visits, alcohol only (age < 21)3 125,888
Gender Number of drugs involved
Male 71,306 Single drug 125,888
Female 54,574 Multiple drugs
Unknown Alcohol involved 125,888
Age Disposition
0-5 years Treated and released 112,671
6-11 years Discharged home 102,839
12-17 years 51,901 Released to police/jail 7,870
18-20 years 73,598 Referred to detox/treatment 1,962
21-24 years Admitted to this hospital 7,479
25-29 years ICU/critical care 1,123
30-34 years Surgery 90
35-44 years Chemical dependency/detox
45-54 years Psychiatric unit 943
55-64 years Other inpatient unit 5,197
65 years and older Other disposition 5,738
Unknown Transferred 3,506
Race/ethnicity Left against medical advice 688
White 73,624 Died
Black 7,427 Other 1,032
Hispanic 23,602 Not documented 501
Race/ethnicity not tabulated above 1,709
(NTA)
Unknown 19,526
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.
Three dots (...) indicate that an estimate with an RSE greater than 50% or an estimate less than 30 has been suppressed.
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 reported in Table 4.
SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2006 (03/2008 update).
DAWN, 2006: NATIONAL ED ESTIMATES
31
S31VWI1S3 03 lVNOIlVN :900l 'NMVO
Z:€
'(aj8pdn 800Z/tO) 900Z '~JOMlaN 6UIUJ8M asnqv 6nJO 'VSH~VS 'salpnlS pallddV jO a~!jjO :3:)~nOS
alewa~
ale~
0
001
;;>:J
~
19l ro
DOL ~
0
0
OOE g
0
-0
0
-0
DOt? ~
0'
::l
OOS
009
V1 .l:> w W N N
m V1 V1 V1 0 V1 00 ~ ~
V1 '" U, .f,. W N N N 0
+ .l:> .l:> .l:> .l:> <.D .l:> 0 ..... v,
0
DOl
;;>:J
~
ro
DOL ~
o
o
ODE g
o
-0
o
-0
OOt? "'-
~
0'
::l
ODS
009
900Z :Japua6 pue a6e Aq SaleJ l!S!^ 03 '( ~Z > a6e) AIUO 1040:>1'1
V aJn6!:1
..
NONMEDICAL USE OF PHARMACEUTICALS
se of illicit drugs is, by definition, substance abuse. For pharmaceuticals, however, distinguishing medical
from nonmedical use is more complicated.13In 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.14 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. Also, it is not possible to know, based
on the documentation available in ED medical records, the extent to which pharmaceuticals came from legitimate
prescriptions versus other sources.
Nonmedical use of pharmaceuticals (Tables 9-10, Figure 5)
For 2006, DAWN estimates that 741,425 (Cl: 674,198 to 808,652) ED visits involved nonmedical use of
prescription or OTC pharmaceuticals or dietary supplements (Table 9). The majority of these visits (54%) involved
multiple drugs (Table 10):
IIlI Approximately one fifth (19%) of all nonmedical-use ED visits involved alcohol,
III One fifth (21%) involved pharmaceuticals in combination with an illicit drug, and
III About 6% involved pharmaceuticals in combination with both alcohol and an illicit drug.
Central nervous system (CNS) agents (50% of nonmedical-use visits) and psychotherapeutic agents (44%) 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 eNS agents, the most frequent drugs were opiate/opioid analgesics (33% of nonmedical-use visits),
including single-ingredient formulations (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:
13 DAWN cases are identified through a retrospective review of medical charts. Given the limitations of medical record documentation,
we have concluded that distinguishing misuse from abuse reliably is not feasible.
14 Taking less than the prescribed or recommended dose is not considered "nonmedical use."
DAWN, 2006: NATIONAL ED ESTIMATES
33
"
S31V~IlS3 03 lVNOI1VN :900Z 'NMVO
178
vQl7'8 - OS6 rs(; m'(; ajeplUa4dlA4jal^J
.., - .., .., .., aU!Weja4dweoJjxao
g08'9 - 60g'(; 0'(;(; LOn au!aJJe::J
LL9'L - LL8'(; 6'9(; LW'g aU!Weja4dweoJjxap-aU!Weja4dw\f
8S8'S ~ - ~ QI7' 6 g'9~ (;6S'8 ~ sjUelnw!ls SN::J
m'v - ~09'(; g'v~ 6(;9'8 SON SOljoudA4 pue 'sa^!jepas 'SO!jAIOIXU\f
(;SS'(;(; - 889' ~ ~ 99~ LgtH wap!dlOZ
909'8 - 6vn L'H SL9'(; aUIZAXOJpAH
686'v~ - 8v9'6 o ~ ~ ~6t(;~ au!WeJpA4Ua4d!0
Lv6'Sv - v08'(;8 g'O~ 9(;9'OV SO!jOUdA4 pue 'sa^!jepas 'SO!jAIO!XUe 'OSIl^J
0(; ~ '8s - gLg'88 n(; Sv8'Sg SON sau!daze!pozuaS
~98'S(; - 6LO'6 ~ O'O~ OU8(; wedazeJOl
v9L'8(; - so ~ '9 ~ S'6 986'6 ~ wedaze!o
v8g' ~ v - OSg'g(; ~(; ~ Lgg'88 wedazeuol::J
~9g'6L - ~ ~6'Og n~ 98tg9 WeIOZeJdl\f
~9n(;(; - 6SL' L9 ~ U g(;9'g6 ~ sauldazelpozuas
8~6'V~ - S90'L rs~ ~ 66' 0 ~ sajeJnj!qJeS
LW09(; - v6tLO(; Sg gLS'88(; SO!jOUdA4 pue 'sa^!jepas 'SO!lAIO!XU\f
LS8'(;g - OSO'L8 L'B 88L'vv SO!j040ASdljU\f
SLL' ~ ~ - vvn g'S(; ~9g'L SjuessaJdap!jue snoauellaosll^J
gst(;(; - vWO~ 9'H v9g'9 ~ SjuessaJdap!lue O!lOAOPl
~6V'gv - Svtg(; 9v~ OLE'gE SjuessaJdap!jue IClSS
.., - .., .., .., SJOj!qI4U! O\fl^J
SEn6 - 9(;0'99 L'B (;S9'6L sjuessaJdapljU\f
vOg'OgE - g6V'L6(; n 666'8(;E SlN38\f ::Jlln3d\fCl3HlOHJASd
199'SOS - S6~'vL9 g'v glV' ~ vL asn leO!paWuou 'Sj!S!^ 03
punoq - punoq (3SCl) Jom
Jaddn JaMol pJepuejs H,zSj!S!^ ~ s6nJp pajoalaS pue sapo6ajeo 6nJp pajoalas
a^!lelaCl pajew!ls3
le^Jaju! aouap!Juo:) %g6
900l :SIB:mnaOBWJB4d 10 asn IBOlpawuoN
6 alqel
'(6Sf:'P9 OJ OLS'9f: :18) Sj!S!^ 03 Of: ~ '9P U! 8uopel.Jj8lt\j l1li
pue '(Of:O'OS Oj9PL'6P :18) Sj!S!^ 03 SSS'P9 U! suo!leu!qwo::J/8UOPO::JAXQ III
'(S6nL OJ ~OL'tP :18) Sj!S!^ 03 099'L9 U! suo!jeu!qwo::J/8UOPO::>OJpAH III
Table 9 (continued)
Nonmedical use of pharmaceuticals: 2006
Relative 95% Confidence interval
Estimated
Selected drug categories and selected drugs 1 visits2,3,4 standard Lower Upper
error (RSE) bound - bound
CENTRAL NERVOUS SYSTEM AGENTS 373,138 5.4 333,720 - 412,556
Analgesics 323,579 5.5 288,441 - 358,717
Antimigraine agents 1,191 29.2 509 - 1,873
Cox-2 inhibitors ... 68.9 ... - ...
Opiates/opioids 247,669 6.9 214,160 - 281,177
Opiates/opioids, unspecified 50,978 12.6 38,416 - 63,540
Narcotic analgesics 201,280 8.2 168,954 - 233,606
Bu pren orph i net co m bi n ati ons 4,440 41.6 823 - 8,057
Codeine/combinations 6,928 18.4 4,433 - 9,424
Fentanyl/combinations 16,012 27.3 7,441 - 24,583
H yd rocod one/ co m b in atio ns 57,550 12.3 43,701 - 71,398
Hyd romorphone/combi nations 6,780 23.6 3,649 - 9,911
Meperidi ne/combinations 1,440 38.7 349 - 2,532
Methadone 45,130 10.5 35,870 - 54,389
Morphine/combinations 20,416 14.2 14,750 - 26,082
Oxycodone/combi nations 64,888 11.9 49,746 - 80,030
P ropoxyph ene/ com bi n ati ons 6,220 18.6 3,955 - 8,485
Nonsteroidal anti-inflammatory agents 27,662 8.9 22,846 - 32,479
I bu profen 20,541 8.6 17,071 - 24,011
Naproxen 6,651 17.9 4,314 - 8,987
S al icyl ates/ combi n ati ons 10,399 14.5 7,444 - 13,354
Miscellaneous analgesics/combinations 54,313 7.9 45,938 - 62,687
Acetaminophen/combinations 44,314 9.0 36,482 - 52,146
Tramadol/combinations 6,048 16.2 4,128 - 7,969
Tramadol 5,961 16.4 4,050 - 7,873
Acetaminophen-tramadol ... ... ... - ...
Analgesic combinations not tabulated above (NTA) 898 30.8 355 - 1,441
Anorexiants 1,168 28.2 522 - 1,815
Anticonvulsants 31,169 13.2 23,099 - 39,238
Antiemetic/antivertigo agents 1,360 32.6 491 - 2,230
Anti-Parkinson agents 3,816 31.5 1,457 - 6,174
General anesthetics ... ... ... - ...
DAWN, 2006: NATIONAL ED ESTIMATES
35
.
S31VWIlS3 03 lVNOllVN :900Z 'NMVO
98
'(ejepdn Baal/SO) 900l '~JoMjeN 6u!UJeM esnqlf 6nJO VSHV'JlfS 'se!pnjS pe!lddlf )0 e:JI))O :3:nInOS
-pesseJddns ueeq se4 os ue4j sse I ejew!lse ue JO %Og ue4j JejeeJ6 3SCJ ue 4jlM ejeWljSe ue je4j eje:JIPuI (",) SjOp eeJ41 V
'Sj!S!^ 03)0 sjuno:J pejelJUI pue peJJo:JuI e:JnpoJd II!M pejJodeJ se Sj!S!^ 03 6ulwwns '(elqej SI4j uI e:JIMj Jeedde 111M euopo:JOJPA4
pue euopO:JAXO 6UI^IO^UI jIS!^ e "6'e) elqej SI4j U! sew!j eld!llnW Jeedde 111M Sj!S!^ 4:Jns 's6nJp eld!jlnW e^lo^uI uelJo SjISI^ 03 C
'sejejS pej!Un
e4j U! s03 Jn04-Yl 4jlM SIejlds04 AejS-jJ04S 'leJepe.::l-uou )0 eldwes e^!jejueseJdeJ e uo peseq Sj!S!^ 03 )0 sejewljse eJe ese41 G
'lUOn1ll1I1nw'MMM/j:dn4je jeuJejUI e4j uo puno) eq ue:J pue If x!pueddlf uI pepI^oJd sl uO:J!xe7
e4j)0 esn 6UIUJe^06jueweeJ61f 6uIsue:J!1 wnjlnV'J e41 '(LOOl) sjUeWeJlnbeJ enb!un S,NMlfO jeew OJ pel)IPOW seM uOlje:J!)lssep
e41 ':Jul 'se:JINes uOljewJO)UI wnjlnV'J 'LOOl (2) 'uoJ!xe7 wnjlnV'J e4j WOJ) pe^pep sl NMlfO U! pesn s6nJp)0 UOlje:JI)!SSep e41
LLS'OZ - 669 't ~ L'O~ 8St' H 'r/ 1N sjue6e Jeln:Jse^O!pJeJ
9v~'L - 090 't VOZ W~'9 s:JljeJn!O
L06'9 - 9v9't v'9~ at9 sjue6e 6u!>i:JOlq leuue4:J wnpleJ
~L9'9 ~ - 88L'9 9' ~z 6U~~ sIue6e 6u!>i:JOIQ :J!6JeueJpe-ejes
99~'9 - 99ft n~ 0~8'v 6u!pe AlleJjUe:J 'sjue6e :J16JeueJpe!lulf
v6ttv - ~6S'6Z 8'6 tvt'9S SlN381f CJ'r/lnJSlfAOIOtJlfJ
z98'9 - OVL'Z 9'8~ 96tv If 1N sjue6e AJOleJ!dsetJ
089'8 ~ - 099' ~ ~ O'z ~ 9 ~ ~ '9 ~ SUOljeuIQwO:J AJOjeJldseJ Jeddn
S9t't - L88 Hz m'z SjUeJOI:Jedx3
8zV'z - S69 0' ~S ~ ~9' ~ sjuejse6uo:Jeo
m'v - t~n ~' ~z OG6'z SJOjeI!Po4:JUOJS
608'g - oWz 8'Ol OS~'V seUIWejS14!jUIf
~89'vt - SgO'tz SO~ L98'8z SlN381f ACJ01 IftJldS3CJ
tz9'~ - vLS 6' ~S 666 sjue6e SNJ snoeuelle:Js!V'J
9L6'8 - 80n ~n m'L eupdezueQol:JAJ
899'9S - Z9t'U Gtz gOg'yZ IOPoJdospeJ
0~9'~9 - 9ZS'9Z 9'9~ 8 ~6'8S sjuexeleJ el:JsnV'J
punoq punoq (3S~) Jom
Jaddn JaMol pJepuets vt'zSt!S!^ ~ s6nJp papalas pue sa!Jo6ate:l 6nJp papalas
a^!tela~ patew!tS3
le~atu! a:luapljuo:l %S6
900Z :Sle:mna:>eWJe4d 10 asn le:>!paWUON
(penuquO:l) 6 alqel
~
..
Table 10
Nonmedical use of pharmaceuticals, by patient and visit characteristics: 2006
Patient characteristics Estimated Visit characteristics Estimated
visits 1,2 visits 1,2
ED visits, nonmedical use 741,425
Gender Number of drugs involved
Male 353,066 Single drug 341 ,796
Female 388,084 Multiple drugs 399,629
Unknown ...
Age Disposition
0-5 years 6,360 Treated and released 430,260
6-11 years 4,366 Discharged home 392,512
12-17 years 65,268 Released to police/jail 17,646
18-20 years 51,972 Referred to detox/treatment 20,102
21-24 years 71,351 Admitted to this hospital 223,622
25-29 years 73,753 ICU/critical care 64,777
30-34 years 66,650 Surgery 876
35-44 years 157,450 Chemical dependency/detox ...
45-54 years 131,797 Psychiatric unit 49,413
55-64 years 50,933 Other inpatient unit 104,633
65 years and older 61,346 Other disposition 87,543
Unknown 181 Transferred 49,514
Race/ethnicity Left against medical advice 16,097
White 508,708 Died 1,574
Black 77,553 Other '"
Hispanic 59,847 Not documented 5,459
Race/ethnicity not tabulated above 8,433
(NTA)
Unknown 86,884
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, 2006 (03/2008 update).
Note that ED records frequently do not distinguish methadone used for treatment of opiate addiction from the
methadone in pill form that 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 information to distinguish whether the methadone was
related to the ED visit.
DAWN, 2006: NATIONAL ED ESTIMATES
37
.
S31VV>lIlS3 03 lVNOl1VN :90Ol 'NMVO
9f:
'S1U868 AJ018Jids8J S8 "6'8 '8J84M8S18
P8il!SS8P 8J8 8U!W8JPA4U84diP 6UiU!81UOJ SI8JIln8J8WJ84d lU8iP8J6ui-illnw AU8V1j 'SUOn8InWJOllU8iP8J6U!-816U!S AIUO S8pnpU! si41 9~
'Ja6UnOA pue ~ ~ pa6e SIUa!led JOJ ISaMol aJaM pue 1717 01 8 ~ pa6e SIUa!led JOJ ISa46!4 aJaM SaleJ I!S!^ 'a6e JO SWJal ul
'(9 am6!.::!) (uO!lelndod 000'00 ~ Jad SI!S!^ LEG) salew pue (uO!lelndod 000'00 ~ Jad SI!S!^ E9G) salewaJ uaaMlaq JaWP
IOU PIP Sle:l!lna:leWJe4d JO asn le:l!pawuou JOJ SI!S!^ 'luno:l:le 01U! JOJJa JO u!6Jew a41 pue az!s UO!lelndod 6u!~e1
'alep!Ua4dlA41aw pa^IO^U! SI!S!^ 03 asn-Ie:l!pawuou (pOp'E 01086 :18) G6 ~ 'G W41 salew!lSa
NM\fO 'AlluanbaJJ ssal 4:lnw SJn:l:lO 'UO!lUane 4:lnW paJnlde:l se41e411uelnw!IS SN8 e 'alep!Ua4dIA41aV\l
'(L8E'G9 01 OSO'LE :18) SI!S!^ 03 EU'pp U! 'au!de!lanb se 4:lns 'S:l!104:lAsd!lU\f III
pue '(8EE'E6 019W'99 :18) SI!S!^ 03 G89'6L U! slueSsaJdap!lu\f II
:saleW!ISa NM\fO 'S:l!104:lAsd!IUe pue slUeSsaJdap!lue apnpu!
ISaJalu! JO slua6e :l!lnadeJa4104:lAsd Ja410 'Sle:l!lna:lewJe4d JO asn le:l!paWuou 41!M pale!:losse SI!S!^ 03 a41 JO.::!
'(6E6'H 01 EP9'6 :18) SI!S!^ 03 ~6tG~ U! 9~au!WeJpA4Ua4d!0 II
pue '(E~6'p~ 01 890'L :18) SI!S!^ 03 ~66'0~ U! 'paweuun Alpewpd aJe 4:l!4M 'SaleJnl!qJes II
'(G88'G(: 01 EE9' ~ ~ :18) SI!S!^ 03 L9tH U! wap!dlOZ III
:SI!S!^ 03 asn-Ie:l!pawuou
JO sJaqwnu Jel!W!S U! paJeadde s6nJp 6u!MOIIOJ a41 'S:l!IOudA4 pue 'Sa^!lepaS 'S:l!lAIO!Xue Ja410 a41 6uow\f
'SI!S!^ 03 (p9L'tG 01 80~'9~ :18) 9E6'6~ U! wedaze!p
pue SI!S!^ 03 (~9E'8G 016LO'6~ :18) OGL'EG U! wedazeJOI papnpu! sJaqwnu le!IUelsqns U! 1I!IS lnq AllUanbaJJ ssal
6upJn:l:l0 sau!daze!pozuaS 'SI!S!^ 03 (OG ~ 'E8 019L9'EE :18) 8pE'89 :sJaqwnu Jel!W!S U! paJeadde paweu lua!paJ6u!
:l!Jpads e ln041!M sau!daze!pozuaS 'SIISI^ 03 (pE9' ~ 17 01 089'9G :18) L99'EE U! wedazeuop pue SI!S!^ 03 (~99'6L
01 ~ ~6'09 :18) 9Et99 U! WelOZeJdle aJaM sau!daze!pozuaq paweu AllUanbaJJ ISOW a41 'NM\fO 016u!pJo:l:l\f
'900G U! sau!daze!pozuaq pa^IO^U! Sle:l!lna:leWJe4d
JO asn le:l!paWuou 41lM pale!:losse SI!S!^ 03 (~gp'EG(: 0168L'L9~ :18) 9G9'96~ le41 SaleW!lsa NM\fO 'slua6e
:l!lnadeJa4104:lAsd JO sadAl Ja410 a41 JO Aue 6u!^10^u! as041 Jaqwnulno Apeap sau!daze!pozuaq 6u!^10^u! SI!S!^
03 'sau!daze!pozuaq pue saleJnl!qJeq sapnpu! Sle:l!lna:leWJe4d JO AJ06ale:l S!41 'sle:l!lna:leWJe4d JO asn le:l!paWuou
41!M paleposse SI!S!^ JO (%W PJ!41 e lnoqe JO (L9P'09G 01 p6tLOG :18) 9L8'EEG U! 6upJn:l:l0 'luanbaJJ ISOW
a41 aJaM S:l!IOudA4 pue 'sa^!lepas '(slua6e Ala!xue-!lue) S:l!lAIO!XUe a41 'slua6e :l!lnadeJa4104:lAsd a41 6uow\f
'900G U! SI!S!^ 03 asn-le:l!paWuou JO '%E JO '(899'9E 01 G9n~ D) 909'pG U! pa^lo^u!
seM 4:l!4M 'IOPoJdospe:l seM SI!S!^ asn-le:l!paWuou U! lUexelaJ apsnw luanbaJJ ISOW a41 'spnpoJd Ua4dou!wela:le
p!o!douou 6u!^10^U! SI!S!^ asn-Ie:l!pawuou (9p~'G9 01 G8P'9E :18) p~np SaleW!ISa NM\fO '(%17 'SOI\fSN)
slua6e AJOlewweIJU!-IIUe lep!OJalSUOU pue '(%17) sIUeSln^UO:l!lue '(%9) sluexelaJ apsnw '(SI!S!^ asn-Ie:l!pawuou
JO %9) Ua4dou!Wela:le 6u!U!eluO:l s:l!sa6IeUe p!o!douou a41 Aq A:luanbaJJ U! paMolloJ aJaM sp!o!do a41
In terms of race and ethnicity, 69% of visits related to nonmedical use of pharmaceuticals involved patients who
were white (Table 10). Evaluating the relative frequencies of the race/ethnicity groups is impeded by missing data; in
12% of visits, race/ethnicity was unknown.
Patients were treated and released in about half (58%) of ED visits associated with nonmedical use of
pharmaceuticals, with most discharged home (91 %) and only 5% referred to detox or substance abuse treatment. In
one third (30%) of all nonmedical-use visits, patients were admitted to inpatient hospital units (Table 10). Of those
admitted to the hospital, about one third (29%) were sent to a critical care unit, about 22% to a psychiatric unit, and
about half (47%) to other inpatient units. About 7% of ED visits for nonmedical use of pharmaceuticals resulted in
transfers to another health care facility.
Figure 5
Nonmedical use of pharmaceuticals, ED visit rates by age and gender: 2006
500 500
41 0 4~~
c 400 c 400
0 0
'';:; '';:;
re re
:; :;
"'- "'-
0 0
"'- 300 "'- 300
0 0 253
0 0
0 0 237 r-'"
6 6
0 0 I
~ 200 ~ 200
:;:; :;:; I
"'- "'-
2 2 I'
re re
ex:: ex::
100 100
0 0 I
lrl ...... 0 """ O'l """ """ """ """ + Male Female
6 N ":' N CV) "'r lrl co lrl
<l, N 00 J, 6 lrl J, J, co
N N CV) CV) """ lrl
SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2006 (03/2008 update).
DAWN, 2006: NATIONAL ED ESTIMATES
39
40
DAWN, 2006: NATIONAL ED ESTIMATES
o
o
COMPARISONS OF ED VISITS: 2004, 2005, AND 2006
his chapter presents the comparison of the estimates of ED visits for 2006 to prior years. Differences between
years are presented in terms of the percent increase or decrease in visits in 2006 compared to the estimates
for 2004 or 2005. Only statistically significant changes are discussed and are shown as changes in the tables.
However, with only three years' estimates to compare, caution is urged in interpreting these significant differences as
trends.
Drug misuse and abuse in ED visits (Table 11)
In 2006, hospitals in the United States delivered a total of 113 million ED visits, an increase of 3.9% over 2004.
The population of the United States increased 2.9%, from 294 million to 302 million, over the same period.
According to DAWN, the number of ED visits attributable to drug misuse and abuse was stable from 2004 to
2006 (Table 11 ).16 That is, the apparent difference is within the margin of error. Across the different types of drug
involvement, changes were detected for visits involving:
III pharmaceuticals alone (i.e., with no other type of drug), which increased 44% from 2004 to 2006;
III pharmaceuticals used in combination with illicit drug(s), which increased 36% from 2004 to 2006; and
I'i! pharmaceuticals used in combination with alcohol, which increased 22% from 2005 to 2006.
Regarding the significant increases detected, it is worthwhile to consider that the number of pharmaceuticals
dispensed for legitimate therapeutic uses may be increasing over time, and DAWN estimates are not adjusted to take
this into account. Nor do DAWN estimates take into account the increases in the population or in ED use between
2004 and 2006.
16 In this publication, drugs are classified using the Drug Reference Vocabulary that was current as of May 2007.
DAWN, 2006: NATIONAL ED ESTIMATES
41
S31lfv.l11S3 03 llfNOl1lfN :900<: 'NMlfO
Zv
'(al8pdn BOOlIEO) 900l '~JOMlaN 6U!UJ8M asnqlf 6nJO '\fSHVIJIfS 'Sa!pnlS pa!lddlf jO aO!jjO :3~tlnOS
'uMoLls spopad aLll JOj sal8wIlsa uaaMlaq SaS8aJOap JO SaS8aJOU! (90'0> d) lU80!j!u6!s AII80!IS!181S salouap uwnloO sILl1
'sal81 S pal! U n
aLll U! s03 JnOLl-vl Lll!M SI81!dsOLl A81S-jJOLlS '18Japa,j-uou jO aldw8s a^!181uasaJdaJ 8 UO pas8q SI!S!^ 03 jO SaI8W!ISa aJ8 asaLl1
'UIoownllnuIMMM/rdlllll8 laUJalul aLll uo punOj aq U80 PU8 If x!puaddlf U! pap!^oJd S! UOJ!X;n
alii jO asn 6u!uJa^061uawaaJ6v 6u!sUaOll wnlln~ aLl1 '(LOOl) SIUaWaJlnbaJ anblun S,NMVO laaw 01 paw pow S8M UO!180!j!SS8P
a1l1 'oul 'sao!^,JaS UO!18WJOjUI wnlln~ 'LOOl @ 'UOJ!Xa7 wnlln~ aLll WOJj pa^pap S! NMVO U! pasn s6nJp jO UOI180!j!SS8P a1l1 ~
E99'69 009'v9 ~L9'9v S180!lna08WJ8Lld
PU8 IOLlO:>I8 Lll!M s5nJp 1101111
%ll Ev L' w 9LtOv ~ 9~L'60 sl8ollna08WJ8Lld Lll!M 10LlooIl/
%9E 9E9'lv~ 9vtW nO'90~ sl801lna08wJ8ljd ljl!M s6nJp 1!0!1I1
~l9'6~l ElB' ~ll BE9'BEE IOljOol8 ljl!M s6nJp 1!0!1I1
suol18UlqWOJ
%vv 9Lt9Bv 60E'vvv LB6'9EE AIUO sl80!lna08wJ8ljd
vOL'9l ~ 669'0 ~ ~ BB6'09 ~ (~l > a68) AluO 10ljooll/
v99'9E9 B99'n9 9E ~ 'l09 AIUO s6nJp llO!111
Lllll'lvn ~ ~ E'9 ~9' ~ v90'6~9'~ 8snqBj8SnS!W 5nJp 10 s8dA11I'V
gOal 'gOal gOal 'vaal gOal gaOL vaal ~IU8W8^10^U! 5nJO
885uBljO lU80J8d <:SI!S!^ P81BW!IS3
900~ pue 'SOO~ 'VOO~ :JuewaAIOAU! 5nJp JO adAJ Aq "s'n a4J U! SJ!S!A 03 U! asnqe pue asns!w 5nJO
~ ~ alqel
Illicit drugs in ED visits (Table 12)
No changes from 2004 to 2006, nor from 2005 to 2006, were detected for ED visits involving major illicit drugs:
cocaine, marijuana, heroin, and stimulants (Table 12).
Table 12
Illicit drugs in ED visits: 2004, 2005, and 2006
Drug category and selected drugs 1 Estimated visits2 Percent change3
2004 2005 2006 2004,2006 2005,2006
Total drug misuse/abuse ED visits 1,619,054 1,616,311 1,742,887
ED visits, illicit drugs 991,363 921,127 958,164
Cocaine 475,425 483,865 548,608
Heroin 214,432 187,493 189,780
Marijuana 281,619 279,664 290,563
Stimulants 162,435 137,650 107,575
Amphetamines 34,085 34,928 32,240
Methamphetamine 132,576 109,655 79,924
MDMA (Ecstasy) 10,220 11,287 16,749 64% 48%
GHB 1,789 1,036 1,084
Flunitrazepam (Rohypnol) ... ... ".
Ketamine ... 303 270
LSD 2,146 2,001 4,002 100%
PCP 31,342 14,825 21,960
Miscellaneous hallucinogens 3,150 3,194 3,898
Inhalants 9,523 5,156 5,643 -41%
Combinations not tabulated above 3,201 2,055
(NTA) ...
The classification of drugs used in DAWN is derived from the Multum Lexicon, @ 2007, Multum Information Services, Inc. The
classification was modified to meet DAWN's unique requirements (2007). The Multum Licensing Agreement governing use of the
Lexicon is provided in Appendix A and can be found on the Internet at httpJ/www.l1Iultum.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.
This column denotes statistically significant (p < 0.05) increases or decreases between estimates for the periods shown.
SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2006 (03/2008 update).
DAWN, 2006: NATIONAL ED ESTIMATES
43
"
S31V~IlS3 03 lVNOl1VN :90Ol 'NMVO
vv
'(ajepdn BOOl/EO) 900l '~JoMjaN 5u!UJeM asnq\f 5nJO '\fSHl^J\fS 'sa!pnjS pa!lddv)o aO!JJO :3::>~nOS
'uMoLls spopad aLlj JO) sajew!lsa uaaMjaq saseaJoap JO saseaJou! (90'0 > d) jueo!)!u5!s AlleO!jS!jejs sajouap uwnloO S!L11 S
'sajejS paj!Un
aLlj U! s03 JnoLl-vl L1j!M Slej!dsOLl AejS-jJoLlS 'reJapa::l-uou )0 ardwes a^!jejuasaJdaJ e uo paseq Sj!S!^ 03 )0 sajew!jsa aJe asaLl1 ~
'woownlII1WMMM!/d1l4je jauJajUI aLlj uo puno) aq ueo pue \f x!puadd\f U! pap!^oJd S! uO:J!xe7
aLlj)O asn 5uluJa^05juawaaJ5\f 5u!suao!l Wl1jrl1l^J a41 '(LOOl) sjuawaJ!nbaJ anb!un S,NM\fO jaaW,Oj pal)!pOW seM UO!jeo!)!ssep
a41 'our 'sao!AJas uO!jewJO)Ur wnjlnl^J 'LOOl @ 'uo:J!Xe7 wnjrnl^J aLlj WOJ) pa^pap S! NM\fO U! pasn s5nJp)0 uO!jeo!)!ssep aLl1
U6'tL l8E'L9 L8nO~ auole 10LlOOI\f
lOnE v8L'a 9l6'~€ uOljeu!qwoo U! 10LlOOI\f
9L9'90 ~ 99 ~ '96 H€'m 10Lloole 'Sj!S!^ m
Ol-8 ~ palle Sjua!led
lvt'l9 6€L'lv v€0'9v auole 10LlOOI\f
8 ~ V'Vl OU6 ~ 999' ~l uOljeu!qwoo U! 10Llool\f
09L'9L 69V'l9 689' L9 10Llo::lle 'Sj!S!^ m
L ~ -l ~ palle sjua!led
900l'900l I 900l'vOOl
salluBLlO luaoJad
900l
I
900l
I
vaal
~ sllnJp papalas pUB AJollalBO llnJO
~Sl!S!^ palBW!ls3
900l pue 'gOal 'vaal : ~l aBe Japun Slua!led U! Sl!S!^ 03 palelaJ-BnJp U! I0400lV
v~ alqel
'(ajepdn 800l/EO) 900l '~JOMjaN 5u!UJeM asnq\f 5nJO '\fSHl^J\fS 'sa!pnjS pa!ldd\f )0 ao!))o :3::>~nos
'UM04S spopad aLlj JO) sajew!lsa uaaMjaq saseaJoap JO saseaJou! (90'0 > d) jueo!J!u5!s Arle::l!jS!jejs sajouap UWnlO:J S!41 S
'sajejS paj!Un
aLlj U! sm mOLl-vl L1j!M Slej!dsOLl AejS-jJ04S 'leJapa::l-uoU )0 ardwes a^!jejuasaJdaJ e uo paseq Sj!S!^ 03 )0 sajewljsa aJe asaLl1
'WOO'WI111I1w'MMM//dnLlje jauJajul aLlj uo puno) aq ue::l pue \f x!puaddv U! pap!^oJd S! UO:J!xa7
aLlj)O asn 6u!uJa^06juawaaJ5v 5U1suao!l wnjll1l^J aLl1 '(LOOl) SjuawaJ!l1baJ anb!un s,NMVO jaaw OJ pa!)lpow seM uO!le::l!)lssep
aLl1 ':Jul 'sa::l!AJas uO!jeWJo)ul wnjlnl^J 'LOOl @ 'UO:J!xe7 wnjlnl^J aLlj WOJ) pa^pap sl NM\fO U! pasn s5nJp)0 uO!jeO!)ISSep aLl1 ~
vOL'9l ~ 669'0 ~ ~ 886'09 ~ auolB 10LlO::lI\f
LW09v 669'9 ~ v 9l6'tl9 UOljBUlqWO::l U! 10Llo::lI\l
~ 19' LL9 86~'a9 v~6'vL9 10LlO::lIB 'SI!S!^ 03
LBB'lv L' ~ m'9~9'~ v90'6W~ Sl!S!^ 03 asnqB/asns!w llnJp IBl01
900l'900l 900l'vOOl 900l goo<: vaal ~ sllnJp papalas pUB AJollalBO llnJO
salluB4::1 luaOJad ~Sl!S!^ palBWns3
900l pue 'gOal 'vaal :Sl!S!^ 03 palelaJ-BnJp U! I0400lV
S~ elqel
'SIUa!l8d a58JapUn U! auol8 1040018 PU8 's5nJp Ja4l0 4l!M UO!l8U!qwoo U! 1040018 '1I8JaM
1040018 :Sl!S!^ 03 pal8jaJ-1040018 a4l118 JOJ lUalS!SuOO aJaM s5u!pu!J asa41 '(v~-t~ salq81) 900Z Ol900Z popad
a4l JOJ JOU '900Z Ol VOOZ WOJJ popad a4l 5upnp paJJnooo Sl!S!^ 03 pal8IaJ-10400\8 U! sa5u840 lU80!J!u5!s ON
(v~-c ~ salQel) Sl!S!^ 03 U! I04031V
Nonmedical use of pharmaceuticals (Table 15)
ED visits related to nonmedical use of pharmaceuticals increased 38% in the period from 2004 to 2006
(T able 15). Among the drugs most frequently implicated in nonmedical use, the following changes from 2004 to 2006
are notable:
III Psychotherapeutic and eNS agents increased 31 % and 32%, respectively.
III Anxiolytics, sedatives, and hypnotics increased 32% overall, with benzodiazepines increasing 36%.
III Opiate/opioid analgesics increased 43%, with hydrocodone/combinations increasing 44%,
oxycodone/combinations increasing 56%, and unspecified opiates increasing 60%.
For the period 2005 to 2006, no change was detected in the overall number of ED visits related to nonmedical
use of pharmaceuticals nor were changes noted for the substances most frequently implicated in nonmedical-use
visits.
Table 15
Nonmedical use of pharmaceuticals ED visits: 2004, 2005, and 2006
Drug category and selected drugs 1 Estimated visits2,3 Percent change4
2004 2005 2006 2004,2006 2005,2006
ED visits, nonmedical use 536,247 669,214 741,425 38%
PSYCHOTHERAPEUTIC AGENTS 247,324 308,655 323,999 31%
Antidepressants 66,917 67,051 79,682
MAO inhibitors ... ... ...
SSRI antidepressants 32,285 30,374 35,370
Tricyclic antidepressants 12,412 14,515 16,564
Miscellaneous antidepressants 9,414 7,452 7,561
Antipsychotics 35,198 44,393 44,733
Anxiolytics, sedatives, and hypnotics 177,394 227,486 233,875 32%
Barbiturates 11,721 14,693 10,991
Benzodiazepines 143,546 189,704 195,625 36%
Alprazolam 46,526 57,419 65,236 40%
Clonazepam 28,178 30,648 33,557
Diazepam 15,619 18,433 19,936
Lorazepam 17,674 23,210 23,720
Benzodiazepines NOS 36,039 61 ,486 58,347
Misc. anxiolytics, sedatives, and 31,554 35,561 40,626 29%
hypnotics
Diphenhydramine 10,452 10,294 12,291
Hydroxyzine 2,363 2,179 2,678
Zolpidem 12,792 14,730 17,257
Anxiolytics, sedatives, and 2,657 4,421 3,629
hypnotics NOS
DAWN, 2006: NATIONAL ED ESTIMATES
45
S31lfV'jIlS3 03 lIfNOlllfN :900<: 'NMlfO
917
S6S f:'19 LL6 (,</IN) a^oqB pajBlnqBj
JOU SUOljBU!qWO:J :J!saBIBU,</
", ", 606 10pBWBJj-ua~dou!WBja:J,</
f96''1 af'1 sv6'f: 10pBWBJl
SVO'9 Sf6''1 6VB'v SUO!jBU !qwo:J/lopBWBJ 1
Vff:'VV s'1'1tv L9f'6f: SUO!jBU!qwo:J/ua~dou!WBja:J,</
Hf:'v'1 fSS'f'1 L'1S'vv SUO!jBU!qWO:J
ISO!saBIBUB snoauBllaos!~
66t'0 f f:2:f'2:f OS'1'6 SUO!jB U! q wo:J ISajB IAO!I B S
f'19'9 06f''1 '1fL'V UaXOJdBN
fV'1'02: S9tu W'U uaJoJdnql
2:99'a Lf:S'S2: 2:9f:'a SjUaBB
AJOjBWWBIJU!-!jUB IBp!OJajsUON
02:t9 SV9'L VV L'9 SUO!jBU!qwoo/aua~dAXodoJd
%9'1 SSS'V9 f:v6'2:'1 fOL' fV SUOIjBU!qwoo/auopooAXO
%9v 9 f f02: 2:9L''1f 996tf SUO!jBU!qwoo/au!~dJo~
Of:f''1V VS9'2:V 90S'9f: aUOpB~ja~
OVV'f f:Sf: 2:SL SUOIjBU!qwoo/aU!P!Jada~
OSL'9 VfL'V '1Sn SUO!jBU !qwoo/auo~dJowoJ PAH
%vv O'1'1'L'1 2:6f'Lv vVB'6f: SUO!IB U!qwoo/auopo:JOJpAH
2:fO'9f ffnf f:2:S'6 SUOIjBU!qwooIIAuBlua::l
S2:6'9 OSf'9 W'L SUO!jBU!qwoo/au!apoJ
OVV'v '" '" suo !jB U! q W 00 lau! ~dJOU aJ d n 8
%02: %6f: ost f02: 9Lf:'S9 f VV9'VVf so!saBIBUB O!IOOJBN
%09 SL6'O'1 OL9'2:'1 9VS'ff: pa!Jpadsun 'SP!O!dO/SaIB!do
%f:v 699'Lv2: v6'1'n2: 9UW SP!O!dO/SaIB!do
'" '19L '1f:6'f SJOj!qlljU! 2:-XOJ
f6f'f SfO'f S9S sluaBB aU!BJB!w!lu,</
%vf: 6L'1t2:f: f'1tv62: SL'1'fV2: so!saBIBu,</
%2:f: SH'Uf: 006'9f:f: 96G'GS2: SlN38'</
~31SASSnO^~3Nl'</~lN3J
m'2: 6f'1'2: 9VV'2: aIBP!Ua~dIA~ja~
'" '" '" aUlwBla~dwBOJIXao
LOV'v L9'1'v 9f:L'2: aU!aUBJ
%Sff ao''1 699'2: tDf:'2: aU!WBla~dwBOJIXap-aU!WBja~d w'</
%2:v 2:6Stf '196'Of f0B'6 sIUBlnW!IS SNJ
900l''1OOl 900l'vOOl 900l '1OOl POOl ~ sBnJp pajoalas pUB AJoBajB:J BnJO
vaBUB4:J juaOJad €'<:Sj!S!^ pajBw!ls3
gOal pUB 'gOal 'vaal :Sl!S!^ 03 SIB:mna:>BWJB4d }O asn IB:>lpawuoN
(panulfuo8) g~ elqel
Table 15 (continued)
Nonmedical use of pharmaceuticals ED visits: 2004, 2005, and 2006
Drug category and selected drugs 1 Estimated visits2,3 Percent change4
2004 2005 2006 2004,2006 2005,2006
Anorexiants ... 1,757 1,168
Anticonvulsants 28,652 27,641 31,169
Antiemetic/antivertigo agents 1,678 1,771 1,360
Anti-Parkinson agents 2,472 1,692 3,816
General anesthetics ... ... ...
Muscle relaxants 25,934 33,695 38,918 50%
Carisoprodol 14,736 20,082 24,505
Cyclobenzaprine 6,183 7,629 7,142
Miscellaneous CNS agents 869 900 999
RESPIRATORY AGENTS 22,286 28,017 28,867
Antihistamines 5,761 4,429 4,130
Bronchodilators 2,294 3,043 2,920
Decongestants 1,864 1,310 1,511
Expectorants 832 1,960 2,125 155%
Upper respiratory combinations 10,314 15,837 15,115
Respiratory agents NT A 2,903 3,692 4,296
CARDIOVASCULAR AGENTS 27,396 37,095 36,343
Antiadrenergic agents, centrally acting 3,616 5,125 4,810
Beta-adrenergic blocking agents 7,094 9,824 11,729
Calcium channel blocking agents 3,115 5,434 5,227
Diuretics 3,625 5,332 5,102
Cardiovascular agents NT A 14,930 18,881 17,338
The classification of drugs used in DAWN is derived from the Multum Lexicon, @ 2007, Multum Information Services, Inc. The
classification was modified to meet DAWN's unique requirements (2007). 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.
Three dots (...) indicate that an estimate with an RSE greater than 50% or an estimate less than 30 has been suppressed.
4 This column denotes statistically significant (p < 0.05) increases or decreases between estimates for the periods shown.
SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2006 (03/2008 update).
DAWN, 2006: NATIONAL ED ESTIMATES
47
S31VV'JIlS3 03 lVNOIlVN :900(; 'NMVO
st>
SPECIAL TYPES OF DRUG-RELATED ED VISITS
his chapter profiles two special types of drug-related ED visits captured by DAWN: drug-related suicide
attempts and seeking detox cases. These are analyzed by DAWN as separate and distinct classes of drug
misuse or abuse.
Suicide attempts (Tables 16-17, Figure 6)
DAWN estimates 182,805 (CI: 154,185 to 211,424) ED visits for drug-related suicide attempts in 2006
(Table 16). Although DAWN includes only suicide attempts that involve drugs, these attempts are not limited to drug
overdoses. If there is drug involvement in a suicide attempt by other means (e.g., by gun), the case is included as
drug related. However, suicide attempts not involving drugs at all (e.g., by gun alone) are excluded. Also excluded are
suicide-related behaviors documented as something other than actual attempts (e.g., suicidal ideation, suicidal
gesture, or suicidal thoughts).
Nearly two thirds (65%) of ED visits for drug-related suicide attempts involved multiple drugs (Table 17). Alcohol,
either in combination with other drugs or alcohol alone in patients under age 21, was the most frequently implicated
drug and was involved in one third (30%) of the ED visits for drug-related suicide attempts. Since DAWN excludes
visits for adults when alcohol is the only drug, the role of alcohol in suicide attempts is probably larger. Illicit drugs
were involved in just under one quarter (23%) of the ED visits for drug-related suicide attempts. The most frequently
reported illicit drugs were cocaine (15% of visits) and marijuana (8% of visits), but the margins of error for the illicit
drugs are quite large and the numbers are relatively small when compared with the pharmaceuticals.
Pharmaceuticals were involved in the majority (92%) of ED visits for drug-related suicide attempts, and it is not
possible, based on ED medical record documentation, to measure the extent to which these pharmaceuticals may
have been prescribed to the patient for a preexisting condition. More than half (58%) of ED visits for drug-related
suicide attempts involved psychotherapeutic agents, and 45% involved central nervous system (CNS) agents. The
most commonly used psychotherapeutic agents were benzodiazepines (48% of suicide-attempt visits involving
psychotherapeutics) and antidepressants (35%). The CNS agents were primarily analgesics (pain relievers) and
included both prescription and over-the-counter (OTC) formulations. DAWN estimates that the most commonly used
pain relievers were opiates/opioids and acetaminophen/combinations, which were each present in approximately a
third (33% and 31%, respectively) of suicide-attempt visits involving CNS agents, followed by nonsteroidal anti-
inflammatory agents (NSAIDs, such as ibuprofen and naproxen, 19%) and salicylates/combinations (aspirins, 7%).
About half (55%) of the suicide attempts were admitted for inpatient hospital care. A fifth (21%) were admitted to
an ICU/critical care unit; others were admitted to psychiatric units (18%) or other inpatient units (16%). Another 25%
were transferred to another health care facility; only 14% were discharged home. Very few died in the ED. However,
DAWN does not record deaths for patients who died before arriving at the ED or patients who died after admission to
inpatient units of the hospital.
DAWN, 2006: NATIONAL ED ESTIMATES
49
S31VVlllS3 03 lVNOIlVN :900Z 'NMVa
09
OG9'H 9U'Of V'Gf W'Vf wedazeUOIJ
vL6'6f f6nf G"Vf EE9'9f WelOZeJdrif
GES'L9 OEO'tv 9'L fEV'09 sau!daze!pozuaS
969't L9E S'fV fto'G sajeJnj!qJes
EU'LL GE9'S9 f'L LH'S9 SO!joud^4 pue 'sa^!jepas 'SOlj^IO!XU\;I
9 f V'SG 999'9f Hf f6V'a SO!j040^sd!ju\;I
E96'9 099' f SSG 90S't sjuessaJdap!lue snoauellaos!V>J
99tL LOf'G f'SG fS9'V sjuessaJdap!jue 0!P^OP1
6S9'OG L9t'H 6'Of tL6'9f sjuessaJdap!jue ItJ88
SJOj!q!4U! O\;lV>J
vsL'9v OL9'a L'Gf LL9'9E sjuessaJdap!ju\;l
fLS'fGf 9SE'06 9'L SU '90 f 81N38\;1 Jl1n3d\;ltJ3HlOHJA8d
saouejsqns Ja4jO
(\;I1N) a^oqe pajelnqejjou suo!leu!qwoJ
sjuele4uI
sua50upnlle4 snoauellaos!V>J
S' fL dJd
081
au!weja)i
(loud^40tJ) wedazeJj!Unl.::J
SH8
LLn fOf 6'9v 6En (^SejS03) \;IV>JOV>J
an an 9'LG LLS'G aU!Weja4dwe4jaV>J
E9t't VOf'f S'9G SGtG saU!Weja4dw\;l
Of9'9 SWE S'Sf 6GS'v sjuelnwlj8
W'tG fLE'L v'9G Ut9f euenflJeV>J
a9'9 E06'f E'SG 99G'V u!oJaH
9fE'Ov 90L'G f 9'9G Of9'9G au!eooJ
GSn9 vf6'a t'tG SVf'GV Sjp!!1! 104001e-uoN
E06 E9 V'Vv ESv auole 104001\;1
LSO'09 LS9'Sv v'9 LEn9 uO!jeu!qwoo U! 104001\;1
Lv9'09 E66'Sv V'9 OGS'v9 104001\;1
asnqe to saouejsqns JO[eV>J
pZv'm - 98f'P9f 0'8 908'ZS f SjdwallB ap!o!ns 'Sj!S!^ 03 pajBlaJ-5nJp IBj01
punoq - punoq (38tJ) JOJJa
Jaddn JaMOl pJBpUBjS V'E'ZSj!S!^ f s6nJp pajoalas pUB ^J06ajeo 6nJO
a^!jBlatJ pajBw!ls3
IB^JajU! aouap!!uoJ %96
900l :Sldwane ap!o!ns
9 ~ alqel
Table 16 (continued)
Suicide attempts: 2006
Relative 95% Confidence interval
Estimated
Drug category and selected drugs 1 visits2,3,4 standard Lower Upper
error (RSE) bound - bound
Diazepam 5,910 24.4 3,086 - 8,733
Lorazepam 6,682 13.6 4,904 - 8,460
Benzodiazepines NOS 7,080 35.9 2,092 - 12,069
Misc. anxiolytics, sedatives, and hypnotics 21,527 9.7 17,443 - 25,611
Diphenhydramine 7,756 14.6 5,543 - 9,970
Hydroxyzine 1,957 23.6 1,053 - 2,860
Zolpidem 6,674 13.6 4,890 - 8,458
Anxiolytics, sedatives, and hypnotics NOS 1,406 25.7 698 - 2,115
CNS stimulants 1,949 33.1 683 - 3,214
Amphetamine-dextroamphetamine 559 47.5 38 - 1,079
Caffeine ... ... ... - ...
Dextroamphetamine ... ... ... - ...
Methylphenidate 633 39.6 141 - 1,124
CENTRAL NERVOUS SYSTEM AGENTS 82,442 7.3 70,683 - 94,201
Analgesics 67,623 7.4 57,880 - 77,366
Antimigraine agents ... ... ... - ...
Cox-2 inhibitors ... ... ... - ...
Opiates/opioids 27,185 9.9 21,928 - 32,442
Opiates/opioids, unspecified 3,129 23.5 1,686 - 4,573
Narcotic analgesics 24,470 10.0 19,695 - 29,244
Buprenorphine/combinations ... ... ... - ...
Codeine/combinations 2,349 22.7 1,306 - 3,392
F enta nyl/ co mbi nati ons ... ... ... - ...
H yd rocodon e/ co m bi nations 8,998 11.4 6,981 - 11,016
H yd romorphone/ co m bi nations 262 49.5 8 - 516
Meperidine/combinations ... ... ... - ...
Methadone 1,772 29.3 755 - 2,788
Morphine/combinations ... 50.5 ... - ...
Oxycodone/combinations 7,842 18.9 4,934 - 10,750
P ropoxyph e n e/ co m bin ations 2,811 26.9 1,331 - 4,292
Nonsteroidal anti-inflammatory agents 15,956 15.0 11,280 - 20,632
Ibuprofen 12,064 15.0 8,523 - 15,605
N aproxen 3,726 20.9 2,201 - 5,252
S a I icyl ates/com bi n ati ons 5,400 10.4 4,294 - 6,506
DAWN, 2006: NATIONAL ED ESTIMATES
51
S31Vv.l11S3 03 lVNOl1VN :900Z 'NMVO
Z~
(ajepdn BOOZ/tO) 900Z '~JOMjaN 5u!UJeM asnqlf 5nJO 'lfSHlf'JlfS 'SalpnjS pa!lddlf )0 a~!!!o :3::nmOS
'uM04s spopad a4j JO) sajew!lsa uaaMjaq saseaJ:Jap JO saseaJ~u! (SO'O > d) jue:J!)!u5IS Alle:JljSljejS sajouap uwnlo:J S!41
'passaJddns uaaq se4 Ot ue4j ssal ajew!jsa ue JO %OS ue4j JajeaJ5 3SCl ue 4j!M ajewljSa ue je4j aje:JIPuI (',,) SjOp aaJ41 t
'sajej S pajl u n
a4j uI s03 Jn04-vZ 4j!M Slejlds04 AejS-jJ04S 'leJapa.::J-uou)O aldwes aAljejUasaJdaJ e uo paseq Sj!S!A 03)0 sejeWljSe eJe ese41
'wo:J'wnllnwMMM//dllLlje jeuJejul e4j uo puno) eq ue~ pue If xIPueddlf U! pep!AoJd sl uO:J!Xi17
e4j)0 esn 5UIUJeA05juaweeJ5v 5uisue:J!l wnjlnlf'J eLl1 '(LOOZ) sjueweJlnbeJ enb!un s,NMlfO jeew OJ pe!)!pow seM uO!je:J!)lssep
e41 ':Jul 'Se~IAJes UOljeWJo)ul Wnjlnlf'J 'LOOZ Q) 'uOJ/xa7 Wnjlnlf'J eLlj WOJ) peApap S! NMlfO U! pesn s5nJp)0 UO!je~I)ISSep e41
S6L'v - 66n ~'€Z S6tt V 1N sjue5e Jeln:JseAOIPJeJ
..' - '" 0' ~g ,.. s:J!jeJn!o
V ~g' ~ - ggv Z'SZ ova' ~ sjue5e 5u!~:J0Iq leuuelj:J wnpleJ
g6L'Z - zot~ 8'OZ 666'~ sjue5e 5u!~:J0Iq :J!5JeueJpe-ejes
Zv6'Z - L~6 S'g~ 086'~ 5u!pe AlleJjUe:J 'sjue5e :J!5JeueJpe!julf
Zvg'O ~ - 6S8'g gg~ g96'L SlN381f CllflnJSIf ^OIOClVJ
vBO'~ - g8~ S'Z8 099 V IN sjue5e AJojeJ!dsaCl
v6tg - OL9'~ S'g~ ZS6'8 suoijeu!qwo:J AJojeJ!dseJ Jaddn
gLL'~ - ~98 S'88 S90' ~ sjueJOpedx3
g~tz - 6Lv 6'Z8 Lvn sjuejse5uo:JeO
'" - .., .., .., SJOjel!polj:JUOJS
6~8'~ - gZ6 O'U ag'~ seu!wejs!lj!luV
Lv9'0 ~ - zgf'g g'8~ g ~ V's SlN38V AClOl VClldS3Cl
'" - '" .., ", sjue5e SNJ snoauella:Jsllf'J
Zgot - Ov ~'~ n~ 960'~ eupdezueqopAJ
vgg'g - S90'Z nz ~ ~ st 10PoJdospeJ
VLO'6 - ~LO'g n~ lLO'L sjuexeleJ epsnlf'J
", - .., .., .., s:J!jeljjseue leJaue8
.., - '" 6'~S .., sjue5e UOSUI~Jed-!jUV
'" - '" '" '" sjue5e 05!jJeA!jUe/:l!jewenUV
~~g'g~ - Svg'6 n~ OBg'Z ~ sjUeSlnAuo:JljUV
SgO'~ - ~g~ g' ~8 vgg sjue!xeJouv
9Zn - v~~ Dv 0~6 V IN suo!jeu!qwo:J :J!se5IeUIf
'" - '" .., .., lopew eJj- u e4do U! w eja:JV
SBQ'z - ggg g'9Z lL8'~ 10peweJl
~~g'~ - g~6 g,€~ 6~n suo!jeu!qwo:J/lopeWeJl
L9S'6~ - LgL'O~ ~'6 ~ ~ t'g~ su one U!q W O:J /u e ljdo U! w eja:J1f
9L8'~8 - L9t'U 86 ~L8'a SUO!j8U!qwo:J/s:J!sa518U8 snoau8I1a:JS!lf'J
punoq - punoq (3SCl) JOJJa
Jaddn JaMOl PJ8PU81S vnS1!S!A ~ s5nJp pal:Jalas pue ,(J05aI8:J 5nJO
aA!lelaCl pa18W!IS3
leAJalu! a:Juapiluo:) %96
900~ :Sldwane apP!ns
(p8nul~U08) 9~ Ellqel
"
Table 17
Suicide attempts, by patient and visit characteristics: 2006
Patient characteristics Estimated Visit characteristics Estimated
visits1,2 visits 1,2
Total drug-related ED visits, suicide 182,805
altem pts
Gender Number of drugs involved
Male 71,657 Single drug 64,143
Female 111,137 Multiple drugs 118,661
Unknown ."
Age Disposition
0-5 years ." Treated and released 31,528
6-11 years ". Discharged home 25,149
12-17 years 20,506 Released to police/jail 2,080
18-20 years 14,232 Referred to detox/treatment 4,299
21-24 years 18,855 Admitted to this hospital 101,409
25-29 years 21,877 ICU/critical care 37,821
30-34 years 17,095 Surgery ".
35-44 years 44,237 Chemical dependency/detox ".
45-54 years 32,970 Psychiatric unit 32,682
55-64 years 8,462 Other inpatient unit 30,129
65 years and older 4,352 Other disposition 49,867
Unknown ". Transferred 45,234
Race/ethnicity Left against medical advice 458
White 114,972 Died ...
Black 28,491 Other ."
Hispanic 18,058 Not documented 1,747
Race/ethnicity not tabulated above 2,095
(NTA)
Unknown 19,188
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, 2006 (03/2008 update).
After accounting for population size and the margin of error, the rate of drug-related suicide visits for females (73
visits per 100,000 population) was higher than that for males (48 per 100,000) (Figure 6). In general, the rates for
patients aged 18 to 54 exceeded the rates for younger and older age groups. The rate for patients aged 12 to 17 (81
visits per 100,000) exceeded the rates for patients aged 55 and over.
DAWN, 2006: NATIONAL ED ESTIMATES
53
"
S31lfWIlS3 03 llfNOlllfN :900Z 'NMlfO
1>9
'%1717 paSeaJ:JU! 4:J!4M 'S:J!sa5IeUe
p!o!do/ale!do pue '%9t paSeaJ:JU! 4:J!4M 'sauldazelpozuaq se 4:Jns 'Sldwane aPP!nS U! pa^IO^UI AIlUanbaJ~
s5nJp a41 JO awos JOJ 900G 01 1700G WOJJ luapl^a aJaM saseaJ:Jul '(8 ~ alqel) 900G 01 900G WOJJ papalap seM aseaJ:Jul
ue lnq '900G 01 1700G WOJJ SId wane applns palelaJ-5nJp JOJ SI!S!^ 03 U! a5ue4:J lue:J!Jlu5!s ou seM aJa41 'lIeJa^o
(9 ~ alqel) 900(; pue 'gOOl 'POOl :sJ!S!^ 03 ldwane apP!ns
'UMou~un seM A1P!U41a/a:JeJ 'SI!S!^ JO %0 ~ U! :elep 5u!sslw Aq papadw! S! sdnoJ5 A1P!U41a/a:JeJ a41 ~o sapuanbaJJ
a^ljelaJ a41 5u!lenle^:J 'al14M aJaM 04M slualled pa^IO^U! sldwane apP!ns a41 JO %t9 'A1P!U41a/a:JeJ JO SWJal UI
'(elE?pdn 800mo) 900G '~JOMleN 5UIUJE?M esnqlf 5nJO 'lfSHVlJIfS 'selpnlS pe!lddlf )0 eO!IIO :3:)Clnos
<J1 .j:> w W N N
m <J1 '" '" C> U'> 00 ~ ~
awwa::l alE?L^J U'> '" U, L. W N N N ?
+ .j:> .j:> .j:> .j:> u:> .j:> C> -..J ~ U'>
0 0
.~
"" ""
~ ~
os rt> os rt>
-0 -0
0; 0;
C> c;
C> C>
f.L 0 0
C> C>
C> C>
-0 -0
0 0
OOl -g OOl -g
~ ~
0' o'
::J ::J
OSl os l
900Z :Japua6 pue a6e Aq saleJ l!S!^ Q3 'sldwane ap!:>!ns
9 aJn6!::1
..
Table 18
Suicide attempts: 2004, 2005, and 2006
Drug category and selected drugs 1 Estimated visits2,3 Percent change4
2004 2005 2006 2004,2006 2005,2006
Total drug-related ED visits, suicide 161,586 151,568 182,805 21%
altern pts
Major substances of abuse
Alcohol 48,726 47,891 54,820
Alcohol in combination 48,080 46,806 54,337
Alcohol alone 646 1,085 483
Cocaine 19,520 19,628 26,510
Heroin 4,579 3,167 4,265 35%
Marijuana 12,074 11,955 15,272
Stimulants 4,535 5,410 4,829
Amphetamines 1,560 1,646 2,228
Methamphetamine 3,136 3,853 2,877
MDMA (Ecstasy) ... 529 1,239
GHB ... ... ...
Flunitrazepam (Rohypnol) ... ... ...
Ketamine ... ... ...
LSD ... ... ...
PCP ... ... ...
Miscellaneous hallucinogens ... ... ...
Inhalants ... 794 ...
Combinations not tabulated above (NTA) ... ... ...
Other substances
PSYCHOTHERAPEUTIC AGENTS 88,034 82,144 106,128 29%
Antidepressants 33,366 27,086 36,677
MAO inhibitors ... ... ...
SSRI antidepressants 18,513 13,377 16,973
Tricyclic antidepressants 3,555 3,008 4,681
Miscellaneous antidepressants 3,337 2,681 3,806
Antipsychotics 17,807 17,129 22,491
Anxiolytics, sedatives, and hypnotics 52,653 52,022 68,177 29% 31%
Barbiturates 1,949 1,219 2,031
Benzodiazepines 36,995 35,676 50,431 36% 41%
Alprazolam 11,354 14,530 15,633
Clonazepam 9,403 9,064 14,173 56%
Diazepam 4,630 3,968 599
DAWN, 2006: NATIONAL ED ESTIMATES
55
"
S31VVolllS3 a3 lVNOI1VN :900;: 'NMVa
99
OOV'S Sv9'v ~ ~t9 SUO!jeu!qwoOjSajelA:l![ es
9US vltt Ssn uaxoJdeN
v90'l ~ U6'0~ 609'S ~ uaJoJdnql
9S6'S ~ W'V~ v~~'6~ sjuaoe
AJOjeWweIJU!-llue lep!OJajsuoN
~ ~S'l 6l~ 'l SSS'~ suo!jeu!qwOOjaUa4dAXodoJd
%SS lVS'L 6lG'V OVS'S suo!jeu!qwoojauopOOAXO
... O~n v~L suoljeU!qwoojau 14dJolAJ
lLL'~ 96S' ~ LStf auope4jalAJ
... ... ,.. suo!jeulqwoojaul ppadalAJ
19l ... ... SUOljeU!qwOOjaU04dJowoJ PAH
S66'S SSO'L vSO'L suo!jeulqwoojauopoooJ PAH
... ... ... suoljeu!qwOO/lAUejUa.:!
6vS'l 9S9'l OSL'f suo!jeu!qwoojau!apoJ
... ... ... S uOlje U!q W DO jau! 4 dJ ouaJd ns
%LS %SV OLnl fOS'U Sl6'9f SO!SaOleUe oljooJeN
6lf't 6~S'l S9t'l pa!lpadsun 'SP10!dojsaje!do
%VS %vv SS ~'a 6SS'Ol 6S6'Sf SP!Oldojsaje!do
... V~S LOS SJOj!qI4U! l-xoJ
'" ... ... sjuaoe au!eJO!WljUI;f
%Sl Sl9' L9 SSS'VS S60'~9 sOISaO[eUI;f
%vl It'V'lS flS'99 6V6' tL SlN381;f
lAJ31SASSnO^~3Nll;f~lN3J
SS9 SfS ... ajep!Ua4dlA4jalAJ
'" ... ... aUlWeja4dweoJjxao
... OSv ... au!aJjeJ
6C;C; ... ... au lWeja4dweoJjxap-aU!Weja4dw\f
6v6'f lSn VS9'f SjUelnW!jS SNJ
90n m'l 6SS'f SON SO!jOUdA4
pue 'Sa^ljepaS 'SO!jAIO!XU\f
vL9'9 GL6'v SSn wapldloz
9S6'f S6n 9vt'l aU!ZAXOJpAH
9SL'L SSS'9 SWL au!WeJpA4Ua4d!o
as' ~l GlS'U 06L'9 ~ SOljoudA4
pue 'sa^!jepas 'SO!jA[O!XUe 'OS!lAJ
OSO'L SVt't 9ln SON sau!daZelPozuas
lS9'9 lSf'S S90'9 wedazeJOl
900l'900l 900l'vOOl 900l 900l vOOl ~ sonJp papalas pue AJOOajeo onJO
vaflue40 juaoJad 8,zSj!S!^ pajew!js3
900l pue '900l 'POOl :Sldwane ap!::>!ns
(penuljU08) IH alqel
Table 18 (continued)
Suicide attempts: 2004,2005, and 2006
Drug category and selected drugs 1 Estimated visits2,3 Percent change4
2004 2005 2006 2004,2006 2005,2006
Miscellaneous 22,864 22,692 27,371
an a Ig esics/ combi nations
Acetaminophen/combinations 20,701 21,017 25,312
Tramadol/combinations 1,742 1,515 1,719
Tramadol 1,528 1,079 1,372
Acetaminophen-tramadol ... ... ...
Analgesic combinations NT A ... ... 920
Anorexiants '" ... 654
Anticonvulsants 10,957 9,389 12,580
Antiemetic/antivertigo agents ... ... ...
Anti-Parkinson agents 80 543 ...
General anesthetics ... ... ...
Muscle relaxants 5,921 5,785 7,072
Carisoprodol 1,864 2,038 3,811
Cyclobenzaprine 2,966 2,784 2,096
Miscellaneous CNS agents ... ... ...
RESPIRATORY AGENTS 8,361 7,662 8,415
Antihistamines 2,059 1,650 1,627
Bronchodilators ... ... ...
Decongestants ... '" 1,347
Expectorants ... 474 1,068
Upper respiratory combinations 4,818 4,207 3,982
Respiratory agents NT A ... 1,244 660
CARDIOVASCULAR AGENTS 7,667 5,814 7,965
Antiadrenergic agents, centrally acting 995 912 1,929
Beta-adrenergic blocking agents 2,105 1,916 1,999
Calcium channel blocking agents 879 193 1,040 438%
Diuretics ... 539 ...
Cardiovascular agents NTA 3,661 3,024 3,298
1 The classification of drugs used in DAWN is derived from the Multum Lexicon, @2007, Multum Information Services, Inc. The
classification was modified to meet DAWN's unique requirements (2007). 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.
Three dots (...) indicate that an estimate with an RSE greater than 50% or an estimate less than 30 has been suppressed.
4 This column denotes statistically significant (p < 0.05) increases or decreases between estimates for the periods shown.
SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2006 (03/2008 update).
DAWN, 2006: NATIONAL ED ESTIMATES
57
~
S31V~11S3 03 lVNOIlVN :90Ol 'NMVO
89
'UMou~un
seM Ajp!U4l8/a::leJ Sj!S!^ JO %6 U! :ejep 5u!ss!w Aq papadw! S! sdnoJ5 Ajp!U4ja/a::leJ a4j JO sapuanbaJJ a^!jelaJ a4j
5u!jenle^3 'aj!4M aJaM 04M sjua!jed pa^lo^u! SjIS!^ xOjap 5u!~aas JO (%69) Ajpo[ew a4j 'Aj!::llU4ja/a::leJ JO SWJaj ul
'(UO!jelndod OOO'OO~ Jad a) salewaJ JOJ je4j ue4j Ja45!4
seM (uo!jelndod OOO'OO~ Jad ~9) salew JOJ SjlS!^ xOjap 5u!~aas JO ajeJ a41 'a5ueJ VV OJ IH a4j U! sdnoJ5 a5e lie
SSOJ::le Jel!w!s aJaM Sj!S!^ xOjap 5u!~aas JO sajeJ a4j 'juno::l::le OjUl JOJJa JO u!5Jew a4j pue az!s uO!jelndod 5u!~e1
'aw04 OJ pa5Je4::lSlP aJaM Aa4j asne::laq j45nos Aa4j
aJe::l a4j pa^la::laJ a^e4jou Aew sase::l xOjap 5u!~aas JO (%a) JajJenb auo jnoqe 'Ja^aMOH ,(OZ alqe1) Aj!l!::leJ aJe::l
4jlea4 Ja4joue OJ JaJsueJj JO 'Sa::l!MaS juawjeaJj asnqe a::luejsqns JO xOjap JOJ aJa4Masla leJJaJaJ 'UO!ss!wpe jua!jedu!
Ja4j!a 'aJe::l dn-MolloJ JO adAj awos pa^!a::laJ (%69) 0 ~ JO jno L Apeau 'Sj!S!^ 03 xOjap 6ul~aas a4j 5uow\;l
'juanbaJJ jSOW aJaM suo!jeu!qwo::l/auOpO::lAXO
pue suo!jeu!qwO::l/auopo::lOJPA4 'splo!do/saje!do a4j5uow\;I 'alqejou aJaM '(%9Z) s::l!sa5IeUe p!o!do/aje!do
Alpewpd aJaM 4::l!4M 'sjua5e SNJ pue '(%8) sau!daze!pozuaq AI!Jewpd aJaM 4::l!4M 'sjUa6e ::l!jnadeJa4j04::lASd
'Sle::l!jna::leWJe4d a4j 5uow\;I '(Sj!S!^ JO %L) sjUelnW!jS aU!Weja4dwe4jaW JO aUlWeja4dwe pue (Sj!S!^
JO %6~) euen[pew Aq paMolloJ 'AljUanbaJJ jSOW paJJn::l::lo (Sj!S!^ JO %6Z) U!oJa4 pue (Sj!S!^ JO %6v) aUle::lo::l 's5nJp
PII! a4j 5uow\;I 's5nJp Ja4jo 4j!M UO!jeulqwO::l U! 1040::lle AIUO sapnpu! S!4j Japlo pue ~Z pa5e sjlnpe JOJ asne::laq
'aJa4 pajuasaJdaJJapun aq Aew 1040::lle JO aloJ a4j 'Ja^aMOH '(6 ~ alqe1) 1040::lle pa^IO^u! Sj!Sl^ 03 xOjap 6u!~aas lie
JO (%OV) PJ!4j auo ue4j aJOW pue 's5nJp ald!llnw pa^lo^u! Sj!S!^ 03 xOjap 5ul~aas a4j JO (%99) SPJ!4j OMj ApeaN
'Sa::l!MaS asa4j
JOJ puewap a4j JO juajxa IInJ a4j ssedwo::lua JOU saop ajew!jsa S!4j 'aJoJaJa41 'jej!ds04 a4j U!4j!M sj!un juaWjeaJj
asnqe a::luejsqns JO xOjap OJ UO!ss!wpe JOJ 03 a4j U! a::lueJeap le::l!paw aJ!nbaJ je4j Sa::llpeJd a^!jeJjSlU!Wpe 4j!M
Slej!ds04 U! pajeJjua::lUO::l aq OJ puaj Sj!S!^ "xojap 5u!~aas" asa41 '900Z 5upnp Sa::llMaS juaWjeaJj asnqe a::luejsqns
JO uO!je::ly!xojap 5ul~aas sjua!jed JOJ SI!S!^ 03 pajelaJ-5nJp (OV9'9V~ OJ ~H'06 :IJ) 99t'9 ~ ~ sajeW!jsa NM\;IO
(L a.m6!.:1 'OZ-S ~ salqel) xOlap 6uPlaas
Table 19
Seeking detox: 2006
Relative 95% Confidence interval
Estimated
Drug category and selected drugs 1 visits2,3,4 standard Lower Upper
error (RSE) bound - bound
Total drug-related ED visits, seeking detox 118,355 12.1 90,171 - 146,540
Marijuana
Stimulants
Amphetamines
Methamphetamine
MDMA (Ecstasy)
GHB
Flunitrazepam (Rohypnol)
Ketamine
Major substance of abuse
47,102 14.3 33,887 60,316
46,769 14.3 33,646 59,892
57.5
92,385 12.6 69,548 115,223
57,738 14.1 41,815 73,661
34,462 14.6 24,611 44,312
22,104 16.4 14,983 29,226
8,128 26.2 3,955 12,301
2,034 26.1 993 3,074
6,211 31.2 2,407 10,014
483 35.7 145 821
Alcohol
Alcohol in combination
Alcohol atone
Non-alcohol illicits
Cocaine
Heroin
LSD
PCP
989
54.3
41.5
184
1,794
Miscellaneous hallucinogens
Inhalants
Combinations not tabulated above (NTA)
50.3
The classification of drugs used in DAWN is derived from the Multum Lexicon, @ 2007, Multum Information Services, Inc. The
classification was modified to meet DAWN's unique requirements (2007). The Multum Licensing Agreement governing use of the
Lexicon is provided in Appendix A and can be found on the Internet at http://www.multumcom.
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. Visits cannot be summed across drugs because drug-related visits often involve multiple drugs.
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, 2006 (03/2008 update).
DAWN, 2006: NATIONAL ED ESTIMATES
59
S31'v'Vol11S3 03 l'v'NOIl'v'N :900l 'NM'v'O
09
'(aj8pdn BOOmO) 900<: '~JOMjaN 5U!UJ8M asnq'v' 5nJO 'V'SHVIJ'v'S 'Sa!pnlS pa!ldd'v' )0 a~!JjO :3::nlnOS
'passaJddns uaaq s84 OE U84j ssal aj8W!jSa U8 JO %OS U841 Jal8aJ5 3SCl U8 41!M al8W!lsa U81841 eI8~!pU! ("..) SloP eeJ41 G
'se181S pel!Un
e41 U! s03 Jn04-\7<: 41!M S18j!ds04 A8jS-jJ04S '18Jape,j-uou)0 aldw8s e^!j81UeseJdeJ 8 UO pes8q SI!S!^ 03)0 sel8W!ISe eJ8 ese41 ~
L06'0 ~ UMOU~Un
LU (V1N)
e^oq8 pelelnqellou A1P!U41e/e~eCl
w; paluawn~op JON L6E' ~ ~ ~!ueds!H
LW~ Ja4jO BW9<: ~~eI8
... palO L9B'69 al!4M
L\76' ~ a:l!^pe le~lpaw ISU!e5eual Aj!:l!U4ja/a:leCl
6\70'0~ paJJa)sueJ 1 '" UMOU~Un
9 ~0'\7~ UO!I!sods!p Ja4jO ~B9 Japlo pue SJeaA 99
69B'1> jlun jua!jedu! Ja410 ~1:9'1> SJeeA 1>9-99
G06'9 I!Un ~!Jle!4~ASd Gi:t1:1: SJeaA 1>9-91>
01>9'Gi: xOlaP/A~uapuadap le~!wa4J 999' 9E SJeaA 1>1>-9E
... AJa6JnS 66L'G ~ SJeaA 1>E-OE
L6B aJe~ le~!jIJ~JnJI 1>OB'n SJeaA 61:-91:
BLt9E lej!ds04 S!4j OJ pajjlwpv 9E ~ ' ~ ~ SJeaA 1>1:- ~1:
1:VB'SE luawjeaJl/xOjap 01 paJJa)aCl L9L'B SJ8aA O<:-B ~
~6L l!e[/a~!Iod OJ paS8alaCl 69L't SJeaA n-u
OEV'1:E aw04 pa6J84~S!0 ... SJeaA ~ ~ -9
E90' 69 pasealaJ PU8 paleaJ 1 '" SJeaA S-O
uO!l!sods!O allv
... UMOU~Un
1:EV'LL s6nJp aldljlnV'J B<:9'~1> alewa::J
1>1:6'01> 6nJp al6u!s 699'9L a18V'J
pa^lo^u! s6nJp JO JaqwnN J8pU8E)
99E'B ~ ~ xOjap 6U!~88S
'Sj!S!^ 03 P8jel8J-llnJp lej01
nSj!S!^ s~!lspaj:leJe4:l j!S!^ nSj!S!^ s:l!lsp8peJe40 jU8!jed
p8jew!js3 pajew!js3
gOal :s~!ls!Jal~eJe4~ l!S!^ pue lua!led ,(q 'xolap 6uptaas
Ol alqel
Figure 7
Seeking detox, ED visit rates by age and gender: 2006
150
150
c: c:
0 0
'';::; '';::;
m m
~ 100 ~ 100
0 84 85 0
0.. 0..
'" '"
'" '"
'" '"
6 6
'" '"
OJ 51 OJ 51
0.. 50 0.. 50
B ClJ
m ro
0:: 0::
14
2
0 0
Lr> r-. '" "'" O"l "'" "'" "'" "'" + Male
6 N ~ N M "'" Lr> 'f Lr>
cO N 00 J., 6 J., J., Lr> \.0
N N M M "'" Lr>
27
fl
Female
SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2006 (03/2008 update),
DAWN, 2006: NATIONAL ED ESTIMATES
61
..
S31VWIlS3 03 lVNOllVN :900Z 'NMVO
<:9
'(alepdn BOOlIEO) 900l '~10MlaN 6UIU18M asnqv 6n10 'VSHl^J\lS 'SalpnlS pa!ldd\l )0 a:JIIIO :3:>~nOS
'UMO~S spo[1ad a~l 10) SaI8W!ISa uaaMjaq SaSeal:Jap 10 SaS8al:JUI (90'0> d) lU8:J!)IU6IS AII8:J!IS!lels salouap uwnlo:J sl~l p
'passalddns uaaq se~ DE ue~l ssal alew!lsa ue 10 %09 u8~1 lal8a16 3S~ ue ~1!M alewllsa ue le~l aI8:JIPU! (,,,) SlOP aal~l E
'salelS pallun
a~l uI s03 lno~-vl ~1!M SI81!dso~ A81S-jJO~s 'lelapa::l-UoU)O aldwes aAI181uasaldal e uo paseq SllslA 03)0 salewllsa aJe asa~l Z
'wo:Jwnllnw'MMM/ldll~ Ie laulalul a~l uo puno) aq ue:J pue \I xIPuadd\l uI pap!AoJd S! uo:J!x87
a~I)O asn 6ululaA061uawaa16\1 6u!sUa:l!1 wnllnl^J a~l '(LOOl) slUaWal!nbaJ anb!un s,NM\lO laaw 01 pa!)!pow seM UO!18:l!)lssep
a~l ':lUI 'Sa:lIAJas UOI18WJO)UI wnllnl^J 'LOOl Q) 'uo:J!x87 wnllnl^J a~l W01) paA[1ap S! NM\lO uI pasn S6nlp)0 UO!18:JI)ISSep a~l ~
'" ~6 ~ '" ('dlN)
aAoqe palelnqejjou SUO!jeulqwOJ
'" '" '" sjuele~ul
", '" '" sua60ulOnlle~ snoauella:Js!l^J
6B6 6GL aB dJd
'" '" ", OSl
'" '" ", aUIWeja>l
'" '" '" (loudA40tj) wedazeJj!Unl::l
'" ", '" 8H8
EBv w; lBB (ASejs:J3) \ll^J0l^J
~ ~t9 '" '" aU!Weja4dwe4jal^J
vEO'l '" '" saU!Weja4dW\I
m'B GO V' 9 ~ 09L' ~ ~ sjuelnw!lS
VO ~ 'll 9BV'll 996'9l euenfp8l^J
19V'VE 96B'Ov 9EO'Lv uloJaH
BEL'L9 ~90'99 6B6'l9 aU!8:loJ
'" '" '" auole 1040:J1\I
69L'9v v9~'Lv ~EB'~9 uOljeulqwo:J U! 10~0:J1\I
lO~'Lv v6V'Lv 199't9 1040:J1\I
asnqe )0 sa:Jue~sqns JOreL^)
SSC'SH 9lz'9l ~ L98'~P~ xotap
6uPlaas 's~!s!^ 03 patelaJ-6nJp le~ol
9OOl'SOOl 9OOl'POOl 900l SOOl POOl
pa6ue4:l ~ua:JJad t'ZS~!S!^ pa~ew!~s3 ~ s6nJp papalas pue ,{J06a~e:J 6nJO
900Z pue 'gOOZ '~OOZ :XOtap 6u!>taas
~Z alqel
'(~G alqBl) Sj!S!^ asa4j U! pa^lo^U! s6nJp jlO!11! a4j JO 1040:>IB JOl JO 'IIBJaM Sj!S!^
03 xOjap 6u!~aas JOl papajap aJaM '900G OJ 900G WOJl JO '900G OJ tOOG WOJ! Sj!S!^ 03 U! sa6uB4:> jUB:>!!!u6!s ON
(~Z alqel) 900Z pue '900Z 'VOOZ :Sl!S!^ 03 XOlap 6u!)jaas
Appendices
DAWN, 2006: NATIONAL ED ESTIMATES
63
..
S31VVolI1S3 03 lVNOllVN :900l 'NMVO
179
~
APPENDIX A
MUL TUM LEXICON
END-USER LICENSE AGREEMENT
1. Introduction
A. This License Agreement (the "License") applies to the Multum Lexicon database (the "Database"). This License
does not apply to any other products or services of Cerner Multum, Inc. ("Multurn"). A "work based on the Database"
means either the Database or any derivative work under copyright law; i.e., a work containing the Database or a
substantial portion of it, either verbatim or with modifications. A translation of the Database is included without
limitation in the term "modification". Each end-user/licensee is addressed herein as "you".
B. Your use of the Database acknowledges acceptance of these restrictions, disclaimers, and limitations. you
expressly acknowledge and agree that Multum is not responsible for the results of your decisions resulting from the
use of the Database, including, but not limited to, your choosing to seek or not to seek professional medical care, or
from choosing or not choosing specific treatment based on the Database.
C. Every effort has been made to ensure that the information provided in the Database is accurate, up-to-date, and
complete, but no guarantee is made to that effect. In addition, the drug information contained herein may be time
sensitive.
D. Multum does not assume any responsibility for any aspect of healthcare administered or not administered with the
aid of information the Database provides.
2. Terms and Conditions for Copying, Distribution and Modification
A. You may copy and distribute verbatim copies of the Database as you receive it, in any medium, provided that you
conspicuously and appropriately publish on each copy an appropriate copyright notice and disclaimer of warranty;
keep intact all the notices that refer to this License and to the absence of any warranty; and give any other recipients
of the Database a copy of this License (the readme.lxt file) along with the Database and anything else that is part of
the package, which should be identified.
B. You may modify your copy or copies of the Database or any portion of it to form a derivative work, and copy and
distribute such modifications or work under the terms of Section 2.A. above, provided that you also meet all of these
conditions:
i) You must cause the modified files to carry prominent notices stating that they are derived from the Multum
Lexicon database from Cerner Multum, Inc. and that you changed the files and the date of any change(s).
ii) If you incorporate modified files into a computer program, you must cause it, when started running for
interactive use in the most ordinary way, to print or display an announcement including an appropriate copyright
notice, a notice that you have modified the Multum Lexicon database from Cerner Multum, Inc., and a notice that
there is no warranty (or that you provide the warranty) and telling the user how to view a copy of this License.
DAWN, 2006: NATIONAL ED ESTIMATES
65
,
S31Vv.lllS3 03 lVNOllVN :900;: 'NMVO
99
"S:38\flt'J\f0 HJnS .:10 AllllSISSOd 3H1.:10 03SIAO\f N33S S\fH
AlCl\fd tl3HlO AN\f tlO It'Jnllnlt'J .:II N3A3 '3lt'J11 NMOO tlO 'SS3NISnS .:10 SSOl 'Sll.:10tld .:10 SSOl tlO.:l
S38\flt'J\f0 8NIOnlJNI 'S38\flt'J\f0 lJ3tllONI tlO 'l\f11N3n03SNOJ 'l\f1N30IJNI 'l\fIJ3dS AN\f tlO.:l 3lS\fll
3S '3AOS\f O3HIlt'Jtl3d S\f 3S\fS\f1\f0 3H131nSltl1SI03tl tlO/ON\f A.:IIOOlt'J A\flt'J OHM Altl\fd tl3HlO AN\f
tlO 'It'Jnllnlt'J lllM (8Nl11tlM NI 01 033tl8\f tlO M\fl 3lS\fJlldd\f AS O3tlln03tl SS3lNn) 1N3A3 ON NI "S
"NOllJ3tltlOJ tlO tll\fd3tl '8NIJIAtl3S Atl\fSS3J3N ll\f .:10 lS0J
ON\f A1IlISISNOdS3tl3H13lt'JnSS\f nOA '31\ftlnJJ\fNI tlO '3Bldlt'JOJNI '3A11J3.:130 3AOtld 3S\fS\f1\f0
3H1 OlnOHS "nOA H11M SI3S\fS\f1\f0 3H1.:10 3JN\flt'JtlO.:ltl3d ON\f A11l\fnO 3H1 01 S\f >!Sltl3tl11N3
3Hl "3S0dtlnd tl\flnJI1tl\fd \f tlO.:l SS3N11.:1 ON\f A1IlIS\f1N\fHJtl3lt'J .:10 S311N\ftltl\fM O3lldlt'J1 3H1 '01
0311lt'JlllON 1ns '8NIOnlJNI '03 Ildlt'J I tlO Atl01nl\f1S '03SS3tldX3 tl3Hl13 'ONI>! AN\f .:10 AlN\ftltl\fM
1nOH11M "SI S\f" 3S\fS\f1 \f0 3H1 30lAOtld S311tl\fd tl3HlO tlO/ON\f It'Jnllnlt'J "8NllltlM NI 031 \f1S
3SIMtl3HlO N3HM 1d3JX3 "M\fl 3lS\fJlldd\f AS O3HIlt'Jtl3d 1N31X3 3H1 01 '\f1\f0 tlO It'J\ftl80tld
3H1 tlO.:l A1N\ftltl\fM ON SI3tl3H1 '38tl\fHJ.:I0 33tl.:l O3SN3JIl SI3S\fS\f1\f0 3H13Sn\fJ3S "'if
sa6ewea 10 UO!lel!Wn ~Sa!lUeJJeM 10 Jaw!epS!a .C
"esue::>!l S!41 01 seljJed PJI41 Aq e::>ue!ldwo::> BU!::>Jo!ua
JO! alqlsuodsaJ IOU aJe nOA "u!aJa4 pajUeJB Sl4Bp a41!0 aspJaxa ,Slua!dpaJ a41 uo SUOIPPISaJ Ja4jJn! Aue asodwI
IOU Aew nOA "SUOII!PUO::> pue SWJal esa41 01 pa[qns aseqeleo a41 A!IPOW JO alnqlJISIP 'Ado::> 01 wnllnlt'J WOJ! asua::>!1 e
sa^la::>aJ Alle::>!lewolne lua!dpaJ a41 '(aseqeleo a41 uo paseq ~JOM Aue JO) aseqeleo a41 alnqplS!paJ nOA aWII 4::>e3 "8
"I! uo paseq S~JOM JO aseqejeO
a41 BUIA!!POW JO BUllnqplslP 'BUIAdo::> JO! SUO!IIPUO::> pue SWJal SII lie pue 'os op 01 asua::>ll S!41!0 e::>uelda::>::>e
JnOA ele::>lpul nOA '(aseqeleo a41 uo paseq ~JOM Aue JO) aseqeleo a4lBullnqplS!p JO BU!A!IPOW 'BUIAdo::> Aq 'aJO!aJa41
"asua::>!l S!41Ida::>::>e IOU op nOA!! Mel Aq pal!q!40Jd aJe suoIpe asa41 "S~JOM a^lle^pap sll JO aseqeleo a41 alnqplslP
JO A!!POW 'Ado::> 01 UO!SSIWJad nOA SlueJB aSle BUI410U 'Ja^aMOH "asua::>!l S!41Ida::>::>e 01 paJlnbaJ IOU aJe nOA ".:I
"a::>ue!ldwo::> IIn! uI ulewaJ saljJed 4::>ns se BUOI os pajeU!wJel sasua::>11 Jla41
a^e410U II!M asua::>ll Sl41 Japun nOA WOJ! 'SI4BIJ JO 'saldo::> pa^la::>aJ a^e4 04M sa!jJed 'Ja^aMOH "asua::>!l S!41 Japun
Sl4BIJ mOA aleu!WJal Alle::>llewolne II!M aseqeleo a41 ajnqlJIsIP JO asua::>llqns 'A!IPOW 'Ado::> 01 aSlMJa410 Idwane AU\f
"asua::>ll sl41 Japun pep!MJd AISSaJdxa se Ida::>xa eseqeleo a4j alnqlJISIP JO 'asua::>!Iqns 'A!IPOW 'Ado::> IOU Aew nOA "3
"aBue4::>JaIUI eJeMUOS JO! pasn AIIJewOIsn::> wnlpaw e uo aMqe "S"G pue YG suolpas JO SWJal a41
Japun palnqlJISIP aq 01 'CS"G uOlpas Japun 'II UO paseq ~JOM a^!18^pap JnOA JO AlaJ!jua a41 pU8) aS8qeleo a41
!O Ado::> alqep8aJ-aU!4::>8W alajdwo::> 8 'a6J84::> ou JO! 'AIJed PJ!41 Aue a^!6 01 Ja!!o ualllJM 8 411M II AU8dwO::>::>\f (II
'JO :a6ue4::>JajUI 8JeMUOS JO! p8sn AI!J8WOIsn::> wmp8W 8 UO 8^oq8 "S"G PU8 \foG SUOIP8S JO SWJ81 841
J8pUn palnqplslp aq Isnw 4::>14M 'IX81 UI81d alq8pe8J-8U!4::>ew 6u!puodsaJJo::> 8181dwo::> 841 41!M I! AU8dwo::>::>\f (I
:6U!MOII0! 841!0 8UO op OSl8 nOA 1841 P8PI^OJd 8Mq8 "S"G PU8 Y"?' sUOIpas!o sWJal a41
J8pUn WJO! p8po::>ua U8 uI ("S""?, UO!l::>8S Japun 'II uo p8S8q ~JOM 8 JO) 8S8q81eO 841 alnqplslP PU8 Ado::> Aew nOA "0a
"as8q8180 a41 uo p8S8q S~JOM 8^IP8110::> JO 8^!le^p8p!0 uO!lnqpIS!p 84110JIUO::> 0114Bp a41 8SpJaXa 01 sl IUaIU!
841 'J8418J :noA Aq AI8JIIU8 U811IJM ~JOM 01 SI46p JnOA IS8IuO::> JO SI46p W!8P 01 UO!P8S S141!0 IU81uI 841 IOU sl II "J
~
"
C. IN ADDITION, WITHOUT LIMITING THE FOREGOING, THE DATABASE HAS BEEN DESIGNED FOR USE IN
THE UNITED STATES ONLY AND COVERS THE DRUG PRODUCTS USED IN PRACTICE IN THE UNITED
STATES. MUL TUM PROVIDES NO CLINICAL INFORMATION OR CHECKS FOR DRUGS NOT AVAILABLE FOR
SALE IN THE UNITED STATES AND CLINICAL PRACTICE PATTERNS OUTSIDE THE UNITED STATES MAY
DIFFER SUBSTANTIALLY FROM INFORMATION SUPPLIED BY THE DATABASE. MUL TUM DOES NOT
WARRANT THAT USES OUTSIDE THE UNITED STATES ARE APPROPRIATE.
D. You acknowledge that updates to the Database are at the sole discretion of Multum. Multum makes no
representations or warranties whatsoever, express or implied, with respect to the compatibility of the Database, or
future releases thereof, with any computer hardware or software, nor does Multum represent or warrant the continuity
of the features or the facilities provided by or through the Database as between various releases thereof.
E. Any warranties expressly provided herein do not apply if: (i) the end-user alters, mishandles or improperly uses,
stores or installs all, or any part, of the Database, (ii) the end-user uses, stores or installs the Database on a
computer system which fails to meet the specifications provided by Multum, or (iii) the breach of warranty arises out of
or in connection with acts or omissions of persons other than Multum.
4. Assumption of Risk, Disclaimer of Liability, Indemnity
A. THE END-USER ASSUMES ALL RISK FOR SELECTION AND USE OF THE DATABASE AND CONTENT
PROVIDED THEREON. MUL TUM SHALL NOT BE RESPONSIBLE FOR ANY ERRORS, MISSTATEMENTS,
INACCURACIES OR OMISSIONS REGARDING CONTENT DELIVERED THROUGH THE DATABASE OR ANY
DELAYS IN OR INTERRUPTIONS OF SUCH DELIVERY.
B. THE END-USER ACKNOWLEDGES THAT MUL TUM: (A) HAS NO CONTROL OF OR RESPONSIBILITY FOR
THE ENDUSER'S USE OF THE DATABASE OR CONTENT PROVIDED THEREON, (B) HAS NO KNOWLEDGE OF
THE SPECIFIC OR UNIQUE CIRCUMSTANCES UNDER WHICH THE DATABASE OR CONTENT PROVIDED
THEREON MAY BE USED BY THE END-USER, (C) UNDERTAKES NO OBLIGATION TO SUPPLEMENT OR
UPDATE CONTENT OF THE DATABASE, AND (D) HAS NO LIABILITY TO ANY PERSON FOR ANY DATA OR
INFORMATION INPUT ON THE DATABASE BY PERSONS OTHER THAN MUL TUM.
C. MUL TUM SHALL NOT BE LIABLE TO ANY PERSON (INCLUDING BUT NOT LIMITED TO THE END-USER AND
PERSONS TREATED BY OR ON BEHALF OF THE END-USER) FOR, AND THE END-USER AGREES TO
INDEMNIFY AND HOLD MUL TUM HARMLESS FROM ANY CLAIMS, LAWSUITS, PROCEEDINGS, COSTS,
ATTORNEYS' FEES, DAMAGES OR OTHER LOSSES (COLLECTIVELY, "LOSSES") ARISING OUT OF OR
RELATING TO (A) THE END-USER'S USE OF THE DATABASE OR CONTENT PROVIDED THEREON OR ANY
EQUIPMENT FURNISHED IN CONNECTION THEREWITH AND (B) ANY DATA OR INFORMATION INPUT ON THE
DATABASE BY END-USER, IN ALL CASES INCLUDING BUT NOT LIMITED TO LOSSES FOR TORT, PERSONAL
INJURY, MEDICAL MALPRACTICE OR PRODUCT LIABILITY.
5. Miscellaneous
A. You warrant that you have authority within the organization you identified during registration for the Database to
enter into license agreements with other organizations including Multum.
DAWN, 2006: NATIONAL ED ESTIMATES
67
;.
..
S31V~IlS3 a3 lVNOIlVN :900<: 'NMVa
99
UOlleJlsl6eCj UOJ!Xel
wl~aSUeJIIIUJOJWnllnW<MMM/rd1l4 :WOJJ 900W/6 pepeOIUMOp eSUeJ!l
000<: 'Of: JaqwaAoN peS!AeJ lUeWnJOO
<:U09 OpeJOIO:) 'JeAUao
000 ~ ~ al!ns
pJeAalnOS OpeJOIO:) ~lnOS 000<:
aUQ JaMOl JalUa:) OpeJOIO:)
<JUI 'WnllnV\l JaUJa:)
LOO<: @ UOJ!Xal WnllnV\l
<asuaJ!l S!~l JO ApOq a~l U! UanpM J! se UO!lel!W!1
a~l SaleJodJoJU! aSUeJ!l S!41 'eSeJ 4JnS UI <papnpxa sn4110U SeplUnOJ 6uowe JO U! AIUO pawwJad S! UO!lnq!J1S!P le~l
os 'SaplUnOJ as041 6U!pn1JXa uO!lej!w!I UO!lnq!JjS!P leJ!4deJ60a61p!ldxa ue ppe AeW WnllnV\l 'SaJeJjalU! paj~6!JAdO:l
Aq JO Slueled Aq Ja~j!a saplunOJ U!ejJaJ U! paPP1SaJ SaWOJaq JO S! eseqeleo a~j JO asn Jo/pue UO!lnq!J1S!P a4j JI <3
<saJUelSwnJJp Ja4lO U! Aldde 01 papuelU! S! al04M e se asue:l!l a~l pue Aldde 01 papuajui S! asuaJil
S!~j JO aJueleq a41 'a:luejswn:lJp Jeln:l!jJed Aue Japun elqea:lJoJuaun JO p!leAU! Pla~ si asuaJ!l S!~jlO uO!jJod Aue II <0
<lie je aseqejeo a41 ajnqplS!p
JOU Aew nOA e:luanbasuo:l e se ua~l 'SUO!le6!1qo Ja~lO Aue pue asua:l!l si41 Japun suo!le6!1qo mOA AlsnoeuellnW!S
AJS!les 01 se os alnqplS!p jOUueJ nOA II <asua:l!l S!41l0 SUO!I!PUO:l a~l WOJl nOA asnJxa IOU op Ae~l 'asUaJ!l S!41
lO SUO!l!PUOJ e~l P!peJ1UOJ le~l (as!MJa~IO JO luawaeJ6e 'JapJO jJnOJ Aq Ja~la4M) nOA uo pasodw! eJe sUO!l!PUO:lll <:)
'aseqeleo
a41 paSue:l!l aAe~ UOilez!ue6Jo JnOA Jo/pue nOA le41 6U!l81S esealaJ ssaJd e 'SaJiSap I! J! 'anss! Aew WnllnV\lle41 aaJ6e
oSle nOA 'suo!leJ!UnWWO:lla~Jew leUJalxa s,wnllnV\l U! wnllnV\110 ..juaiP" e JO aseqeleo e41 JO "UO!leZ!ue6Jo 6u!suaJ!I"
JO '..Jasn paSueJ!I" '"aaSueJ!I" e se aweu Aq UO!leZ!ue6Jo JnOA Jo/pue nOA AJ!lUap! Aew wnllnV\lle41 aaJ6e no). <S
-d
APPENDIX B
GLOSSARY OF TERMS
This glossary defines terms used in data collection activities, analyses, and publications associated with the
emergency department (ED) component of the Drug Abuse Warning Network (DAWN).
Accidental ingestion: This category of drug-related ED visits includes those involving the accidental use of a drug,
for example, childhood drug poisonings and individuals who take the wrong medication by mistake.
Adverse reaction: This category of drug-related ED visits represents the consequences of using a prescription or
over-the-counter (OTC) pharmaceutical for therapeutic purposes and includes visits related to adverse drug reactions,
side effects, drug-drug interactions, and drug-alcohol interactions. Adverse reactions that involve a pharmaceutical
with an illicit drug are exceptions that are excluded from this category.
Alcohol only (age less than 21): This category of drug-related ED visits includes those in which alcohol was the only
drug involved and the patient was aged less than 21. Although alcohol is an illegal drug for minors, combining these
cases with other cases involving illicit drugs tends to mask rather than highlight their importance for prevention and
treatment efforts. Most instances of alcohol as the only drug in patients under age 21 are classified in the alcohol only
(age < 21) case type. However, some are classified as suicide-attempt or seeking detox, case types that precede
alcohol only (age < 21) in sequence.
Case description: A description of how the drug(s) was related to the patient's ED visit. The case description, in
conjunction with other documentation in the ED medical record, is used to determine if the ED visit is reportable to
DAWN. It is copied verbatim from the patient's chart when possible.
Case type: See Type of case.
Case type other: See Drug misuse and abuse.
Confidence interval (CI): An interval estimate, that is, a range of values around a point estimate that takes sampling
error into account. Ninety-five percent is an accepted standard of confidence. 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. Practically, a 95% CI
summarizes both the estimate and its margin of error in a straightforward way with a reasonable degree of
confidence. Calculation of 95% Cis is discussed in Appendix C.
Diagnosis: The condition(s) for which the patient was treated as determined by the clinician after study.
Disposition: The location or facility to which an ED patient was referred, transferred, or released.
DAWN, 2006: NATIONAL ED ESTIMATES
69
i-
..
S31V~11S3 03 lVNOI1VN :900<: 'NMVO
OL
'UO!lea!!!Ssep !O sasodJnd JO.::J 'asnqe !O aauelsqns Jo[ew e se aauelJodw! Sl! !O asneaaq SIUelnW!IS (SNJ)
WalS^S snOAJau leJlUaa !O N06alea a41 WOJ! papeJlXa uaaq se4 Saauelsqns !O ssep S!41-S8uJweJ8ljdwv III
'sa6e
lie JO! alqelJodaJ S! UO!leU!qwoa U! 1040al\f 'NM\fO 01 palJodaJ aq 01 aauelsqns Ja410ue 41!M pasn aq lsnw
1040ale 'JapIO pue ~G Slua!led JO.::J 'JaplO JO sJea^ ~G pa6e S! luailed a41!! auole pasn 1040ale uo elep Ja41e6
IOU saop NM \f0 'aauelsqns alqelJodaJ Ja410Ue 41!M lUasaJd 1040ale JO! N06alea a41-uofJeuJqwoa uJ 10ljoalV III
'~G a6e Japun S! luaned a41!! ^IUO auole pasn ua4M 1040ale uo elep spalloa NM\fo-auole 10ljoalV III
:sa!J06alea 6nJp 6u!MOII0! a41 JO! pap!AoJd S! uO!lea!wep leuO!I!PP\f
'Slea!lnaaeWJe4d JalUnOa
-a41-JaAO pue uondpasaJd JO! sasn a!lnadeJa41 a41 MOllO! sa!J06alea wnllnlf\j a41 'leJaua6 ul 'woawnllnw'MMM//d1l4
je alqel!eAe S! UOllewJo!u! aJolf\j 'aseq a6palMou~ 6nJp e pue Swajs^s uOileWJO!u! 6nJp lea!u!p!o JadOlaAap e pue
uOljeJodJoJ JauJaJ a4j !O Ne!plsqns e S! saalAJas uOljewJO!UI wnjlnlf\j 'saa!AJas uO!jewJo!ul wnjlnlf\j !O UOljea!!!ssep
a4j uo paseq 'NM\fO OJ palJodaJ sa::>uejsqns Ja4jO JO sleanna::>eWJe4d pajelaJ!O 6u!dnoJ6 ::>paua6 \f :.tJ06ale::> 5nJO
('ase::> 5nJp-aI5u!s oSle aas) 'palJodaJ sase::> NM\fO!O Jaqwnu lejoj
a4j spaa::>xa s6nJp!0 Jaqwnu lejoj a4j 'aJo!aJa41ase::> NM\fO 4::>ea JO! palJodaJ aq uea C.s6nJp,,) saauelsqns ald!llnlf\j
'SjUele4Ulleailna::>eWJe4duou pue 'SjUaWalddns Neja!p 'sle::>ilna::>eWJe4d Jajunoa-a4j-JaAO pue uond!J::>saJd 's6nJp
jP!II! '1040ale apnpu! NM\fO ^q pajdaa::>e saauejsqns 'lJodaJ asea NM\fO e U! papJo::>aJ seM je4j aauejsqns \f :6nJO
'lJe4a lea!paw a4j U! paluawnaop IOU seM snWjs a6Je4aS!p a41-paJuawmop JON III
'sap06ajea 6u!paaaJd a4j!0 ^ue OjU! m JOU saop lnq lJe4a a4j U! pawawnaop S! snlels a6Je4aS!p a41-J8ljJO II
'paJJa!sueJj JO 'pall!Wpe 'pa6Je4::>S!P 6u!aq aJo!aq lnq 03 a4j U! 6U!ApJe Jaye pa!p lua!jed a41-pe!G ill
'leAOJdde s,Uep!S^4d e jn04l!M 6umas luawjeaJj a4j yalluailed a41--eaJ/lpe fBaJpew JsuJe6e ye7 III
'^JIIpq aJea 41lea4 Ja4joue OJ paJJa!sueJj seM luaned a41-peJJejsueJl III
:sap06aje::> aA!! sapnpu! uO!J!sodsJp JeljJO
'sl!un 6u!paaaJd a41!0 auo 4ajew JOU saop JO pa!!pads IOU seM l!un juanedu! a41-lfun JuefJeduJ J8ljJO III
lfun aJJJBfl/aASd III
xOJep/Aauepuedep leaJweljJ III
Aie6Jns III
eJea leafJf1JfnJI III
:sj!un jua!jedu! !O sa!J06ajea aA!! sapnpu! lelfdsolj sfl/J oJ pemwPtf
'Jap!AOJd JO '^l!lpe! 'weJ60Jd xOlap JO luawleaJl
asnqe aauejsqns e OJ paJJa!aJ seM jua!jed a4jje4j saje::>!pu! lJe4::> a41-JuewJeeJJ/XoJep oJ peJJejeCj III
/!e!leaf/od oJ peseeleCj II
. 4lJO!
os pue '6u!^ejs aJe ^a4j JaAaJa4M JO laj04 J!a41 ueaw ^ew j! 'peOJ a41 uo ~::>!S la6 04M sJalaAeJl JO! :^I!SJaA!un
J!a4j sueaw aw04 'san!SJaA!Un ^qJeau je sjuapnjs JO! 'JaAaM04 :^lIe::>OI aA!1 04M aldoad JO! pasn ^lIeJaua6 S!
awoH 'aauaPlsaJ S,juaned a41 OJ pa6Je4aS!p ueaw 01 ^J06ajea peoJq e se pasn S! "awoH,,--ewolj p86JeljasJG III
:sap06ajea aaJ4j sapnpu! pasealeJ pue peJeeJl
~
{)
"amphetamines" (plural) includes a class of compounds derived from or related to the drug amphetamine.
Although some "designer" drugs fall into the class of amphetamines, we choose to report some of them
individually as major substances of abuse (e.g., methamphetamine). This category does not include other
CNS stimulants, such as caffeine or methylphenidate.
l1li Combinations not tabulated above (NTA)- This category includes combinations composed of two or more
major substances of abuse that are mixed and taken together. For example, "speedball," which usually refers
to the combination of heroin and cocaine taken at once, would be classified as a combination NTA, whereas
heroin and cocaine used separately would be classified separately in the categories heroin and cocaine.
Combinations consisting of a major substance of abuse and another substance are classified in the category
of the major substance (e.g., heroin with scopolamine is classified as heroin).
III Inhalants-This category includes anesthetic gases and psychoactive non pharmaceutical substances for
which the documented route of administration was inhaling, sniffing, or snorting. Psychoactive
non pharmaceuticals fall into one of the following three categories: (1) volatile solvents-adhesives (model
airplane glue, rubber cement, household glue), aerosols (spray paint, hairspray, air freshener, deodorant,
fabric protector), solvents and gases (nail polish remover, paint thinner, correction fluid and thinner, toxic
markers, pure toluene, cigar lighter fluid, gasoline, carburetor cleaner, octane booster), cleaning agents (dry
cleaning fluid, spot remover, degreaser), food products (vegetable cooking spray, dessert topping spray such
as whipped cream, whippets), and gases (butane, propane, helium); (2) nitrites-amyl nitrites ("poppers,"
"snappers") and butyl nitrites ("rush," "locker room," "bolt," "climax," "video head cleaner"); or
(3) chlorofluorohydrocarbons (freons). Anesthetic gases (e.g., nitrous oxide, ether, chloroform) are presumed
to have been inhaled.
III Stimulants-This category includes amphetamines and methamphetamine. Since some drug screens test for
amphetamines only as a class, an amphetamine-positive result could indicate amphetamine or
methamphetamine. For this reason, amphetamines and methamphetamine are combined for analysis into the
category "stimulants." This category does not include other CNS stimulants, such as caffeine or
methylphenidate.
Drug misuse and abuse: A group of ED visits defined broadly to include all visits associated with illicit drugs, alcohol
use in combination with illicit drugs or alcohol alone among those younger than 21 years, and nonmedical use of
pharmaceuticals. Nonmedical use of pharmaceuticals includes prescription and OTC pharmaceuticals in ED visits that
are of the following case types:
III Overmedication- This category was designed to capture nonmedical use, overuse, and misuse of
prescription and OTC medications that are not documented as drug abuse in the medical chart.
III Malicious poisoning-This category was designed to capture cases of drug use in which the patient was
administered a drug by another person for a malicious purpose. Drug-facilitated sexual assault is one type of
malicious poisoning, but other types of malicious poisonings, such as product tampering, would be classified
in this category as well.
III Case type Other-This category includes all drug-related ED visits that could not be assigned to any of the
other seven types. By design, most cases of documented drug abuse will fall into this category.
Drug-related ED visit: Any ED visit related to recent drug use. This is the definition of a DAWN case effective
January 1, 2003. To be a DAWN case, a drug needs only to be implicated in the visit; the drug does not have to have
caused the visit. One patient may make repeated visits to an ED or to several EDs, thus producing a number of visits.
The number of unique patients involved in the reported drug-related ED visits cannot be estimated, because no direct
patient identifiers are collected by DAWN.
DAWN, 2006: NATIONAL ED ESTIMATES
71
~
,.
S31VVlI1S3 03 lVNOllVN :900Z 'NMVO
ZL
'a::>8J JO SSalPJ85aJ 'U!5pO JO aJnlln:J
4S!U8dS Ja410 JO 'U8::>paW\f 18JlUaJ JO 41noS 'U8::>!tJ ojJand 'U8::>!XaV'J 'u8qnJ JO uosJad \f-oUne7 JO :J!ueds!H III
'8::>pN JO sdnoJ5 18P8J ~::>8Iq a41 JO AU8 U! SU!5pO 5U!A84 uosJad \f-ue:JfJaw'tj ue:JfJJ'tI JO >/:Je/8 III
'8::>!JJ\7' 4jJON JO 'IS83 aIPP1V'J a41 'adoJn3 JO Saldoad 18U!5pO a41 JO AU8 U! SU!5pO 5U!A84 uosJad \f-aJilfM iii
:SMOIIOJ S8 aJ8 SWJOJ UO!paIlO::> 818P NM\fO
a41 uo Sap05a18::> AlP!U41a/a::>8J a41 'L66~ U! SV'JO Aq panSS! 10::>010Jd pJ8pU81S a41 015u!pJo::>::>\f :AI!O!U4Ia/a08tJ
('JOJJ9 pJepUelS aA!lelatJ OS Ie aas) '(SlOP t) """,, 10qWAS a41 U!8Iuo::> paJeadde aAe4 PlnoM Saww!lsa
4::>ns aJa4M slIa::> alq81 03 'pa4S!lqnd aq 01 aspaJdw! 001 se papJe5aJ aJe %09 ue41 JawaJ5 s3StJ 41!M SaI8W!ISa
'SUO!leO!lqnd NM\fO ul '(3StJ) JOJJa pJepU81S aA!lelaJ JO (3S) JOJJa pJepUelS Sl! Aq AlaSJaAU! paJnseaw S! aWW!ISa
ue JO uo!spaJd a41 "5u!ldwes paleadaJ U! anleA U8aw Sl! 41!M saaJ5e aleW!ISa ue 4::>!4M Ollualxa a41 :uO!S!09Jd
"aSJaA!Un aas :uollelndod
'aUOl8 a::>ue4::> 01 anp aq plno::> pafI.Jasqo a::>uaJaH!p a411e41 Al!I!qeqoJd %~ 8 S! aJa41
1841 SU8aw I! '~O"O JO anl8A-d e s84 SaI8W!ISa NM\fO OMl uaaMlaq a::>uaJaH!p a41 J! 'aldwexa JO::l 'a::>ue4::> Aq paJJn:J::>o
aA84 plno::> a::>uaJajJ!p a41 Ala~!1 aJOW a41 'anI8A-d a41 Ja5J81 a41 'aW8S a41 AII8aJ aJaM paJ8dwo::> 5ulaq sal8w!jsa a41
J! 'a::>u84::> Aq paJJn::>::>o aA84 PI no::> Sal8W!lsa OMl uaaMlaq a::>uaJaJJ!p a411841 (d) Al!l!q8qoJd a41 JO aJnS8aW \f :anI8A-d
'asnqe pue asnSIW 6nJO aas :UO!180!paWJaAO
'N05aw::> \f1N a41 UI pau!qwo::> aJ8 Sl!un
Jall8WS :1!8Iap alaldwo::> U! palUasaJd IOU aJ8 sap05al8::> ua4M pasn uO!jeu5!sap a41 :(\f1N) aAoqe palelnqelloN
"(SjJ84::> wa!18d 03) UO!18wawn::>op a::>JnOS a41 U! UO!18WJOJU!
uo pas8q alq!ssod IOU S! N05a18::> ::>!Jpads aJOW 8 Ol waWU5!SS8 ua4M AIUO N05aw::> SON U8 OW! pa!J!SS8p
aJ8 sWJa1 'paw8u AII8::>!Jpads IOU aJ8 W41 sa::>u81sqns JOJ N05a18::> 118-4::>18::> a41 :(SON) paIJ!::>ads as!MJa410 ION
'snsuaJ le!uua::>ap oom: a41 WOJJ 818P UO!18lndod
uo pas8q 'tOOi: 'Ot aunr U! (SV'JO) la5pns PU8 luawa58u8V'J JO aO!JJO a41 Aq paU!Jap S8aJ8 saZ!I!jn UO!18::>!lqnd
NM\fO S!41 'snapnu uO!18lndod a5J81 8 41!M Sl!un 18!::>os PU8 ::>!wouo::>a pal8J5alU! aJ8 S8aJ8 asa41 'AII8nlda::>u08
'S8aJ8 ::>!4d8J50a51ua::>8[p8 a41 PU8 sail!::> JO AlP aJo::> a5J81 AlaA!181aJ 8 5u!spdwo::> 8aJ8 U\f :eaJe uemodoJl8V\j
"asnqe pue asns!w 6nJO aas :5U!UOSIOd SnOIO!leV\j
('aSJ8A!Un OSI8 aas) 'as8q8180 AafI.Jns i8nUU\f S,UO!j8POSS\f 181!dSOH U8::>paW\f a41 WOJJ pa!J!luap! S! S03
fO aSJaA!Un a41 "papnpxa aJ8 aO!fl.Jas 4118aH U8!PUI a41 PU8 UO!18JlS!U!WP\f 41leaH SUeJala^ a41 Aq pal8Jado S181!dS04
PU8 'S03 aW!j-jJ8d 5u!18Jado S181!dS04 'SI81!dS04 OPl8!pad 'sa!j!IP8J aJ8::> WJal-5uOI 'SUO!lnmSUI JO sllun 181!dS04
'SI81!dS04 Al18pads "Sa181S pal!Un a41 U! pale::>ol aq PU8 '~aaM 8 SA8p L 'A8p 8 SJn04 Pi: s03 aJOW JO auo aleJado
1841 sa!j!1!::>8J 18::>!5Jns PU8 18::>!paw 18Jaua5 'A81S-jJ04S '18Japa::l-uoU aq lsnw S181!ds04 'alq!5!la aq 01 "aI8d!::>!jJ8d
01 pal!nJ:JaJ aJ8 NM\fO JOJ 8IJaj!J::> Al!l!q!5!1a laaw 1841 S181!dS04 AIUO :(03) W8wpedap A::>ua5Jawa lel!dsOH
'aldw8S 8 WOJJ 818P 01 S145!aM 5U!ldW8S 5U!Aldd8 Aq paApap sl W41 aSJaA!Un
a41 JOJ (SI!S!A 03 pal8laJ-5nJp JO Jaqwnu a41 S8 4::>ns) JalaW8J8d 8 JO anl8A a41 S! alew!lsa 18::>!jS!181S \f :al8wIls3
~
"-
a Asian-A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian
subcontinent including, for example, Cambodia, China, India, Japan, Korea, Malaysia, Pakistan, the
Philippine Islands, Thailand, and Vietnam.
III American Indian or Alaska Native-A person having origins in any of the original peoples of North and South
America (including Central America), and who maintains tribal affiliation or community attachment.
III Native Hawaiian or Other Pacific Islander-A person having origins in any of the original peoples of Hawaii,
Guam, Samoa, or other Pacific Islands.
II Not documented-Used when documentation of race is not available from source records.
Despite the detail allowed by these categories, race and ethnicity are often not documented with this level of
specificity in patient/decedent records. As a result, categories used to tabulate race and ethnicity data in the
publications are:
II White-Anyone meeting the definition of white (above). Those who are identified as white and Hispanic are
classified as Hispanic.
II Black-Anyone meeting the definition of black or African American (above). Those who are identified as
black or African American and Hispanic are classified as Hispanic.
III Hispanic-Anyone whose ethnicity is Hispanic or Latino (above) is placed in the category Hispanic,
regardless of race.
III Race/ethnicity NTA- This includes those categories that are too small to report independently, including the
following: two or more races, American Indian or Alaska Native, Asian, and Native Hawaiian or Other Pacific
Islander.
I!I Unknown-Racelethnicity is unknown. Those who are identified only as Hispanic are classified as Hispanic.
Rate: A measure of the incidence of drug-related ED visits per 100,000 population. A rate can be calculated for the
total population or for any subset defined by characteristics such as age and gender.
Relative standard error (RSE): A measure of an estimate's relative precision. The RSE of an estimate is equal to the
estimate's standard error (SE) divided by the estimate itself. For example, an estimate of 2,000 cocaine visits with an
SE of 200 visits has an RSE of 10%. The larger the RSE, the less precise the estimate. Estimates with an RSE of
50% or greater are not published by DAWN. (See also Precision and Standard error.)
Sampling: Sampling is the process of selecting a proper subset of elements from the full population so that the
subset can be used to make inference to the population as a whole. A probability sample is one in which each
element has a known and positive chance (probability) of selection. A simple random sample is one in which each
member has the same chance of selection. In DAWN, a sample of hospitals is selected in order to make inference to
all hospitals; DAWN uses simple random sampling within strata.
Sampling frame: A list of units from which the ED sample is drawn. All members of the sampling frame have a
probability of being selected. A sampling frame is constructed such that there is no duplication and each unit is
identifiable. Ideally, the sampling frame and the universe are the same. The sampling frame for the DAWN hospital
ED sample is derived from the American Hospital Association (AHA) Annual Survey Database.
Sampling unit: A member of a sample selected from a sampling frame. For the DAWN sample, the units are
hospitals, and data are collected for all drug-related ED visits at the responding hospitals selected for the sample.
DAWN, 2006: NATIONAL ED ESTIMATES
73
e:.
..
S31VI'lllS3 03 lVNOllVN :900l 'NMVO
vL
'ldwene epP!nS :A4:JJeJe!4 5U!MOIIOJ e41 WOJJ se!ldde le411SJ!J e41 'AJ05ele:J euo AIUO pue euo OIU! pepo:J S! ese:J 4:Je3
"SI!S!^ 03 peleleJ-5nJp lie JO lflS eSJe^!p e41 WOJJ sese:J NMlfO JeI!W!S dnoJ5 01 pesn UO!le:J!J!ssel:J If :eSB:J JO edA1
"edAl ese:J Je410ue 01 peu5!sse eJe 'Jles "WJe4" 01 sldwene 5u!pnpu!
'UO!leep! JO 'S145n041 'SeJnlSe5 lepP!ns "pe^IO^U! seM 5nJp e 4:J!4M U! pJo:JeJ je:J!pew e41 U! peluewn:Jop (,Jles II!~
01 pepl" ,:epp!ns peldwene" '"5"e) sldwane ap!:J!ns saJnlde:J SI!S!^ 03 peWlaJ-5nJp JO AJ05ale:J S!41 :JdwanB ap!:J!ns
"eleJ1S :J!4deJ50a5 a41 JO 4:Jea WOJJ papejas S! aldwes :J!leWelSAs If "(SI!S!^
03 JO sWJal U! paJnseaw oSle) az!s pue 'd!4SJaUMO JO adAl 'alelS Aq ua41 pue 'uo!5aJ snsuaJ Aq ISJ!J pa~!leJ1S eJe
saJelS pel!Un a4J JO JsaJ a41 SJeM:J W4J wnleJ1S e4J U! Slel!dSOH "wnleJ1S BaJe Uel!IOdoJJaw 4:Jea U! eleJJsqns J45!a
01 dn 5u!leeJ:J '(SI!S!^ 03 lenuue JO sWJal U! paJnseaw) sap05ale:J az!s JnoJ 01 dn (q) pue (ale^pd ':J!lqnd) d!4SJaUMO
lel!ds04 JO sadAJ OMl (e) Aq pa~!IUap! eleJlsqns OjU! pale:Jolle S! 4:Jea U! Sjel!dS04 JO aSJa^!un a4J 'seaJe uel!lodoJlaW
U!4J!M a5eJa^0:J 45nOJ04J aJnsua 01 "SaW1S paJ!Un a4J JO Japu!ewaJ a4J JOJ lIa:J leuo!l!ppe ue snld slIa:J eeJe
uel!lodoJlaw OIU! pa!meJ1S Si aldwes 03 NMlfO a41 "uo!s!:JaJd JO la^al paJ!sap a41 a^e!4:Je OJ paJ!nbaJ az!s aldwes
a41 a:JnpaJ 01 'AlaSJe^uo:J 'JO 'az!s eldwes ua^!5 e JOJ selew!lsa JO uo!spaJd a41 aseeJ:Ju! 01 pasn S! uO!le:JimeJ1S
"UMeJp aJe saldwes 03 eleJedas 4:J!4M U!41!M aSJa^!un e JO sdnoJ5qns :(JBln5u!s) wnJeJJs '(leJnld) BJBJlS
("anIBA-d oSle aas) "90"0 ue41 ssal S! enle^-d a4J J! jUe:J!J!u5!s Alle:J!IS!leJs paJap!suo:J S! a:JuaJawp e 'Salew!lsa
03 NMlfO JO.:l "auole a:Jue4:J Aq papadxa aq PlnoM ue4J Jallews JO Ja5Jel si a:JuaJau!p e41 JsaJ oJ pesn :JilS!lelS
a4J JO anle^ a4J J! lue:J!J!u5!s Alle:J!IS!lelS aq 01 Pies S! Salew!lsa OMJ uaaMlaq a:JuaJau!p If :Jue:J!J!u5!s AlIe:J!JS!JBJS
"Sl!S!^ 009 S! 3S e411e41 sale:JiPU!
009 JO 3S ue 41!M Sl!S!^ 000'0 ~ JO aleW!lSa ue 'eldwexe JO.:l "JleSl! alew!lse a41 se Sl!un awes a41 U! passaJdxa
sl eleW!lSa ue JO 3S e41 "alew!lsa ue JO uo!spaJd JO Al!liqepe^ 5u!ldwes e41 JO eJnseew If :(3S) JOJJe pJBpUBJS
" ~ Z e5e
ue41 Ja5UnOA seM luepe:JaP/lua!led a41 J! AIUO 1040:Jle 5u!^10^u! s41eep/sl!S!^ 5nJp-eI5u!s seJnlde:J NMlfO "ajq!ssod
aq IOU Aew 5nJp Jeln:J!lJed e pue 41eap/l!S!^ a41 ueeMleq d!4SUO!leleJ lesne:J e 5u!lnqpne 'ue4J ue^3 "UO!leU!qwo:J
U! pasn eJaM s5nJp Ja410 Auew M04 pue Ja41a4M Jap!suo:J sAeMle Pln04S eUQ "4JeaP/l!si^ e4J pesne:J euen[pew
a411e41 JO 41eap/l!S!^ e41 U! pa^lo^ui 5nJp AIUO e41 seM euen[pew le41 ueew IOU seop S!41 'asn euenfpew pejUawn:Jop
luapa:Jap/lua!led e JOJ pJo:JeJ a:JJnos a41 J! 'aldwexa JO.:l "s41eap JO SI!S!^ peleposse JO Jeqwnu a41 pue 5nJp ua^!5
e uaaMleq d!4SUO!leleJ a415u!leJdJalu! U! sno!lne:J eq Pln04s sJapeeJ '(6nJO eas) ase:J NMlfO 4:Jee JOJ pepJo:JaJ aq
Aew sa:Juelsqns eld!llnW esne:Jeg "pa^IO^u! seM 5nJp auo AIUO 4:J!4M U! auo S! ese:J 5nJp-aI5u!s If :aSB:J 5nJp-aI5u!S
"S03 J!a41 U! palueJ5 eq OllUeWleaJl 4:Jns OlU! AJ1Ua JOJ e:JueJeel:J le:J!paw eJ!nbeJ le41 sa!l!lpeJ
U! punoJ eJe sJeqwnu lSa5Jel e41 pue 'se:J!AJas UO!le:J!J!XOlep JO luawwaJl asnqe e:Juelsqns 5u!P!^OJd sl!un lUa!ledu!
pez!lepads eleJedo le41 se!l!I!:JeJ as041 uJ peleJlua:Juo:J eq 01 puaJ Sl!S!^ xOlep 5u!~ees "lel!ds04 ewes e41 U!41!M
eW!l JaM AJe^ Aew pue Slel!ds04 SSOJ:Je AJe^ le41 sa:J!peJd e^!leJls!u!wpe palJaJ ualJo Ae4J esne:Jaq AleleJedes
pe!J!ssep eJe Aa41 "l!un uO!le:J!J!XOlap JO JuawleaJl 5nJp e 01 UO!ss!wpe JOJ e:JueJeap le:J!paW JO 'UO!Wl11!qe4aJ
5nJp 'IUaWleeJl esnqe e:Juelsqns 5u!~aes Slua!led saJnlde:J Sl!S!^ 03 peleleJ-5nJp JO AJ05eJe:J S!41 :xoJap 5uPleas
"se!q JO se:JJnos le!lualod
Je410 pue 'esuodsaJuou alqepe^ '5u!ldwes Al!l!qeqoJd lenbeun 01 anp u5!sap eldwes leUi5!JO e41 WOJJ SUO!le!^ap
JOJ 5u!lsn[pe Aq ejdwes e WOJJ Salew!lsa UO!lelndod a^pap 01 pasn Sluap!ueo:J :JpewnN :sJ45!aM 6u!ldwes
I.
seeking detox, alcohol only (age < 21), adverse reaction, overmedication, malicious poisoning, accidental ingestion,
and other. The rules for assignment of DAWN cases to types of cases are defined in the DAWN ED decision tree in
Appendix C.
Universe: The entire set of units for which generalizations are drawn. The universe for the DAWN ED sample is all
non-Federal, short-stay, general medical and surgical hospitals in the United States that operate one or more EDs 24
hours a day, 7 days a week. Specialty hospitals, hospital units of institutions, long-term care facilities, pediatric
hospitals, hospitals operating part-time EDs, and hospitals operated by the Veterans Health Administration and the
Indian Health Services are excluded. The universe of EDs is identified from the American Hospital Association's
Annual Survey Database.
DAWN, 2006: NATIONAL ED ESTIMATES
75
76
I
DAWN, 2006: NATIONAL ED ESTIMATES
o
o
.t
APPENDIX C
DAWN DATA COLLECTION AND STATISTICAL METHODS
Introduction
The Drug Abuse Warning Network (DAWN) is a public health surveillance system that has monitored drug-
related emergency department (ED) visits to hospitals since the early 1970s. DAWN was initially established by the
Drug Enforcement Administration. Then DAWN was transferred to the U.S. Department of Health and Human
Services (USDHHS), where the National Institute on Drug Abuse (NIDA) conducted DAWN from 1980 to 1992. Since
1992, the Office of Applied Studies (OAS) of the Substance Abuse and Mental Health Services Administration
(SAMHSA), USDHHS, has been responsible for DAWN operations and reporting.
Since its inception, DAWN has relied on data collected from a sample of hospitals. However, over the years, the
exact survey methodology has been adjusted to improve the quality, reliability, and generalizability of the information
produced by DAWN. When NIDA assumed responsibility for DAWN in 1980, implementation of a sample of hospitals
to produce representative estimates for the Nation and for selected metropolitan areas became a priority. This
sample, refreshed with annual maintenance, continued to support DAWN estimates for the coterminous United States
and 21 metropolitan areas until 2002. By that time, major population shifts and changes in the hospital industry over
the preceding two decades made apparent the need for a redesign of the sample of hospitals, which was undertaken
as part of a wholesale redesign of most major features of DAWN.
Currently, the DAWN survey relies on a longitudinal probability sample of hospitals located throughout the United
States, including Alaska and Hawaii. Hospitals eligible for selection into the DAWN sample must be non-Federal,
short-stay, general surgical and medical hospitals located in the United States, with at least one 24-hour ED. This
current approach was first implemented in the 2004 data collection year.
DAWN uses the data from the visits classified as DAWN cases in the selected hospitals to calculate various
estimates of drug-related visits for the Nation as a whole, as well as for specific metropolitan areas. To calculate
these estimates and measure their precision, the DAWN survey requires the application of sampling and weighting
methodologies.
This appendix documents the data collection methods and the sampling, weighting, and variance estimation
methodologies used to develop estimates for the DAWN data collected for 2004, 2005, and 2006.
Target population
The target population is drug-related ED visits in non-Federal, short-stay, general surgical and medical hospitals
in the United States with at least one 24-hour ED.
Hospital sample frame
DAWN uses the American Hospital Association (AHA) Annual Survey Database as the basis for its sampling
frame. The AHA maintains an updated national registry of U.S. hospitals that is estimated to have a coverage rate of
DAWN, 2006: NATIONAL ED ESTIMATES
77
'lo
S31'v'~11S3 a3 1'v'NOI1'v'N :900l 'NM'v'a
'ilL
"9090911 'o6e~!~:) 'laaJIS U!I~UeJ::l ~jJoN aUQ tOOl 1~6!J"do:) ':)11 wnJo::l ~lleaH ~OOl Jea" le~s!::l 'aseqelea "aAJns lenuu'v' 'v'H'v' ~
'~J aln6!.::J U! pap!^old S! SWal! elep NMVO papallo:) a41lle 6U!M04S W10J jlOdal ase:) a41
NM'VO Aq papallo~ SWal! eleo
'SI!S!^ 03 JO aSla^!Un a41 6U!Ma!^al U! ssa1601d 1!a41 '601
UO!lells!6al 03 a41 JO ^do:) e uo '~:)ell oSle slajlodaCj NMVO 'e!lal!l:) uo!palas ase:) :)~pads a41 Slaaw le411!S!^ 03
4:)ea 10J WalS^S NMVO a41 01 jlOdal ase:) :)!uolpala ue Sl!wqns lajlodaCj NMVO a41 'asn 6nlp 01 pajelal SI!S!^ 03
PU!J 01 SPlo:)alle:)!paw lie SMa!^allajlodaCj NMVO paleu6!sap a41 'NMVO U! Saledp!jled le41 ^1!1!:)eJ 4:)ea 10.::J
'lopelluo:) suo!lelado NMVO a41 JO aa^Oldwa ue 10 lel!ds04 a41
JO aa^Oldwa ue aq ^ew lajlodaCj NMVO a41 '^I!lpeJ a41 JO spaau a41 uo 6u!puadao '^I!lpeJ laqwaw 4:)ea U! lajlodaCj
NMVO pau!ell e ^q pawloJjad S! splo:)al a:)lnOS JO Ma!^al a41 'paMa!~alU! la^aU ale sa!l!weJ 10 sluaned '03
a41 U! pale all SIUa!led 10J SPlo:)alle:)!paw 03 JO Ma!^al a^!padSOllal e 46no141 papallo:) ale elep 03 NMVO
uo!paIlO~ elep NM'VO
'^1!I!q!6!la au!wlalap 01 pallnsuo:) ale
sa:)lnOS elep leUO!I!ppe 'uMou~un SU!eWal ^1!I!q!6!la S,lel!ds04 a41 JI '^1!I!q!6!1a aU!Wlalap 01 pasn ale aseqeleo ^a^lnS
lenuuv VHV a41 U! salqe!le^ la410 '^I!I!q!6!1a uMou~un 41!M lel!ds04 ^ue 10.::J '^I!l!q!6!1a uMou~un a^e4 01 palap!Suo:)
S! lel!ds04 a41 'as!Mla410 'alq!6!!au! I! lapual ue:) e!lal!l:) 6u!ss!wUOU a41 JO auo ^ue 'aseqelep VHV a41 W01J
6u!ss!w ale elep ^I!l!q!6!1a le:)!l!l:) ala4M Slel!ds04 10.::J 'a/q!6!la palap!Suo:) ale e!lal!l:) a41lle laaw le41 Slel!ds04 as041
^IUO 'law IOU S! (03 ln04-P(: auo lsealle 41lM 'salelS pal!Un a41 U! pale:)ol Slel!ds04 le:)!paw pue le:)!61nS lelaua6
'^elS-jl04S 'lelapa.::J-uou) ^I!l!q!6!la aU!Jap le41 e!lal!l:) ^a~ a41 JO auo ^ue J! alq!6!laU! palapisuo:) S! lel!ds04 V
Al!l!q!6!1a NM'VO lO UOneU!WJalao
'S03 ald!llnW alelado
Slel!ds04 NMVO ^ueV'j '031n04-P(: auo lseal je 41!M 'salelS pal!Un a41 u! lel!ds04Ie:)!paW pue le:)!61nS lelaua6
'^elS-jl04S 'lelapa.::J-uou e S! I! J! awelJ 6u!ldwes NMVO a41 U! uo!snpu! 10J alq!6!1a aq 01 palap!Suo:) S! lel!ds04 V
'SUO!leZ!ue610 aleJ 41leaH JO UO!lel!pal:):)V uo UO!SS!wwoJ lU!Or a41 se 4:)ns SUOneZ!Ue510 ^q uO!lel!pal:):)e pue :uels
le:)!paw pasua:)!1 ~SUO!I!puo:) le:)!paW :)!Jpads 10 lelaua6 10J ':)!lnadela4110 :)!ISou5e!p 'sa:)!~as lUa!led JO UO!S!^Old a41
apnl:)u! asa41 'VHV a41 ^q lel!ds04 e se pa!J!Ssep aq 01 e!lal!l:) lelaMS laaw lsnw UO!leZ!ue510 ale:) 41lea4 V ~'%66
..
Figure C1
DAWN ED case form
f2Ay~R~ ABUSE
WARNINC NETWORK
1. Facility o::IJIDJ
GMll Nv. 0'13Q-{)(ilfJ ~"l1ir,,> lZ13112008
Emergency Department Case Report
u.s. Depal1ment of Health and Human Sef'Ji((~s . Substance Abuse and Menti11 Health Service:> Administration
2. Date of Visit
OJ OJ L2.\(S;r: 0
. ,"i;j";:;:,..u:;I,;:'~0;<,
5. Patlent'sl~"')'lomc,'lIP ~d~\
/.1/ ,,' ,.,"" :; '}:.
I ,.:*V,,::"~1.. ".,;:;, C::;;' I"
~" <::~.,~>> fl "~.,
OtherwjSt..~~/"€,'~,:~~n",,e "':':'ponse:,1I ',I
o N.o fixed ~';~,~~re;<>{e.g. homeless~ 1/
o I nstit.ution (~~~1",,~(.~~lter I j a i I/hos~:;ta IlJl;;:;::::;:;;;::';:,\~.
o OutsIde u.s. ,"::' :~:;::::::'::; -:::;:J 1.:::::.,;,:::::::::::::;;;;:::-"
o Not documented ~ ,,"'"""r;""1" DI("
:''''''~ "~ll 1"'1
Ii // J~'
8. Diagnosis List up to 4 dia~Sof1s noted)::;;ff;:~~~nt0},art. Do not list/CD codes.
':.1 ':I;~"~~,,(~;V JL i\ 3.
v ,,_ 'V i ,//./4.
'~( // .//7,,;;;:
9. Case Description Beginning with the pres/4tjn,f/comp/;::i~t, d/[<ri<~ how the drug{s) was related to the ED visit,
\,:\ f ".,-:/'" "~I / "./ "-"'<\
Copy verbatim from the patient's chart when pos~<tle. ./;,{/ )/.<:<~'~,<l // .<::~"::':'::"''''\~~:;'',>"
(( "./ ii ;.lA'?" i/
"~iti2"~JF;"";>J'\~~ :p
10. Substance(s) Involved USing available documentatIon, list a' :subs" "nees ...;:/ _.r:~"'l,te"L':\Administration l/;
that caused or contnbuted to the ED VISIt ,Record SUbstances, as s~" t-ally /'/' <(, 'SV1ect One J"
as possible (i.e., brand [trade) name, preferred over generic name preferreff" ~0- ~'-.''l ",/ljd :t
over chemical name, etc.), Do not record the same substance by two ~~~a' J( t:/)" /~ r.l:: 0.' J;:
different names. Do not record current medication.fi unrelated to the visit. ~ cOI:...:.:<:~;:,;/j)y ..z:;::11" ~> _,p ,$ c.r 0$0;
toxicology tesl'Y' O"{/ -$"" -$" c.f
,:,,~,,~
Alcohol involved? 0 Yes 0 No/Not documented 0 ,~,. //"
[7,;:f~
<~ ;/\.
L.',:;" 'l 'I~~
,,"". "". , /:/'~, "'",
o "-"'~" /Y""! .;'.." ">"
'" .'/ 77r ~\..-;;::+'"-,,
~ ~:'~11~,^" '~~~,,\~l:~f
o G~::",DltTI
"\:::::::~~:,
Other di:)position:
o Transferred
o Left against medical advice
D Died
D Other
o Not documented
3. Time of Visit
4. Age
Da.m.
D p.m.
o military
o Less than 1 year
o Not documented
HOUR MINUTE
rnrn
D
1.
2.
6. Sex
o Male
o Female
D Not documented
7" Race/Ethnicity
Select one or more:
D White
o Black or African American
o Hispanic or latino
o Asian
o American Indian or Alaska Native
o Native Hawaiian or Other Pacific Islander
o Not documented
?
~"
..f
v
15'
#
2
3
4
11. Type of Case
Using the Decision Tree,
select the first category that applies:
o Suicide attempt
o Seeking detox
o Alcohol only (age <21)
o Adverse reaction
o Overmedication
o Malicious poisoning
o Accidental ingestion
o Other
~M^ 100-ljHV ;2/1005
12. Disposition Select one;
Treated and released: Admitted to this hospital:
o Discharged home 0 ICU/Critical care
o Released to police/jail 0 Surgery
o Referred to detox/ 0 Chemical dependency/detox
treatment 0 Psychiatric unit
o Other inpatient unit
13. Comments Enter here any questions or issues you have about this case.
Do flot include infon-nation that could identify the patient.
DAWN is operated by the Substance Abuse and Mental Health Services Administration (SAMHSA) of the U.S. Department of Health and Human
Services, as required in Section 505 of the Public Health Service Act (42 V.S.C. 290aa.4). DAWN is used to monitor trends in the adverse health
consequences associated with drug use. Section 501 (n) of the Public Health Service Act prohibits SAMHSA from using or disclosing DAWN data for
any purpose other than that for which they were collected.
Public reporting burden for DAWN emergency departments is estimated at 77 minutes per case. This includes time for reviewing ED charts and
completing case report and activity report forms. Send comments regarding burden to $AMHSA Reports clearance Officer, Paperwork Reduction
Project 0930-0078, 1 Choke Cherry Road, Room 7.' 044. Rockville, MD 20857. An agency may not conduct or sponsor, and a person is not required to
respond to. a collection of information unless it displays a currently valid OMS control number. The OMS control num ber for this project is. 0930~0078.
DAWN; 2006: NATIONAL ED ESTIMATES
79
..
S31lfV>lllS3 03 llfNOl1lfN :900Z 'NMlfO
os
'papnpxa aJe (asn lua:JaJ ou pue) asn 5nJp)0 AJ01S!4 e 41!M Slua!led 'S! le41 l
'(6nJp B!O alll!l 0016U!~Bl "a'!) UO!W::l!paWJapun!o a::luanbasuo::l B SB palBaJl6u!aq S! wa!IBd a41 IIll
'I!S!^ a41 01 palBlaJ IOU aJB (SUO!IB::l!paw luaJJn::l "6'a) palS!1 s6nJp AIUO a41 111
'SllnsaJ lsal A60IO::l!XOl U! S! 6nJp B !O UO!lBluawn::lop AIUO a41 III
'(JaM JO ~Z pa6B) llnpB UB S! lua!lBd a41 pUB pa^IO^U! a::lUBlsqns AIUO a41 S! 1040::l1'v' IIll
'asn lua::laJ ou lnq asn 6nJp !O AJ01S!4 B SB4 lua!lBd a41 III
'I! a\B4U! IOU PiP lnq a::lUBlsqns IB::l!lna::lBWJB4duou B pawnsuo::l lUa!wd a41 III
'palBaJl 6u!aq ln041!M 03 a41 ijallUa!lBd a41 III
'asn 6nJp lUa::laJ !O a::luap!^a ou S! aJa41 III
:!! l!S!^ NM'v'O B IOU S! l!S!^ 03 u'v' 'Bpal!J::l Al!llq!6!1a NM'v'O a41 01 SUO!lda::lxa palBaU!lap ApBap Ma! B aJB aJa41
'asnqB 6nJp l!::l!ldxa '01 pal!W!110U lnq
'6u!pnpu! 'Slua^a palBlaJ-6nJp !O sadA11IB sSBdwo::lua 01 46noua pBOJq aJB Bpalp::l a41 pUB 'lUB^alaJJ! S! 6nJp B pasn
lUa!lBd B UOSBaJ a41z'papnpu! S! asn 6nJp lua::laJ AIUO 'NM'v'O UI 'sa::lUa!pnB ald!llnw!o SlsaJalU! a41 pUB sasodJnd
IB::l!lAIBUB !O AlapB^ B aAJas 01 palB6aJ66BS!P JO palB6aJ66B aq UB::l lB41 Sl!S!^ palBlaJ-6nJp !O las aSJa^!p AJa^
B aJnldB::l 01 pau6!sap aJB Bpalp::l pBOJq 'UO!l!PpB ul 'SIB1!dS04 pUB sJajJodaJ SSOJ::lB Alpapadxaun pUB AIIB::l!lBWalSAS
AlB^ 01 B1BP aSnB::l PlnO::l lB41 Sluaw6pnf JO! IB!lUalOd a41 az!w!u!W Bpal!J::l pBOJS 'SIB1!dS04 U!41!M SUBP!U!P 6UOWB
pUB SIB1!dS04 SSOJ::lB ssaua^!SUa4aJdwo::l pUB Al!JBP U! SapB^ spJO::laJ IB::l!paw U! UO!IB1Uawn::lOp lB41 PB! a411unO::l::lB
OW! a~Bl BpalP::l pBOJS 'SUO!lda::lxa Ma! a^B4 01 pUB 'a^!snpu! pUB pBOJq aq 01 papualu! aJB Bpal!J::l aSB::l a41
'l!S!^ a41 U! palB::l!ldw! aq 01 AIUO spaau 6nJp a41 :IBSnB::l
aq IOU paau 6nJp a41 pUB l!S!^ 03 a41 UaaMjaq UO!lBlaJ a4j 'aSB::l NM'v'O B aq 01 'sasodJnd ::l!lnadBJa4j ajBW!l!6al
JO! s6nJP!0 asn a41 01 palBlaJ Sl!S!^ 03 sapnpu! OSIB NM'v'O 'IB1Uapp::lB pUB IBUO!lUalU! 410q 'asns!w pUB asnqB
a::lUBlsqns 41!M palBpOSSB Sl!S!^ 03 sapnl::lU! NM'v'O 'asn 6nJp lua::laJ 01 palBlaJ l!S!^ 03 AUB S! aSB::l NM'v'O 'v'
NMV'O JOl alq!O!la Sl!S!^ 03
'(SI!Blap aJOW JO! 'SB!S!O uo!pnpatj 'uo!pas JalBI aas) sjJodaJ aSB::l NM'v'O!O 6U!UBap pUB Ma!^aJ asn04-ul III
pUB 'sJajJodatj NM'v'O!O UO!lB::l!!!jJa::l pUB 6U!U!BJj snoJ06!tj 1111
'6u!lSal Al01BJoqBI Aq paWJ!!UO::l s6nJp AmUap! 01 SWal! B1BP !O uo!snpul III
'6u!jJodaJ 6nJp lUBpUnpaJuou pUB '::l!!pads 'ajBJn::l::l'v' III
'6u!jJodaJ 6nJp IB1Uappu! !O UO!lBU!W!13 IIlI
'UO!l!sods!p lUa!lBd uo I!Blap \BUO!l!PPB pUB asn 6nJP!0 spaua 41lBa4 a41 uo Swal! B1BP!0 uo!snpul l1li
'UO!lBP!lB^ B1BP pUB SldWOJd palBWOlnB 41!M 6u!jJodaJ ::l!UOJpaI3 III
'S03 6U!lBd!::l!jJBd U! pawaJllUa!wd Ala^a JO! spJO::laJ IB::l!paW 03 !O Ma!^aJ a^!padsOJlatj flI
:6U!MOIIO! a4j 6u!pnpu! 'B1Bp NM'v'O!O Al!l!qB!laJ pUB Al!lBnb a41 a^oJdw! 01 pasn aJB sp041aw IBJa^as
^l!l!qe!laJ plle ^l!Ienb elep a~ueLJlIa leLJl SaJnleal NMV'O
"
~
Types of cases in DAWN
By design, DAWN's broad case criteria yield a diverse set of visits. To bring order to this heterogeneous mix of
ED visits, each visit is assigned to one of eight types, which may be analyzed separately or in purposeful
combinations. The eight types of visits are:
lID Suicide attempt,
III Seeking detoxification,
III Alcohol only in patients under age 21,
II Adverse reaction,
lID Overmedication,
Ifl Malicious poisoning (including drug-facilitated sexual assault or product tampering),
III Accidental ingestion, and
iii Other.
DAWN Reporters assign each DAWN case to one, and only one, of the eight case types, based on a series of
questions and decision rules. The questions and rules are organized as a decision tree (Figure C2). Starting at the
top, each case is assigned to the first case type that applies, even if the case might also meet the rules for a
subsequent category. The eight case types were ordered with this in mind.
The final category in the decision tree is called Other and it is reserved for DAWN visits that do not meet any of
the rules for classification into one of the first seven types. By design, most cases of drug abuse are classified as
case type Other. This approach, which never directly identifies drug abuse, comes from the recognition that medical
records frequently lack explicit documentation of substance abuse. This lack of documentation may occur for several
reasons. First, the distinctions among use, misuse, and abuse are often subjective. Second, if there is a low index of
suspicion for drug abuse in some types of patients, ED physicians may be unlikely to label those types of patients as
drug abusers. Third, in many States, insurers may legally deny payment for ED visits related to substance abuse.
Thus, financial incentives may be a powerful factor to influence documentation practices.
Drugs included in DAWN
DAWN includes all types of drugs:3
II Illegal drugs, such as heroin, cocaine, marijuana, and Ecstasy,
III Prescription drugs, such as Prozac@, Vicodin@, OxyContin@, alprazolam, and methylphenidate,
iii Over-the-counter (OTC) medications, including aspirin, acetaminophen, ibuprofen, and multi-ingredient
cough and cold remedies,
II Dietary supplements, including vitamins, herbal remedies, and nutritional products,
II Psychoactive, non pharmaceutical inhalants,
l1li Alcohol in combination with other drugs, and
III Alcohol alone, in patients aged less than 21 years.
3 The classification of drugs used in DAWN is derived from the Multum Lexicon, @2007, Multum Information Services, Inc. The
classification was modified to meet DAWN's unique requirements (2007). The Multum Licensing Agreement governing use of the
Lexicon is provided in Appendix A and can be found on the Internet at httpllwww.multum.com.
DAWN, 2006: NATIONAL ED ESTIMATES
81
~
S31VWIlS3 03 lVNOIlVN :900Z 'NMVO
ZB
[ --uo== J:~:~~~:g~:~~~B~:::;'O~. :l
JrtMQ,JPtlI/M_
stJnJp o~ Gnp ~'='!XOJ. # 4
9sn Srup U3JJH ISOfi .
tMoq'u pau6/sSElIQU a6:8:) NMVO A:ulf;o'
11,11/./0 so
------.------.,/
(
I
I
\.
-"
UO!/~lptJW JO 6rvp 6UOJM ,1100.1 .1
BU/UO....!Od P,,({:;;J 'Oluopt:';J~.r S3A
NOU.S3DN/lt/1.N30/:J:JtI.LO
---",.._",,-,,'
SOOUi: ~IZ ~ '/IOl.J
ON
I.A15UIMou~un JO Alloluaplooo pasn SOM 6nJp 0411'''11 0100lpUIlJ040 041 sooa 'L
ON
l,r uadeeM aql"B~~~-;;:~~:;::::~~tO' -G---~~ LUO$,.lsd J8 oue
, (j)dw prmn/ll:.>oJ-6nJQ .. _ S3A "U
il IIn.... P<1'Ol/IJ,./.6rua 0 ' . A~.~a55nJp JO pauoslod AlalOJaqllap SOM IUOlled 0411041 OIOOlpU! 1/040 041 sooO '9
I DN/NOS/Od snOl:Jrlvw 90 - f
'-."~ ____ UOIlU:>lpOW JO 6rup BUDJM Gqll100~ ^J(elu9pl:1:;;Jtf..
UQ1111:1,POW 10 6nJp 5, OSlO aUOfJWOS '1ooj...
6U1UO$lOd $"01:>118$V . ON
S6nipl!:;;JIIIJ.
~
l,if~Op pePUOWUJOOOJ ~m1t1 OP1sqn$1
IOU prp IUlIJ 8'woldwAs pOJeo,U.
I' Dsap " U~'1f11 peq A,rJ,t/J ,ofJJO:J'" j"4-' S3A
, 080p ptJSsJw B dn D~etu OJ pa~Jl" j
L....."......::OI1.V~~~~~..:.~i
6nJp JO ..POJJ~ ~/S~ ..
suo!~a8JoJul tJma ..
SUO/J3UO) :J/6J911tt ..
NOl1.01131J 3SIJ31WV /'0
[---- --..---\
6nJp Aiuo BIn
$1I0qO'lepu'lz.6OJapunjUOI,edo ~- S3A-
(Ii::> 3DV) A1NO 10HO:J1V c) .
~"-~- ~-~-- ...--
lJO!IBll/!qltlliIJ 6nJp JOJ H1iiNlbel:J}_
UO!$$/wpe
JVO~UleOJl 6mp.JO:J Ir.JUf!J,ffOp je'3jpOi'" SaA
uor:fl~IJfJ(oUJP 6Uf.'1"C1S"
X0130 !IN/J/33S ,,0
[
JIOflm" O.l P~dWO~U~"
DP/:J!ns POJoJdwo:J ..
..~dwQUIl apF)lns.. .. - S3.A
l.dW3LLtl30/:JJnS to
~~.,,"-_._,""""-
()N~
lJuawo.lddns hJ6l0lP J'O UO!tn:ll'POW J9lunOO'-94l-J9hO un JO D'80p 'POPU3'WWO:)OJ
a~l 10 5n.p UOlldllOsaJd a 10 asop paQlloOaJd 041 paaoxa Iualled a41 Pia '9
UOUt/.'31pt1W m (Jrop 9,8S16 au08W.o$' >fOOl"
Map ptJq!J':.'J69Jd ;/Jf:tl/~ 6sa, 'toO" ~UOUf10fP9li1 OJUlI oo.{..
.. tlO,,3ei3..1 .(J$J'l).Jl.PU" 10 uotJf11uown:>op m04W~ i"3/~Ol"
slimp 1l'3JW 01 UOI1:N1OJpcn:><<$xoun ..
ON
LpapuawwooaJ JO ,paqlJOswd
se ua~all"awOlddns AI1l10lp JO 'U.OIIIt:l!pOW JOjunoO'''41.JOAO '6nJp UO!ldIJ~swd
a 01 .,uolloao. oSJa^pe" ue P04 Iuolled a4\le4\ alaOlpUIlJe40 041S000 '1'
Jl:JilO JO l & ofJrl SIIUOIJOd .. ON
pOI\I(MU! (JJ11/0L/O:JlfI pUB (tf}BnJp .J9ql(J '"
1.1.040041 U! pouo!luew 5nJp AluO 041 sIIO~ool. pUO ~~ 950 lepun IUellOd 941 sl 'C
XOl;}P 6Uf'lOUS IOU mq ~1r1MeJp(mM" ON
l.WBJ60Jd JuawteaJl
6nJp U OlUJ AJ~ua JO XOl9p 6UP1aas 8eM :luenBd 94118\11 a;OOIPU! ~JBLI:O all1- SGOO 'Z
JJ."$ WJUlI OJ p;lJ.Il '"
uOllrm/BAQ 4:M.Sd ..
ld~B BPI:)!"'" 10 UOnUlu.a.wn:>op ON.. ON
~ UOJJlt9Pl apPI1tS" ..
I.paAIOAU! 5n.p 0 ~I!M aplolns p9ldwo"e IUOIIOd 0411a41 910~lpU! pe40 a41 SOOO '~
SilAlfi.l!J OJ ,J1'e:) to m:1A.l u5[s'SV 'lliP16 U! 'EiuO!tsanb 6u!MOlIOJ Olfi Ja^,\suV
'aseo NM110 e oj SI41
S3A
I
<.asn 6nJp 01 pallllaJ JO Aq pa::mpU! UO!llpUOO II JOIl!S!^03 a4l SliM
'lJ1l40 a41 U! uO!lllwawnoop UO pases ,ase::> NMVO e S!4l 51
aaJl UO!S!Oaa NM\fO
aaJl UO!Spap ase:> lO adAl
Z~ aJn6!:1
If
To be reportable, a nonpharmaceutical substance must be consumed by inhalation, sniffing, or snorting, and it
must have a psychoactive effect when inhaled. An ED visit involving inhalation of a non pharmaceutical, psychoactive
substance and no other drug qualifies as a DAWN case. Carbon monoxide is excluded from the inhalants. Beginning
in 2004, cases involving accidental exposures (e.g., exposure to paint fumes while one is painting a closet) are
excluded as well.
Hospital participation
For 2006, 205 hospitals submitted data on 269,339 drug-related ED visits that were used for estimation
(Tables C1 and C2). The overall weighted response rate was 26.1 %. For the 12 oversampled metropolitan areas and
divisions, individual response rates ranged from 30.8% in the Houston-Bay town-Sugar Land, TX Metropolitan
Statistical Area to 71.2% in the Detroit-Warren-Livonia, MI Metropolitan Statistical Area.
For 2005, 224 hospitals submitted data on 268,128 drug-related ED visits that were used for estimation. The
overall weighted response rate in 2005 was 28.9%. There were 13 oversampled areas in 2005 with response rates
ranging from 31.1 % to 77.3%.
For 2004, 220 hospitals submitted data on 168,841 drug-related ED visits that were used for estimation. The
overall weighted response rate in 2004 was 23.9%. There were 13 oversampled areas in 2004 with response rates
ranging from 35.3% to 70.8%.
Charts reviewed for drug-related ED visits
DAWN cases are found through a retrospective review of medical records in participating hospitals. Across all
participating hospitals in 2006, 9,837,481 charts were reviewed to find the drug-related ED visits that met the DAWN
case criteria. Based on the review of charts, 346,946 drug-related visits4 were found and submitted to the DAWN
database, a case rate of 3.5%. On average, a DAWN member hospital submitted 1,077 DAWN cases. However, the
number of submitted cases varied widely across hospitals, from 7 cases to 6,782 cases (median 820) in a single
hospital during 2006.
Across all participating hospitals in 2005, 11,472,887 charts were reviewed to find the drug-related ED visits that
met the DAWN case criteria. Based on the review of charts, 374,276 drug-related visits were found and submitted, a
case rate of 3.3%. On average, a DAWN member hospital submitted 843 DAWN cases. The number of DAWN cases
varied widely, from 1 case to 9,021 (median 525) for a single hospital.
Across all participating hospitals in 2004, 13,299,739 charts were reviewed to find the drug-related ED visits that
met the DAWN case criteria. Based on the review of charts, 307,094 drug-related visits were found and submitted, a
case rate of 2.3%. On average, a DAWN member hospital submitted 609 DAWN cases. The number of DAWN cases
varied widely, from 1 case to 7,485 (median 377) for a single hospital.
4 For 2004-2006, more hospitals participated in DAWN than were used in estimation. Therefore, the number of drug-related ED visits
from all participating hospitals exceeded the number used for estimation.
DAWN, 2006: NATIONAL ED ESTIMATES
83
~
S31'v'~IlS3 03 l'v'NOIl'v'N :900<; 'NM'v'O
1>9
'AI!J ~JOA MaN )0 S46nOJOS aA!) a41 6u!spdwo~ eaJeqns a41 01 pal!w!I S! a6eJaAO:J :J!4deJ60a6
'~JOA MaN JO) :uo!lda:Jxa auo 41!M '(IWlnO-SOq/SUl)allnq/qwoIA~6'asn04al!4MMMM/;:dll41e alqel!eAe) som: aunr U! la6pns pue
luawa6euelN)0 a:J!JJO a41 Aq panSS! suol)!u!)ap pJepuelS a41 MOllO) SUO!S!A!O uelllOdoJlalN pue (S'v'SlN) seaJ'v' 1f:l:J!IS!If:llS Uf:ll!lodOJlalN S
WIOl a41 01 wns 10U op UM04s sjUauodwo~
'aJo)aJa41 's'n a41)0 Japu!f:lwaJ a41 pue UM04s seaJe Uel!IOdoJlaW WOJ) SIellds04 alq!6!1a apnpu! 's'n a41 U! Slel!ds04 alq!6!1a 1f:lIOl
'NM'v'O JOJ alq!6!1a aJe 'Aall.Jns If:lnuu'v'
(IIHII) uO!leposs'v' lel!dsOH ue:Jpaw'v' a41 uo pasf:lq 'sjUawjJedap A~ua6Jawa Jn04-v1: 41!M SIf:lI!ds04 leJapa:l-uou 'If:lJaua6 'WJal-jJ04S
'v'SlN 'v''J 'IUOWaJ:l-pUf:lI~eo-o:JspUf:lJ:l
G'V9 Hv Hv 8 8~ 8~ Uf:lS JO UO!S!A!O Uf:lI!lodoJlalN 'v''J 'Al!'J
pooMpatj-oalf:llN Uf:lS-o:JspUf:lJ:l Uf:lS
'v'SlN 'v'd-rN-AN 'UOS!P3-~Jf:lMaN
0'99 ~'9v 8'89 ~G 68 09 -~JO A MaN JO Sa!luno'J PUOW4:J!tj
'suaano '~JOA MaN 's5U1)j 'XUOJg
'v'SlN l:l '4~f:lag !Wf:l!lN-alf:lpJapnf:ll
~'09 L'9v 0'09 8 9~ GG jJo:l-!Wf:lilN JO UO!S!A!O uf:ll!lodoJlalN
l:l 'lIf:lpua)j-4:Jf:lag !Wf:l!lN-!Wf:l!lN
G99 9'9v 9'9v O~ GG VG 'v'SlN 'v'M 'anAallag-f:lWo:Jf:l1-alneas
L99 0'09 0'09 8 9~ 9~ 'v'SlN
'v''J 'so:JJf:llN ues-pf:lqslJf:l'J-05a!O ues
~'89 8'89 8'89 v~ 9G 8G 'v'SlN Z'v' 'alf:lpSnO:Js-f:lsalN-X!Ua04d
O'VV O'L8 O'L8 O~ LG LG 'v'SlN IM-NlN
'UOI5u!wOolg-lnf:ld 'IS-s!lodf:lauu!lN
8'OS 8'81: 9'81: Gf GV Lv \lSlN
Xl 'PUf:ll Jf:l6nS-UMOIAf:lg-uolsnoH
nL L'69 L'99 9~ VG L8 'v'SlN IlN 'f:l!uoA!l-UaJJf:lM-I!OJlao
~'89 0'09 0'09 6 9~ 9~ 'v'SlN O'J 'eJoJn'v'- JaAUao
G'98 L'L8 998 LG vL 06 'v'SlN
IM-NI-11 'la!lOr-all!lI.Jadf:lN-05f:l:J!4'J
t'L9 9'89 9'89 H 6G OV 'v'SlN
HN-'v'lN 'A:Ju!no-a6ppqwf:l'J-UOls09
SSf:laJf:lqns PUf:l SUO!S!A!O uf:ll!lodoJlalN
r9G 6'vG L'L8 90l vv9 899'v l's'n If:ll01
alf:lJ alf:lJ SIf:ll!ds04
asuodsaJ asuodsaJ paldwf:ls aldwf:ls U! aldwf:ls U! ~ SIf:ll!ds04
pal4fl!aM 14fl!aM J oJ alf:lJ SIf:ll!dS04 SIf:ll!dS04 alq!fl!la eaJe O!4deJ50a~
SI!S!^ ufl!saa asuodsatj flu!puodsatj I alq!fl!l3 If:ll01
luaOJad I
s(S'v'SV\J) seaJ'v' If:lo!ls!lelS Uel!IOdoJlalN
900Z Jea~ UO!lOaIlOO BlBO
~:) 91qel
d
Table C2
Drug-related ED visits, by type of case: 2006
Unweighted Weighted Relative 95% Confidence interval
standard
sample data estimates 1 error (RSE) Lower bound Upper bou nd
Suicide attempt 11,840 182,805 8.0 154,185 - 211,424
Seeking detox 18,789 118,355 12,1 90,171 - 146,540
Alcohol only (age < 21) 9,940 125,888 12,5 95,087 - 156,690
Adverse reaction 93,507 1,526,010 9,3 1,247,859 - 1,804,161
Overmedication 20,643 285,828 6,2 250,991 - 320,664
Malicious poisoning 750 8,817 13.1 6,546 - 11,088
Accidental ingestion 4,117 79,011 9,1 64,855 - 93,166
Other 109,753 1,115,141 13,0 832,069 - 1,398,213
Total drug-related ED visits 269,339 3,441,855 6.1 3,033,110 - 3,850,600
Total drug misuse/abuse visits 164,334 1,742,887 8.5 1,451,086 - 2,034,688
Total ED visits (all reasons) 8,930,694 113,110,132 0.0 -
Drug-related ED visits
Suicide attempt 25,096 402,907 9,1 331,056 - 474,758
Seeking detox 38,909 243,297 13.3 180,091 - 306,502
Alcohol only (age < 21) 9,940 125,888 12.5 95,087 - 156,690
Adverse reaction 120,016 2,055,783 11.1 1,608,379 - 2,503,188
Overmedication 35,340 506,476 6.6 441,034 - 571,919
Malicious poisoning 1,295 15,293 12.7 11,482 - 19,105
Accidental ingestion 5,200 98,613 9.1 81,048 - 116,178
Other 183,642 1,936,561 10.7 1,531,598 - 2,341,524
Drugs in all drug-related ED 419,438 5,384,819 6.3 4,716,771 - 6,052,867
visits
Drugs in all misuse/abuse ED 282,938 3,086,984 7.2 2,649,699 - 3,524,268
visits
Drugs2
1 These are estimates based on a representative sample of non-Federal, short-stay hospitals with 24-hour EDs in the United States.
2 These are estimates of drugs. A single ED visit may involve multiple drugs.
SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 2006 (03/2008 update).
DAWN, 2006: NATIONAL ED ESTIMATES
85
..
S31VVlIlS3 03 lVNOllVN :900<: 'NMVO
98
'sase:> UO!ISa5uI
leluapp:>e JO uOIpeaJ aSJaApe apnpu! JaAaU Pln04s '45n041 'asn le:>!pawuoN 'asn le:>lpawuou se paJap!suo:> aq 145!W
Aa41 sasodJnd Ja410 JO) Inq 'AlaleJedas pazAleue aJe XOlap 5u!~aas pue Idwane apP!ns)o sadAI ase:> a41 UO!le:>!lqnd S!41 UI :31ON
(asnqe BnJp paluawn:>op sapnl:JuI :adAI ase:J
Ja410ue 01 pauBIsse aq IOU Plno:J le41 sase:J) Ja410 adAI aseJ -
(asodJnd snop!lew e JO) Ja410ue Aq BnJp e paJaIS!u!wpe
seM lua!led a41 4:J!4M uI sase:J) Bu!uos!od sno!:J!leV'J -
(asnqe BnJp )0 uO!leluawn:Jop 1!:J!ldxa BU!~:Jel sluawalddns AJela!o -
asns!w 'aSnJaAO 'asn le:J!pawuou)o sase:J) UO!le:JlpawJaAO - sle:J!lna:JeWJe4d sle:J!lna:JeWJe4d
sad"l ase:J aaJ41)0 uO!leUlqwoJ JlO pue uO!ldp:JsaJd - )0 asn le:JlpawuoN
(~Z > aBe) "IUO 1040:J11i -
XOlap Bu!~aa8 -
sldwalle apP!n8 - ~Z )0 aBe
~Z aBe Japun slua1led JO) sad"l ase:J a41 Japun Slua!led uI "luO 1040:J11i -
BUIMOIIO) a41 UI "IUO Jeadde BnJp alos a41 se 1040:Jle 41!M saseJ (s)BnJp
aBe )0 SSalPJ8BaJ 'sad"l aS8:> IIIi Ja410 41!M UO!18ulqwo:J U! 1040:J11i - 1040:J18 )0 asn
sBnJp IP!lI! )0 suol18UlqwOJ -
s1u8184u! 18:J!lna:J8WJ84duON -
suaBoupnll84 Ja410 -
dJd -
081 -
aUlw8la>t -
(loudA40tj) w8daz8JI!unl.:l -
8H8 -
liV'JOV'J -
( aU!w8la4dw84law
PU8 saulw8la4dw8) s1U81nw!18 -
8U8nf1J8V'J -
u!oJaH -
sad"l aS8:J IIIi aU!8:JoJ - sBnJp IP!II! )0 asn
papnl:>u! sad~ ase:::> papnpu! s6nJQ luawaAIOAU!
6nJp 10 adAl
NMVO u! esnqe pue esnS!w 6nJp O~ pe~eleJ S~!S!^ 03
f:J elqel
'900i: pue '900i: 'VOOi: U! 'a6ela^e
uo 's6nlp 9' ~ pa^lo^u! l!S!^ 03 palE?lal-6nJp 'rJ 'a^!snpxa ^lIenlnw IOU ale sap06ale:J asa4l 'l!S!^ al6u!s E? U! pa^IO^U!
aq Aew s6nlp ald!llnw asnE?:Jag 'tJ alqel U! UM04s se adAl ase:J pue 6nlp Aq paU!lap ale sap06ale:J aa14l asa41
'(s6nlp Jl0 10 UO!ldp:>sald "6'a) sle:J!lna:JeW1E?4d lO asn le:J!pawuoN III
pue '~i: lO a6e a411apun SIUa!led UI auolE? 1040:Jle pue 's6nlp la4lo 41!M UO!leu!qwo:J U! '1040:Jle lO asn III
's6nlp lP!lI! lO asn E!
:UO paseq ale '4lleaH pue asn 6nlO uo AaAlns leuO!leN a4llo 4:Jeoldde a4llalleled Ol pau6!sap
'sap06ale:J asa41 'pau!lap alaM asnqe pue asns!w 6nlp Ol palelal Sl!S!^ O3lo sap06ale:J aa14l 'S!SAleUe 10;1
uone::>!Iqnd S!l/l U! ewp NM'\10
..
Sampling and estimation
DAWN sample design
The redesign of the DAWN system introduced in 2003 altered most of the major features of the DAWN data
collection and included a new sample of hospitals that constituted the DAWN. The new sampling plan, fully
implemented for the first time for the 2004 estimates, formed a nationally representative panel of hospitals to be
followed longitudinally for the indefinite future. Briefly, this new design is a probability-based, stratified, one-stage
sample. A complete and accurate list of all hospitals in the United States was drawn and, from that, all hospitals
meeting the criteria for the target sample frame were identified. Samples were drawn to provide the capability to make
estimates for the Nation as well as select Metropolitan Statistical Areas (MSAs) and divisions (Table C4). Each year
the sample frame is updated to account for new hospitals.
The stratified design called for drawing oversamples of hospitals in 48 MSAs; in four of those 48 MSAs,
additional oversamples were drawn for a total of nine divisions.5 In effect, there are 53 nonoverlapping geographic
areas (44 whole MSAs and nine divisions). (See Table C4 for list of MSAs and divisions6 where oversamples were
drawn.) These areas are collectively referred to as oversample areas, or OS areas.
Metropolitan Statistical Areas and subdivisions
In order to accommodate a planned expansion of the metropolitan areas covered by DAWN, a maximum set of
metropolitan areas, based on the definitions issued by the Office of Management and Budget (OMB) in June 2003,
was selected. Which metropolitan areas to include was a topic of the DAWN redesign.? Retention of the existing 21
metropolitan areas was important because there was significant demand for estimates for those areas, and addition
of the five most populous metropolitan areas in each of the nine Census divisions was deemed important to improve
DAWN's geographic and population coverage. This yielded a total of 48 metropolitan areas. For many of the 48
metropolitan areas, the June 2003 definitions resulted in larger metropolitan areas. In some cases, these larger areas
represented a merger of previously separate metropolitan areas. However, there continued to be strong interest
among users of DAWN statistics in the areas covered by the original 21 metropolitan areas. In order to address the
needs of these users, four of the merged areas were subdivided.8 For each of these areas, there was a sample for
the metropolitan area, as well as a sample for each subdivision. This would enable DAWN to produce estimates for
the metropolitan areas and for the subdivisions. As a result of this process, the final metropolitan-area sample
included a total of 53 geographic units: 48 metropolitan areas, 2 subdivisions each for 3 of these metropolitan areas,
and 3 subdivisions for one of these metropolitan areas.
5 The four MSAs where samples were drawn for divisions are Los Angeles, Miami, New York, and San Francisco. The division
definitions used by DAWN follow Census Bureau definitions of Metropolitan Divisions, except in New York where the three
submetropolitan areas were defined uniquely based on local input.
6 MSAs and Metropolitan Divisions follow the standard definitions issued by the Office of Management and Budget in June 2003
(avail able at http://www.whitehouse.gov/omb/bulletins/b03-04.html and http://www.census.gov/populalion/www lestimates/metrodef htm I).
7 Substance Abuse and Mental Health Services Administration, Office of Applied Studies. Drug Abuse Warning Network: Development of
a New Design (Methodology Report). DAWN Series M-4, DHHS Publication No. (SMA) 02-3754, Rockville, MD, 2002.
8 When metropolitan areas were redefined in June 2003 based on data from the 2000 decennial Census, several legacy MSAs were
merged with other MSAs to form new, much larger MSAs. However, a strong constituency of DAWN data users still needed estimates
for the pre-merger areas. Because of this, four of the 48 metropolitan areas-Los Angeles, Miami, New York, and San Francisco-
were subdivided into a total of nine divisions, corresponding to the constituents' areas of interest.
DAWN, 2006: NATIONAL ED ESTIMATES
87
.q
S311lv.lIIS3 03 lllNOlllIN :90OZ 'NMIIO
99
'eaJII le:>ljs!jejS uej!lodoJjal^J lid
-rN- AN 'UOS!P3-~JeMaN-~JO A MaN a4j uI pau!ejuo:> aJe (~JeMaN pue ~JO A MaN) seaJe A:>e5al ajeJedas OMI 'eaJe A:>e5al e sajouao
S>i 'ej!4:>!M
.AM-O l^J-'if A -80 'eppUeXal'if-uoj5uIIJ'if-uojBUl4SeM
Z'if 'uoson 1
lj 'JajeMJeaIJ-BJnqsJajad 'js-edwel
.11-0l^J 'slnol 'jS
. 'ifM 'anAallas-ewooe l-ameas
(UOISIAIO uel!lodoJjal^J 'if8 'Aj18
pooMpaCj-Oajel^J ues-oospueJj ues sUlejuoo) uOIsIAlp
oospueJj ueS - 'if8 'juowaJj-pUel~eO-OOspueJj ueS
(UOISIA10
Uej!lodoJjal^J 'if8 'pJeMAeH-jUOWaJj-pUel~eo SUlejUoo)
UO!S!AIP puel~eo - 'if8 'juowaJj-pUel~eo-oOsloueJj ueS
. 'if 8 'juowaJj-pUel~eO-OOs!oueJj ues
. 'if8 'sooJelf\J ues-peqspeJ-oBa!o ueS
Xl 'OIUOjU'if ueS
In 'AjIJ a~eljles
'if8 'aIlIAasoCj-apeoJ'if-uapJ'if-ojuaweJoes
AN 'JajSa400Cj
'if8 'opejUO-OUIPJeUJas ues-ap!sJaAICj
'iflf\J-ICj 'JaAICj Ilej-pJoJPaS MaN-aOuap!AOJd
'ifM-CjO 'uojJaAeaS-JaAnOOUeA-pueljJod
'ifd '4BJnqsn!d
.Z'if 'alepSnOOs-esalf\J-x!ua04d
.0 If\J-3 O-rN-'if d 'uojBUIW I !M-UapweJ-e! 4d lapel! 4d
'if1-3N 'sUnlS IpunoJ-e4ewo
(AN 'SaljUn08 PUOW40!Cj 'suaano
'~JOA MaN 's5UI>i 'XUOJS Su!ejUoo) UO!S!A!P S45noJos 9'
'Aj!J ~JOA MaN - 'ifd-fN-AN 'UOSIP3-~JeMaN-~JOA MaN
(AN 'sa!junoJ Jajsa40jsaM
'~Iouns 'puel~ooCj 'WeUjnd 'nesseN su!ejuo:>) UO!SIA!P
ueqJnqns ~JOA MaN - 'ifd-fN-AN 'UOS!P3-~JeMaN-~JOA MaN
('ifd 'Ajun08 a~ld pue 'rN 'sa!junoJ :>Iessed 'uospnH
'uaBJas 'UO!Un 'xassns 'SpJOlf\J 'uopJajUnH 'xass3
'jasJaWOS 'ueaoo '4jnOwUOlf\J 'xaSaIPp!l^J Su!ejUo:>)
UO!S!AIP AasJaf MaN - 'ifd-rN-AN 'UOS!P3-~JeMaN-~JOA MaN
. 'ifd-rN- AN 'UOS!P3-~JeMaN-~JOA MaN
. 'ifl 'JaUUa>i-aplejalf\J-Sueapo MaN
lJ 'pJojl!lf\J-UaAeH MaN
Nl 'OJoqsaaJjJnlf\J-UOSP!Aeo-all!A4SeN
.IM-Nlf\J 'UOjBUIWOOIS-lned 'js-s!lodeauu!l^J
(UOISIAIO uel!lodoJlalf\J lj
'llepUa>i-40eas !wellf\J-lwe!lf\J SUlejUOO) UO!SIAIP Alun08
apeO-Iwe!lf\J -lj '40eas !we!lf\J-alepJapnel jJOj-!wellf\J
(SUO!SIA!O
Uel!IOdoJjalf\J 'lj '4:>eas UOIUAoS-UOleCj eooS-4:>eas
wled jsaM pue 'lj '40eas Pla!jJaaO-40eas ouedwOd
-alepJapnel jJOj SUlejUoo) UOIS!AIP alepJapnel
jJOj -lj '40eas Iwe!lf\J-alepJapneljJOj-!well^J
.lj '40eas !we!lf\J-alepJapnel jJOj-!we!l^J
Cj'if-Slf\J-Nl 'S!4dwalf\J
NI-A>i 'all!AS!nOl
AN 'as!peJed-seBaA sel
(UO!S!AIO uel!lodoJlalf\J 'if8
'aU!AJI-Wla4eU'if-eU'if ejues su!ejuoo) UOIS!A!P AjUn08
aBueJO - 'if8 'eu'if elueS-40eas Buol-SaiaBu'if sOl
(UO!SIA!O uel!lodoJlalf\J 'ifJ
'alepuaI8-40eas Buol-SaiaBu'if sOl su!ejuoo) UO!S!A!P
SalaBu'if sOl - 'ifJ 'eu'if ejueS-40eas Buol-SalaBu'if sOl
. 'if8 'eu'if ejueS-40eas Buol-SalaBu'if sOl
S>i-Olf\J 'AI!8 sesue>i
NI 's!lodeUeIPul
Xl 'puel JeBnS-UMOjAeS-UOjSnOH
IH 'nlnlouoH
lJ 'pJo)lJeH jse3-pJojjJeH jsaM-pJojjJeH
.1lf\J 'e!uoA!l-uaJJeM-jIOJjaO
.OJ 'eJoJn'if-JaAUao
.Xl 'uojBu!lJ'if-4jJOM jJoj-selleo
HO 'snqwnl08
HO 'Jojualf\J-epAI3-puelaAaIJ
NI- A>i-HO 'uMolaIPp!lf\J-lleuupuIJ
.IM-NI-11 'ja!lOr-aIlIAJadeN-05eo!4J
.AN 'epueMeuol-eBeMOj~aa48-0Ieuns
lJ '~leMJON-pJOjWejS-jJodaBpPS
.HN-'iflf\J 'Aou!no-aBppqwe8-UOjSOS
l'if 'JaAOOH-We4Bu!WJ!S
.0lf\J 'uosMol-aJOWllles
Xl '~ooCj punoCj-u!jsn'if
. 'if8 'enapelf\J-sBupdS Apues-ejUell\f
UD!Sep eldwes NMVO U! seeJe (SO) eldwesJeAO
v8 elqel
<>
Sampled hospitals in each of the OS areas were stratified by hospital size (up to four categories based on
volume of ED visits) and ownership type (public and private). (Size categories were determined independently for
each OS area.) The stratification plan included an additional geographic construct for the remainder of the United
States outside the OS areas. Hospitals in the remainder area were stratified into 24 remainder strata based on four
regions (Northeast, South, Midwest, West), hospital size (three size categories based on volume of ED visits), and
ownership type (public and private).
To begin, a cross classification was created by categories of ownership type and geographic unit. Within each
combination of geographic area and ownership type, the number of hospitals determined the number of unique size
categories. If there were three or fewer hospitals, only one size category was defined. If there were four, five, six, or
seven hospitals, two size categories were defined. If there were eight or more hospitals, four size categories were
defined. In the remainder sample, within each combination of Census region and ownership, there were three size
categories. This produced 24 unique strata from which to draw the hospitals for the remainder sample.9
The DAWN national estimates are the sum of the estimates for OS areas and the remainder area. Using a
formula, the national estimate is depicted as:
( ~ajJ+b
where ai is the estimate for OS area i, 53 is the number of OS areas, and b is the remainder area estimate.
It was never expected that DAWN would be able to expand data collection into all 53 OS areas. Instead, the
expectation was that DAWN would build up gradually to the number of OS areas its budget could support. The DAWN
sample design was conceived to provide the flexibility to change gradually over time in terms of the number of OS
areas where data were collected, while providing the statistical infrastructure to enable the production of reliable and
representative estimates for the Nation and select OS areas, regardless of their number.
To accomplish this, the DAWN design incorporates an approach whereby a subset of the hospitals within the OS
areas was identified a priori as having a dual-purpose in estimation. Referred to as "dual-purpose hospitals," these
designated hospitals can contribute to an estimate for the OS area in which they are located or they can contribute to
the estimate for the remainder area. Dual-purpose hospitals carry two probabilities of selection (PaS) and two stratum
identifiers. One PaS/stratum is associated with membership in an OS-area sample and the other is associated with
membership in the remainder-area sample.10
9 Four Census regions times two ownership categories times three size categories equals 24 strata.
10 In addition, a portion of hospitals in the nine oversampled divisions were identified a priori to serve in their MSA-Ievel oversample and
were assigned an OS area level POS/stratum for that third purpose. Therefore, hospitals in the four MSAs with division-level
oversampling can have up to three nonzero POS/strata: (1) a POS/stratum for membership in the MSA; (2) a POS/stratum for
membership in the division; and (3) a POS/stratum for membership in the remainder area.
DAWN, 2006: NATIONAL ED ESTIMATES
89
~
S31'v'Vol11S3 03 l'v'NOIl'v'N :90Ol 'NM'v'O
06
'WnleJls/SOd eaJe-so J!a4l 6u!sn alew!lSa eaJe-so a4l Ol alnqplUO::> Aa4l pue 'SeaJe SO a4l U! "Slel!ds04
aldwesJaAO" aq Ol paJap!Suo::> aJe 'aldwesqns asodmd-Ienp a4l U! 6u!aq se paleu6!sap Alleu!6po aS04l6u!pnpU!
'SeaJe SO auole-pUelS U! Slel!ds04 IIIi ,:seaJe SO auole-puels" se Ol paJJa!aJ aJe asa41 'Salew!lsa aleJedas JO!
S!Seq a4l se UMO J!a4l uo puelS Ol paMolle aJe Al!Ienb elep alqelda::>::>e 4l!M SeaJe SO as041 'Al!Ienb elep aU!WJalap
Ol paMa!AaJ aJe eaJe SO 4::>ea JO! sUJaned asuodsaJuou pue SaleJ asuodsaJ a4l 'S!4l op 01 "SaleW!lSa s.JeaA
le4l U! Aeld II!M lel!ds04 paldwes 4::>ea aloJ 4::>!4M aU!WJalap Ol S! dals lSJ!! a4l 'JeaA elep 4::>ea JO! uO!lew!lsa JO::l
J:f J:f J:f ~~ ..
J:fJ:f J:f ~ .. ..
J:f J:f J:f .. ..
J:f J:fJ:f ~~ .. ..
J:f J:f J:f ~ ..
J:f J:f J:f i~ ~9 .. ..
J:f J:fJ:f ..
J:fJ:fJ:fJ:f ~ ..
..
J:f J:f J:f J:f ~ ..
J:f J:f J:f !, 19- 19-, .. ..
" ,
"
, ,
\.
)~l
)
V
Slel!dsOH
aldwesJaAO
y
Slel!dsOH Slel!dsOH
esodJnd : aldwes Japu!ewaCl
-lena :
\.
V
seaJV aldwesJaAO
)
UD!sep eldwes NM'v'O leU!DPO
~8 eJn5!.::l
"AJlUno::> a4l !O lsaJ a4lluasaJdaJ Ol aldwes Japu!ewaJ e III
pue 'seaJe as04l U!4l!M Slel!ds04 asodJnd-lenp iii
'seaJe SO !O sap as e WOJ! saldwes lenp!A!pU! I1Il
:ap!AoJd Ol UMeJp seM l! se aldwes le!l!U! a4l sp!dap 88 am6!::!
<>
...
If it is determined based on response rates and bias analyses that an OS area cannot stand alone, the design
provides that the OS area is eliminated as a separate area but becomes part of the remainder area. In this instance:
II only those dual-purpose hospitals that are designated a priori to contribute to the remainder-area estimate
are retained in the remainder-area subset,
III these hospitals contribute to the remainder-area estimate using their remainder-area PaS/stratum, and
l1li data from any other hospitals in the OS area are excluded from the national estimates.
Figure C4 depicts the assignment of dual-purpose hospitals to either an OS area or the remainder area and the
exclusion of OS hospitals outside of stand-alone OS areas that are not designated as dual purpose.
Figure C4
DAWN design in practice
Oversample Areas
^
r
l
* * i::Ii::I i::I i::I i::I
* i::I i::I i::I i::I i::I
* i::I i::Ii::Ii::Ii::I
*
* i::Ii::I i::I
* * Ui::Ii::I i::I i::I' i::I
* i::I i::Ii::I i::I
* * **
* *
* * *
* **
Stand-alone
Oversample Areas
i::I Oversample hospital
* Remainder-sample hospital
D Areas in stand-alone oversample estimates
D Areas in remainder estimate
DAWN, 2006: NATIONAL ED ESTIMATES
91
~
~
S31l/VolI1S3 03 1l/NOIll/N :900<: 'NMI/O
Z6
'vOOl 'OVIJ 'all!^~:JOCJ 'lL6S-vO (I/VlJS) 'oN UO!jll:J!lqnd SHHO '9l-0 salJas NMI/O 'Sj!S!1I juewjJedeo
A:Jue6JeW3 peje/etf-6nJO JO sejew!ls3/eUO!leN w!Jeju/ TOOl >tJoMjeN 6U!UJllM esnqlf 6nJO 'se!pnjS pa!lddl/ jO a:J!JJO 'UO!jllJjS!U!WPI/
sa:J!Nas 4jlllaH IlljUaVIJ pUll asnql/ a:Julljsqns :U! lljllO NMI/O jO ^j!lllno a4j a^oJdWI OJ sa6ull48 :sajON Ill:J!u4:Jal '8 x!puaddl/ aas ~~
~~'UO!le::>!Iqnd NMVO Ja!l1ea ue U! pap!^oJd S! se!q a::>npaJ pue ^l!lenb elep NM\fO aoue4ua 01 pasn Sa!50IOp041aW
^a~nS a41 uo I!elap leuO!l!pp\f 'ssa::>oJd UO!paIlO::> elep a41 U! SIU!Od leJa^as Ie SMa!MJ ^1!lenb olpafqns
aJe elep a41 pue :pasn aJe Nlua elep JOJ sp041aw palewolne :5u!u!eJl a^!SualU! pue paz!lepads 41!M pap!MJd aJe
NM\fO JOJ elep pallo::> 04M slenp!^!pu! a41 'se!q luawaJnseaw az!w!u!W 01 'UO!lelndod la5Jel a41 JO a5eJa^0::> %00 ~
^lIenlJ!^ se4 aweJJ 5u!ldwes a41 asneoaq 'paz!w!u!W S! se!q a5eJa^0:) 'aweJJ 5u!ldwes lel!ds04 lemU! a41pnJlSuo::>
01 pasn aJe epalP::> pau!Jap ^l1eap 'aldwexa JO.:l 'se!q 5upnpOJlU! JOJ le!IUalOd a41 a::>npaJ le41 SIO::>OlOJd pue 'sa::>!peJd
'sanb!U4::>al ua^oJd sapnpu! ^50IOp041aw ^a~ns NM\fO a41 'sanle^ UO!lelndod 5u!puodsaJJo::> lnoqe a5palMou~
aleJno::>e saJ!nbaJ I! asne::>aq lln::>!H!p S! se!q 5upnseaV'J 'JOJJa lIeJaM 01 alnqplUo::> oSle le41 ,:se!q" se 01 paJJaJaJ uayo
'JOJJa JO sa::>Jnos leuO!I!ppe aJe aJa41 'JOJJa az!w!u!W 01 pau5!sap aJe a^oqe paqp::>sap Sa!50IOp041aw le::>!ls!lelS a41
'ISaJaju! JO uO!lelndod a41 JO as041 WOJJ JaWP aldwes ^a~ns a41 WOJJ s5u!pu!J 4::>!4M Ollualxa a41 S! JOJJa ^a^JnS
se!q !O UO!pnpa~
'pale::>ol S! lel!ds04 alq!5!1a
^IMaU a41 4::>!4M U! wnleJlS a41 JO uO!loeJJ 5u!ldwes a41 uo paseq 'aldwes a41 OIU! papalas aq 01 ^1!UnlJoddo a41
pap!MJd aJe Slel!ds04 alq!5!1a ^IMaU a41 'Jea^ 4::>e3 'alq!5!1a MOU aJe le41 Slel!ds04 alq!5!laU! ^ISnO!^aJd JO Slel!ds04
Mau as041 aJe 4::>!4M 'Slej!ds04 alq!5!1a ^IMaU apnpu! salepdn asa41 'sam VH\f a41 01 salepdn uo paseq 'Slel!ds04
pa5Jawap pue 'pa5Jaw 'pasop 'Mau palJaJ 01 pawpdn S! aweJJ 5u!ldwes a41 'Jea^ luanbasqns NaM UI 'aseqeleo
^a~ns lenuu\f \fH\f ~001: a41 WOJJ paleaJo aweJJ 5u!ldwes e WOJJ 8001: U! papalas seM aldwes le!l!u! a41 'UO!Wlndod
la5Jel a41 JO a^!WluasaJdaJ su!ewaJ aldwes a411e41 aJnsua 01 pawJoJjad aJe aldwes a41 01 salepdn lenuue
'aw!j Ja^o Sj!S!^ 03 palelaJ-5nJp U! SPUaJl aZ^leUe OJ pasn aq II!M je4j ^a~ns leU!pnj!6uOI e S! NM VO asne:Ja8
a~UeUalU!ew aldwes
'seaJe SO a41 U!41!M ^l!Ienb elep pue
SaleJ asuodsaJ a41 uo 5u!puadap Jea^ 01 Jea^ WOJJ sa5ue4::> aldwes Japu!ewaJ a41 U! d!4SJaqwaw lel!ds04 :p!nIJ aq OJ
pau5!sap S! Slel!ds04 JO aldwes Japu!ewaJ a41 pue eaJe Japu!ewaJ a41 JO UO!j!u!Jap a411e41 alOu OlluelJodw! S! II
'auole puelS IOU aJe le41 seaJe SO U! Slel!ds04 asodJnd-lenp JO a^!snpu! alew!lsa eaJe
Japu!ewaJ a41 S! q pue 'seaJe SO aUOle-puejs JO Jaqwnu a41 S! Sg '1 eaJe SO auole-puels JOJ aleW!ISa a41 S! 'e aJa4M
q+('e~ J
:se pap!dap S! aleW!ISa leuO!leu
a41 'elnWJoJ e 5u!sn 'eaJe Japu!ewaJ a41 snld seaJe SO auole-puels JOJ SaleW!ISa a41 JO wns a41 aJe UO!le::>!Iqnd
S!41 U! palJodaJ se Salew!jsa leuo!leu NM\fO a41 'auole puels aq II!M seaJe SO 4::>!4M paU!WJalap S! I! Jaw
...
~
Sample size and sample allocation
DA WN defines precision in terms of the relative standard error (RSE) of an estimate. The RSE is the standard
error of the estimate divided by the actual point estimate. DAWN is designed to have RSEs less than or equal to 10%
for metropolitan-area estimates, and RSEs less than or equal to 15% for national estimates pertaining to total drug-
related visits, cocaine visits, heroin visits, and marijuana visits. As discussed below, these desired precision levels are
important drivers for setting sample size targets.
Sample sizes for each geographic area were determined by the area's targeted precision level in combination
with the theory of optimal allocation for stratified samples. According to this approach, the variance of the sample
estimates will be minimized when the sample size, nh, in each sampling stratum is made proportional to the quantity
WhS/Ch, where Wh is the proportion of sampling units, Sh is the population standard deviation for the parameter being
measured, and Ch represents the square root of the cost of sampling in stratum h.
Using these optimum allocation conditions, the minimum required sample sizes necessary to achieve the
targeted levels of precision in each DAWN area were calculated using the following general considerations:
ID Geographic units for which estimates are desired (national and metropolitan areas described under
Stratification),
BI Precision level desired (see Target levels of precision),
III Specific types of estimates for which minimum precision is desired (e.g., estimates of total, cocaine, heroin,
and marijuana ED visits), and
III Cost.
In addition to these considerations, sampling rates (i.e., the number of sampled hospitals divided by the number
of eligible hospitals) were also subject to the following constraints:
11II First, if fewer than four hospitals existed in the stratum population, then all hospitals in the stratum were
selected into the sample.
II Second, if the sampling rate for a particular stratum was greater than 90%, then all units in the stratum were
selected into the sample.
III Finally, if any calculations produced a sample size smaller than two hospitals, then the sample size was set
to two hospitals.
Response rate calculations
In 2006, the initial DAWN sample included 1,286 hospitals divided among 53 OS areas (48 MSAs and nine
divisions) and one remainder area. Response rates and non response bias analyses were assessed to determine
which of these 53 OS areas could stand alone (Figure C3). Once this determination was made, hospitals that were
neither dual-purpose nor located in a stand-alone OS area were treated as if they were not sampled. For 2006, this
has the effect of reducing the sample from 1,286 hospitals to 544 hospitals, which is the number used for purposes of
computing the unweighted response rates (Table C1).
Of the 53 original oversample areas, a total of 12 areas (nine metropolitan areas and three submetropolitan
areas) were determined to be able to stand alone in 2006. A total of 13 areas were determined to be able to stand
DAWN, 2006: NATIONAL ED ESTIMATES
93
~
~
S31\fV>lIlS3 03 1\fNOI1\fN :900Z 'NM\fO
1>6
lelOl JO wns pal45!aM a41 01 SI!S!^ lelol fO luno:J \fH\f a41 JO O!leJ a41 se paleln:Jle:J seM JOpeJ luaWlSnfpe a41 'WnleJlS
4:Jea U!41!M 'sawa4:Js UO!le:J!J!leJlS 5u!ldwes paUO!IUaWaJoJe a41 uo paseq paWJoJ aJaM eleJlS UO!le:JY!leJlSlSOd
'luaWlsn[pe S!411UaWaldw! 01 eleJlS U!41!M lUaWlSnfpe O!)eJ e pasn NM\fO 'aseqeleo
^aNns lenuu\f \fH\f lua:JaJ ISOW a41 WOJJ SI!S!^ lelOl JO Jaqwnu a41 41!M Slel!dS04 5U!puodsaJ JOJ SI!S!^ lelOl JO Jaqwnu
pal45!aM a41 salPuo:JaJ le41 JOpef luaWlSn[pe UO!je:J!J!leJlSlSod e sapnl:JU! OS Ie ueld 5u!145!aM NM\fO a41
(UO!W:>!meJISIsod) S>lJeW4:>uaq UO!lelndod JOJ luaWIsnfpe BU!IlIB!aM
'S145!aM lel!ds04 paldwes a41 JO wns a41 Ollenba seM S145!aM
5u!ldwes palsnfpe-asuodsaJuou a41 fO wns a411e41 aJnSua 01 papnpuo:J seM ~:Ja4:J UO!le:J~pa^ e 'ssep 5u!145!aM
4:Jea JO;:j '145!aM 5u!ldwes a41 pue Jopef luaWlsn[pe asuodsaJuou a41 fO pnpoJd a41 se paleln:Jle:J ua41 seM 145!aM
5u!ldwes palsnfpe-asuodsaJuou e 'leU!f paJap!suo:J aJe sJopeJ luaWlsnfpe asuodsaJuou la^al-lel!ds04 a41 ua4M
'pajeln:Jle:J aJe sJopeJ luaWlsnfpe
asuodsaJuou Mau pue pasdellO:J aJe sassep 5u!145!aM lua:Jefpe '(a5Jel 001 JO lIews 001 Ja41!a) spunoq JO lno S!
JopeJ luaWlsnfpe asuodsaJuou e JI 'spunoq alqeuoseaJ U!41!M aJe Sluawlsn[pe a41 ams a~ew 01 pa~:Ja4:J aJe sJopeJ
luaWlsn[pe asuodsaJuou lel!ds04 a41 'Slel!ds04 5u!puodsaJ a41 JO S145!aM a41 JO wns a41 ^q pap!^!p S145!aM lel!ds04
paldwes a41 JO wns a41 se paleln:Jle:J S! JopeJ luaWlsnfpe asuodsaJuou a41 'ssep 5u!145!aM 4:Jea U!41!M 'sawa4:Js
UO!le:J!J!leJlS 5u!ldwes paUO!IUaWaJOJe a41 uo paseq paWJoJ aJaM sassep 5u!)45!aM 'ssep 5u!145!aM 4:Jea U!41!M
pa!ldde pue padOla^ap aJaM le41 sJopeJ luaWlsn[pe asuodsaJuou sapnpu! ueld 5u!145!aM NM\fO a41 'asuodsaJuou
lel!ds04 fO pedw! a41 az!w!u!W 01 'elep ^ue ap!^oJd OII!eJ Slel!ds04 ua4M SJn:J:Jo asuodsaJuou la^al-lel!dsOH
asuodsaJuou lel!ds04 JOJ luawIsnfpe BU!l4B!aM
'lel!ds04 4:Jea JOJ 5nJp 4:Jea JOJ luno:J I!S!^ pal45!aM lelol
e a^!5 01 s41uow pue sa!l!l!:JeJ lie JaM pawwns ua41 aJe slelol pal45!aM a41 '4jUOw-^I!lpeJ le41 JOJ JopeJ luawlsnfpe
lel!ds04-U!41!M 5u!puodsaJJo:J a41 ^q pa!ld!llnw ua41 pue 5nJp 4:Jea JOJ pawwns ISJ!J aJe 41UOW-^I!I!:JeJ ua^!5
e JOJ sjUno:J I!S!^ a41 'S! le41 '^I!lpeJ ^q pue 41uow ^q elep ase:J a41 01 pa!ldde aJe S145!aM lel!ds04-U!41!M a41
'41UOW-^1!I!:JeJ awes le41 JOJ sj.le4:J
paMa!MJ JO Jaqwnu lelol a41 ^q pap!^!p ^1!I!:JeJ e U!41!M 41uOW e U!41!M SI!S!^ 03 JO Jaqwnu lelol a41 se paleln:Jle:J
S! JopeJ luawlsn[pe asuodsaJuou lel!ds04-U!41!M a41 '^I!lpeJ 4:Jea U!41!M UO!pallo:J elep JO 41uOW 4:Jea JOJ pa!ldde
pue padOla^ap aJaM je41 sJopeJ luawlsnfpe asuodsaJuou sapnpu! ueld 5u!145!aM NM\fO a41 'asuodsaJuou lel!ds04
-U!41!M fO pedw! a41 az!w!u!W 01 'elep alaldwo:Ju! sap!MJd lel!ds04 e ua4M SJn:J:Jo asuodsaJuou lel!ds04-U!41!M
luawIsnfpe BU!14B!aM lel!ds04-U!41!M
'luawlsn[pe ~Jew4:Juaq JO ,:uO!le:J!J!leJlSlSod" se UMOU~ aJnpa:JoJd e ^q pue
asuodsaJuou alqepe^ JOJ palsnfpe ua41 pue uo!palaS JO ^1!l!qeqoJd a41 JO aSJa^u! a41 se paleln:Jle:J ISJ!J aJe S145!aM
5u!ldwes 'ssa:JoJd uone:Jolle WnW!ldo ue 45noJ41 pau!WJalap aJaM saz!s aldwes WnleJls a41 'seaJe Uel!IOdoJlaw
papalas U! 5u!ldwesJaM 41!M 5u!ldwes WopueJ aldw!s pa!J!leJlS 5u!sn papalas aJe Slel!ds04 NM\fO a41
SlLJ6!aM 6u!ldwes
'900Z U! Slel!ds04 Z99 pue VOOZ U! Slel!ds04 999 JO az!s aldwes
e papla!^ SUO!leu!wJajap asa41 '\fl 'Jauua)l-ap!elaV\l-Sueapo MaN seM eaJe SO 41f: ~ a41 '900Z pue VOOZ U! auole
....
()'
visits for responding hospitals. The factors were verified to ensure they were within reasonable bounds. If they were
out of bounds (either too small or too large), adjacent poststratification strata were collapsed and new
poststratification adjustment factors were calculated.
When the poststratification adjustment factors were considered final, a poststratified weight was then calculated.
The final weight was calculated as the product of the poststratification adjustment factor and the nonresponse-
adjusted sampling weight. For each poststratification stratum, a validity check was conducted to ensure that the sum
of the poststratified weighted total visits was equal to the corresponding AHA count of total visits from each stratum.
Special consideration was given to New Orleans because Hurricane Katrina (on August 29, 2005) and its
aftermath caused serious disruptions to the operations of hospitals and, consequently, the DAWN data collection
process for the remaining four months of the year. Weight adjustments were implemented by referring to the AHA
total counts in combination with a case-by-case study of each hospital in the New Orleans metropolitan area.12 Based
on these studies, estimates were made of the proportion of the year that each hospital was open and serving the
public. These were used to adjust the AHA totals, which in turn serve as input for population benchmark counts for
New Orleans.
Total drug-related ED visits
Estimates for the entire universe of DAWN-eligible hospitals in the United States are produced by applying
poststratified weights to the data received from the sampled hospitals. Thus, for 2006, 269,339 submitted cases were
extrapolated to an estimate of 3,441,855 drug-related ED visits. Considering the margin of error, this estimate may
range from 3,033,110 to 3,850,600 drug-related ED visits out of more than 113 million total ED visits estimated for the
United States (Table C2).
Calculation of estimates
All estimates produced for this publication were calculated using data that had been weighted according to the
plan described above. Estimates for any variable of interest were determined by first summing the case totals within
facility-month, applying the within-hospital weight, summing to the hospital level, applying the final hospital weight,
and summing over all hospitals.
Variance estimation
Each hospital in the DAWN sample was selected through a random process, which theoretically could have been
repeated many times, resulting in many hypothetical samples. "Sampling variance," or the margin of error, refers to
the extent to which these samples vary. Two measures of this variability are the standard error (SE) and the relative
standard error (RSE), which is defined as the SE of the estimate divided by the estimate itself. The precision of an
estimate is inversely related to the sampling variance, as measured by the RSE. The greater the RSE value, the lower
the precision.
12 Information provided by the Louisiana Hospital Association, the Louisiana Public Health Institute, the City of New Orleans Health
Department, and available at numerous websites maintained by individual hospitals, news organizations, and State and Federal
agencies was invaluable in conducting this assessment. We are grateful for their assistance.
DAWN, 2006: NATIONAL ED ESTIMATES
95
"
'"
S311f~11S3 03 llfNOlllfN :900l 'NMlfO
96
'UO!lelndod a41 U! Ja5Jel S!
le41 dnoJ5 a41 JOJ AlleJnleu In:J:Jo 01 papadxa aq PlnOM SI!S!^ 03 JO aleW!ISa Ja45!4 e 'awes a41 5u!aq SJopeJ Ja410 IIV
'vv 019t pa5e Slenp!^!pu! JO Jaqwnu a41 ue41 JaMOI 4:Jnw S! salelS pal!Un a41 U! O((OIIH pa5e Slenp!^!pu! JO Jaqwnu
a41 'aldwexa JOJ :sdnoJ5 a5e SSOJ:Je AlqeJap!suo:J SJajJ!p UO!lejndod 5U!ApapUn a41 JO az!s a41 'Jeln:J!lJed U! a5e JO,j
'sap05ale:J Japua5 pue a5e SSOJ:Je salew!lsa JO suospedwo:J P!le^ a~ew 01 papaau aJe saJnseaw paz!pJepUelS
SaleJ paz!pJepUelS
'aJeMllOS@Nvvons 5u!sn paleln:Jle:J aJaM SaleW!ISa
a:Juepe^ 'UO!leZpeau!l sap as JOIAe1 5u!sn paU!WJalap aJaM UO!le:J!lqnd S!41 U! palJodaJ saleW!lsa a:Juepe^
'WnleJlS 4:Jea U!41!M SjelOljel!dS04
pal45!aM uaaM}aq a:Juepe^ a41 se paleln:Jle:J seM le41 a:Juepe^ lel!ds04-uaaMlaq a41 ue41 Jallews AlqeJap!suo:J
seM lUauodwo:J S!41 'Alle:J!dA1 'uO!lnq!JlUO:J lel!ds04-U!41!M a41 palUasaJdaJ sale:J!ldaJ OMl a41 uaaMlaq a:Juepe^
a41 pue jel!dS04 4:Jea U!41!M paleaJ:J aJaM sale:J!ldaJ WopueJ OMl 4:J!4M Aq A5aleJlS UO!le:J!ldaJ e 5u!sn paleW!ISa
seM a:Juepe^ lel!ds04-U!41!M 'JOJ paluno:J:Je aJaM Sluauodwo:J a:Juepe^ lel!ds04-U!41!M pue -uaaMlaq 4108
'aW!1 a41 JO %96 leNalu! a:Juap!Juo:J a41 U!41!M lIeJ PlnoM sanle^ UO!lelndod anJl a41 'saJnpa:JoJd UO!pallo:J
elep pue 5u!ldwes awes a41 5u!sn 'Slel!ds04 JO uO!lelndod awes a41 WOJJ UMeJp aJaM saldwes paleadaJ JI
'086'0 ~ 01 OZO'6 :18 %96
086'0 ~ = 086 + 000'0 ~ :1!W!1 Jaddn
OGO'6 = 086 - 000'0 ~ :1!W!I JaMol
0'086 =+= 000'0 ~ = (OOO'O~ x 90'0 x 96'~) =+= 000'0 ~
:aq PlnOM 18 %96 a41 'a^oqe aldwexa a41 01 elnwJoJ a41 6U!AlddV
'ueaw a41 JO SUO!le!^ap pJepuelS 96' ~ U!41!M
sa!l uO!lnqplS!p lewJou a41 JO lua:JJad a^!J-Alau!N 'sanle^-z UO!lnqplS!p leWJOU JO alqel a41 WOJJ sawo:J 96' ~ aJa4M
(aleW!IS3 x 3SCl x 96'~) =+= aleW!IS3 = 18
:se paleln:Jje:J S! 18 %96 a41 'SaleW!ISa a41 41!M 5uole
lxal a41 U! palP ualJo aJe pue salqel a41 JO Auew U! papnpu! aJe (S18) "SleNalU! a:Juap!Juo:J" 'UO!le:J!lqnd S!41 Uj
'%9 JO '90'0 = 3SCl
000'0~/009 = 3SCl
alew!IS3/3S = 3SCl
:%9 S! anle^ 3SCl a41 ua41 'SI!S!^
009 JO 3S ue se4 alew!lsa S!41 pue '5nJp ua^!5 e 5u!^10^u! SI!S!^ paleW!ISa 000'0 ~ aJe aJa41 J! 'aldwexa JO,j
<=l
'"
To take the size of the underlying population into account, rates of ED visits per 1 00,000 population were
calculated using population data from the U.S. Bureau of the Census.13
For each age and gender category, the estimate for a category was divided by the population for that category,
which was then divided by 100,000. For example, consider an estimate of 1,000 visits for an age group of 1,000,000
persons, and an estimate of 1,000 visits for an age group of 500,000 persons. The rates would be calculated as:
1,000 I (1,000,000/100,000) = 1,000/10
= 100 visits per 100,000 population
1,000 I (500,000/100,000) = 1,000/5
= 200 visits per 100,000 population.
Population estimates used to generate rates for 2006 are provided in Table C5.
Table C5
Population by age and gender: 20061
Gender and age Total United States Males Females
Total 302,225,862 149,002,083 153,223,779
0-5 years 24,640,694 12,601,585 12,039,109
6-11 years 23,807,562 12,174,360 11,633,202
12-17 years 25,447,520 13,037,107 12,410,413
18-20 years 12,674,580 6,507,886 6,166,694
21-24 years 16,977,014 8,780,282 8,196,732
25-29 years 21,221,621 10,871,501 10,350,120
30-34 years 19,655,279 9,974,102 9,681,177
35-44 years 43,297,681 21,691,759 21,605,922
45-54 years 43,932,378 21,623,7 41 22,308,637
55-65 years 32,737,374 15,786,874 16,950,500
65 years and older 37,834,159 15,952,886 21,881,273
1 Population estimates for 2006 are, as of 6/9/2008, from the U.S. Bureau of Census Postcensal Resident Population National
Population Dataset, National estimates by demographic characteristics - single year of age, sex and race, and Hispanic Origin,
Monthly Population Estimates. Link: http://www.census.gov/popest/datasetshtml. File: NC-EST2007 -ALLDATA-R-File14.csv.
Standardized rates were not calculated for race and ethnicity subgroups, because the racelethnicity 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 0 describes the race and ethnicity data reported for DAWN.
13 Population estimates for 2006 are, as of 6/9/2008, from the U.S. Bureau of Census Postcensal Resident Population National
Population Dataset, National estimates by demographic characteristics - single year of age, sex and race, and Hispanic Origin,
Monthly Population Estimates. Link: http://www.census.gov/popestldatasetshlml. File: NC-EST2007 -ALLDA T A-R-File14.csv.
DAWN, 2006: NATIONAL ED ESTIMATES
97
..
..
S31VVlI1S3 03 lVNOllVN :900Z 'NMVO
96
"sJOJJa 5u!ldwes aleW!xoJdde 01 alqel!e^e IOU aJe elep AJessa:>au a41 'SUO!jenl!S
asa41 ul "SaleW!lSa a41 01 5u!lnqpluo:> Slel!ds04 JO Jaqwnu lIews a41 pue asuodsaJuou 01 anp S! elep lel!ds04
paldwes Aue JO a:>uasqe a41 aJa4M 'Sl!S!^ 03 JO sJaqwnu lIews 41!M sUO!lenl!s U! Ala^!Snpxa lsowle In:>:>o SllnsaJ
asa41 "OJaz ollenba S! 3SCJ a41 pue SUO!lenl!S 4:>ns U! JOJJa 5u!ldwes ou S! aJa41 '5u!~eads AIPP1S "Al!Un S! Al!l!qeqoJd
5u!ldwes J!a41 'S! je41 'A1U!ejJa:> 41!M papalas aJaM aleW!lSa le41 01 5u!lnqpluo:> Slel!ds04 a41lle pue lIews S!
palew!lsa 5u!aq Sl!S!^ 03 JO Jaqwnu a41 ua4M SJn:>:>o S!41 "OJaz ollenba 3SCJ ue 41!M salew!jsa awos aJe aJa41
"UO!le:>!Iqnd JOJ ajqe!laJun 001 pawaap aJe pue ejep anm AJa^ uo paseq
ssala4jaUOU aJe UO!le:>!Iqnd JOJ e!Jalp:> 3SCJ laaw le41 Slua^a aJeCJ "auOle 3SCJ Sl! JO asne:>aq passaJddns aq PlnOM
alew!jsa a411e41 a5Jel os sa:>uepe^ a^e4 Slua^a aJeJ 4:>ns 'sa:>uelSu! Auew ul "AJ!luenb Ollln:>~J!p aJe le41 sla^al
uo!spaJd a^e4 pue sase:> JO Jaqwnu lIews e uo paseq aJe 4:>!4M 'Slua^a aJeJ alnmSuO:> lIews S!41 salew!js3
"Ot ue41 ssal seM Sl!S!^ 03 JO Amuenb pa145!aMUn JO pa145!aM a41 III
"Ia^al uo!spaJd S!411e OJaz WOJJ luaJaH!p Alle:>!jS!lelS IOU S! alew!jsa a411e41 sueaw OJaz sapnpu! le41
18 'V "OJaz anle^ a41 sapnpu! JO sa4:>eoJdde 18 %g6 a41 JO punoq JaMol a41 '%Og ue41 JaleaJ5 S! 3SCJ a41 ua4M
"%Og ue41 JaleaJ5 seM alew!jsa a41 JO 3SCJ a41 iii
:salnJ 5u!MOIIOJ a41 01 5u!pJo:>:>e
(pa4S!lqnd IOU '"a"!) passaJddns aJaM salew!ls3 "alqel pa4S!lqnd a41 U! (..") sloP aaJ41 Aq pa:>eldaJ seM alew!lsa
a41 'suo!jenl!S asa41 ul "alqe!laJ aq OJ elep anm 001 uo paseq JO 'lIeWS 001 'as!:>aJdw! 001 aJe SaleW!lSa asa41 JO
awos lnq 's:>!lSpapeJe4:> l!S!^ pue 's:>!lSpapeJe4:> lua!led 's5nJp JO spuesn041 JOJ SaleW!lSa a:>npoJd ue:> NM'VO
epal!J:> UO!Je:>!Iqnd
"Saldwes lenuue OMl a41 uaaMlaq
depaAO S!411uno:>:>e 01U! sa~el a:>ue:>!J!u5!s 4s!lqelsa 01 pasn ssa:>oJd uO!leW!lSa a:>uepe^ a41 "Saldwes OMl a41
JO uO!jnqpluo:> pau!qwo:> a41 puoAaq a:>uepe^ 5u!ldwes lIeJaAO a41 aseaJ:>ap 'sn41 'pue a:>uepe^o:> a41 01 alnqpluo:>
sJeaA 410q U! elep ap!AOJd pue saldwes 410q U! Jeadde le41 Slel!ds04 'sn41 "OMl a41 uaaMlaq a:>uepeAO:> a41 pue
aleW!lSa s,JeaA 4:>ea JO a:>uepe^ a41 Jap!suo:> sJeaA OMl uaaMlaq sa:>uaJawp JO a:>ue:>!J!u5!s a41 JOJ sIsal "lue:>!J!u5!s
Alle:>!lS!lelS S! sJeaA OMl a41 uaaMlaq a:JuaJawp a41 J! AIUO UM04s S! 4:J!4M 'a5elua:JJad e se paluasaJd S! llnsaJ
a41 "alew!jsa gom: a41 Aq pap!^!p alew!lSa gOOZ a41 snu!w alew!jsa 900Z a41 se paleln:Jle:J aJe asa41 'suospedwo:J
wJal JajJ04s JO:l "ajeW!lSa tOOZ a41 Aq pap!^!p aleW!lSa tOOz a41 snu!w aleW!lSa 900Z a41 se paleln:Jle:J aJe asa41
"sa:JuaJawp a5elua:>Jad JO WJoJ a4j U! paluasaJd aJe sJeaA UaaMjaq Sl!S!^ 03 JO SaleW!lSa a41 U! suospedw08
SJea^ uaaMlaq sa::>uaJamp Jue:>!l!u6IS lO uOlleUIWJalaa
0,. ..,-,
.~ .
...
APPENDIX D
RACE AND ETHNICITY IN DAWN
In October 1997, the Office of Management and Budget (OMB) issued a revised standard protocol for race and
ethnicity categories used in Federal data collection systems.1 The new protocol permitted separate reporting of race
and Hispanic ethnicity, and it incorporated the ability to capture more than one race for an individual, a few
modifications in nomenclature (e.g., "black" was changed to "black or African American"), division of certain
categories ("Asian or Pacific Islander" was split into two categories, "Asian" and "Native Hawaiian or Other Pacific
Islander"), and elimination of the "other" category. For data collections such as DAWN, where self-identification of the
individual is not feasible (no patient is interviewed for DAWN), the OMB protocol also permitted a combined format,
whereby race and Hispanic ethnicity would be recorded in a single data item, which could still record multiple entries
for race and/or Hispanic ethnicity. The single data item for race and ethnicity is shown in the DAWN ED case form
that has been used since 2003 (Appendix C, Figure C1).
Despite the increased detail allowed by the new categories and the provision for multiple entries, the actual
race/ethnicity data extracted from source records and submitted to DAWN is quite limited. This is because the source
documents (i.e., the ED medical records from which DAWN data are abstracted) rarely contain such detailed
information on race/ethnicity of patients.
For reference, estimates of drug-related ED visits by race/ethnicity are presented in Table D1. This analysis,
which is based on the most detailed coding of race/ethnicity in DAWN case reports, reveals that estimates for the
following categories are too small to be meaningful:
II Multiple (i.e., two or more) races/ethnicities (i.e., two or more races/ethnicities were documented in the
source record for the same individual),
II Hispanic or Latino ethnicity with any specific race indicated,
III American Indian or Alaska Native,
HI Asian, and
II Native Hawaiian or Other Pacific Islander.
Therefore, in the tables of estimates in this and other DAWN publications we have retained a more limited set of
categories: white, black, and Hispanic. A fourth category, called "Race/ethnicity not tabulated above (NTA)," is used
to tabulate those categories that are too small to report independently.2 All cases reported to DAWN as Hispanic or
Latino ethnicity are tabulated as Hispanic race/ethnicity, regardless of race.
This lack of detailed race and ethnicity data in DAWN case reports also prevents us from generating rates per
100,000 population for race and ethnicity categories. Data from the 2000 decennial Census were collected and are
being tabulated according to the revised race and ethnicity protocol and are therefore incompatible with DAWN
estimates.
1 See Office of Management and Budget, Revisions to the Standards for the Classification of Federal Data on Race and Ethnicity, 62
Fed. Reg. 58,782 (October 30, 1997).
2 One exception is that, if two races are reported and the second is reported as unknown, the episode is coded for the known race.
DAWN, 2006: NATIONAL ED ESTIMATES
99
""".
I.cf
...
S31'v'VlIIS3 03 l'v'NOII'v'N :900l 'NM'v'O
o 0 ~
'(al8pdn Baal/tO) gOal '~JOMlaN fiUiUJ8M asnq'v' finJO "v'SHv'J'v'S 'Sa!pnlS pa!ldd'v' )0 a:JijjO :3:n:lnOS
'passaJddns uaaq s84 at U841 ssal Al!lU8nb 8 JO %09 u841 Jal8aJfi 3S~ U8 41!M al8W!lsa U8 1841 aI8:J!pU! (',,) SlOP aaJ4I l
'sal8lS pal!Un
a41 U! s03 Jn04-vl 41!M S181!ds04 A81S-jJ04S '18Japa;j-uou )0 aldw8s a^il8luaSaJdaJ 8 UO pas8q SI!Si^ 03)0 Sal8W!lsa aJ8 asa4I
99t
JapU81S1 :J!)ped Ja410/ue!!eMeH a^!leN + ue!s\f + al!4M
ue!s\f + :Jiueds!H + al!4M
:J!ueds!H + u8:JpaW\f ue:Jp)\f/~:JeI8 + al!4M
Sa!I!:J!u4Ia/sa:JeJ aaJ4I
a^!leN e~sel\f/ue!pul ue:Jpaw\f + ue!s\f
a^!leN e~s81\f/ue!pul ue:Jpaw\f + :J!u8dS!H
ue!S\f + :J!u8dS!H
a^!leN 8~sel\f/ue!pUI u8:JpaW\f + u8:JpaW\f U8:J!Jj\f/~:J818
U8!S\f + u8:JpaW\f U8:Jpj\f/~:J818
:J!u8dS!H + u8:JpaW\f ue:Jpj\f/~:J818
a^il8N 8~S81\f/U8!PUI U8:JP8W\f + 8114M
U8!S\f + 81i4M
:J!u8dSIH + 81i4M
U8:JP8W\f U8:JiJj\f/~:J818 + 8114M
S8!IP!U418/S8:J8J OMI
UMou~un 8:J8Cj
J8pU81S1 :J!)!:J8d J8410/U8i!8M8H 8^!18N
8^!18N 8~S81\f/U8IPUI U8:JP8W\f
U8IS\f
:J!U8dS!H
U8:JP8W\f U8:Jpj\f/~:J818
81!4M
AI!:J!U418/8:J8J 8UO
Sl!S!^ 03 palelaJ-flnJp lelol
Al!:J!U4l8/a:JeCj
9~l
669
It
o ~ ~
v6t'8l
HL
B6L'Ot
w'9~v
9L8't
96t'6l
99L'9
899' 86l
OlV'Vl9
0~8'm'l
990' ~ ~ v't
999'~Wf:
n Sl!S!^ palewlls3
900~ :Al!:>!U4la/a:>eJ pal!elap Aq 'Sl!S!^ 03 palelaJ-6nJO
~O alqel