Medical Emergencies Involving Drug Abuse/Misuse Victoria Albright, MA RTI International, Research Triangle Park, NC Elizabeth Crane, PhD, MPH SAMHSA/CBHSQ Presented at The 138th Annual Meeting of the American Public Health Association Denver, CO November 6 10, 2010 www.rti.org Phone 919-541-6805 Fax 919-541-7250 e-mail valbright@rti.org RTI International is a trade name of Research Triangle Institute
Presenter Disclosures Victoria Albright No relationships to disclose.
Goal of Presentation Raise awareness of level and types of drugs involved in medical emergencies Focus on: ED visits involving use of illicit drugs as well as misuse/abuse of pharmaceuticals Trends among youth and young adults, metro areas, and over time
DAWN 2008 Drug Abuse Warning Network Public health surveillance system Emergency department (ED) visits involving drugs Produced by SAMHSA s Center for Behavioral Health Statistics and Quality (CBHSQ) All data presented here are available on web: http://dawninfo.samhsa.gov/data/
DAWN Emergency Departments Non-Federal general hospitals with full-time EDs (24/7); no specialty hospitals National sample of hospitals Nationally representative 12 oversampled metropolitan areas ED records reviewed to identify DAWN cases
DAWN Emergency Department Visits ED visits involving recent drug use All motives All ages All types of drugs Illicit drugs Pharmaceuticals (Rx, OTC meds, dietary supplements) Nonpharmaceutical inhalants Alcohol when combined with drugs All alcohol for patients under 21
Mediating Factors Between Drug Misuse/Abuse and ED visits DAWN data does not speak to reasons behind variations in the level and type of drug-related ED visits. Examples of mediating factors are: Frequency of misuse/abuse Likelihood drug will cause medical emergency Access to emergency care Likelihood that patient will seek care
Table 1: ED Visits Misuse/Abuse of Illicit Drugs: 2008 700 600 ED visits in 1,000s 500 400 300 200 100 0 Source: DAWN Trend Tables, 2008
Survey Error; or What differences are significant? DAWN Trend Tables provide several indicators of variance and significant differences Relative Standard Error (RSE) of estimates (percent) Confidence intervals around estimates Significance tests comparing estimates across years
Use CI for Comparing Estimates 2008 cocaine visit estimate 482,188 visits Lower confidence level 336,462 Upper confidence level 627,913 2008 marijuana visit estimate 374,435 visits Lower confidence limit 263,546 Upper confidence limit 485,324
Table 2: ED Visits Misuse/Abuse of Illicit Drugs: 2008 ED visits per 1,000s 700 600 500 400 300 200 100 0 Lower CL Estimate Higher CL Source: DAWN Trend Tables, 2008
Table 3. Misuse/Abuse of Illicit Drugs, by Age: 2008 500 450 ED visits per 100,000 population 400 350 300 250 200 150 100 50 12-17 18-20 21-24 25-29 0 Cocaine Heroin Marijuana Stimulants Source: DAWN Trend Tables, 2008
Table 4. ED Visits Misuse/Abuse of Illicits and Pharms: 2004 2008 1,200 1,000 ED Visits in 1,000s 800 600 400 2004 2005 2006 2007 2008 200 0 Illicits Pharms Source: DAWN Trend Tables, 2008
Table 5: Misuse/Abuse of Pharmaceuticals: 2008 ED visits in 1,000s 600 500 400 300 200 100 0 Principal drug Other drugs Source: DAWN Trend Tables, 2008
Table 6. Misuse/Abuse of Pharmaceuticals, by Age: 2008 500 ED visits per 100,000 population 450 400 350 300 250 200 150 100 50 12-17 18-20 21-24 25-29 0 Pain relievers Narcotic pain relievers Drugs for insomnia & anxiety Source: DAWN Trend Tables, 2008
Table 7. Misuse/Abuse by Area New York - 5 Bor Chicago Boston Houston Detroit Seattle Phoenix Minneapolis Denver San Francisco-SF Div San Diego Miami - Dade Miami - Fort Lauderdale Boston New York - 5 Boro. San Francisco-SF Div Chicago Detroit Seattle Minneapolis Denver Nation Houston Phoenix Miami - Dade San Diego Miami - Fort Lauderdale 0 20 40 60 80 100 ED Visits in 1,000s 0 500 1,000 1,500 ED Visits per 100,000 pop Source: DAWN Trend Tables, 2008
Summary Cocaine, marijuana are the most common illicit drugs Narcotic pain relievers and benzodiazepines are most common drugs in misuse and abuse of pharmaceuticals Illicit drugs stable since 2004, but misuse and abuse of pharmaceuticals increasing Different patterns in ED visits for different drugs, age groups, and locations
Center for Behavioral Health Statistics and Quality, SAMHSA Drug Abuse Warning Network National Survey on Drug Use and Health Treatment Episode Data Set National Survey of Substance Abuse Treatment Services Substance Abuse and Mental Health Data Archive