1. Findings from the Drug Abuse Warning Network Immediate and Sustained Release Opioid Analgesics Judy K. Ball, Ph.D., M.P.A. Office of Applied Studies, Substance Abuse and Mental Health Services Administration 9 September 2003

2. Emergency Departments  Stratified probability sample  Short-term, general, non-Federal hospitals operating 24-hour emergency departments  Representative estimates for coterminous U.S.  437 hospitals (80%) participated in 2002

3. DAWN Cases  Age 6-97 treated in ED  ED visit related to drug abuse  Abuse defined by patient’s motive for drug use –Dependence –Psychic effects –Suicide attempt/gesture

4. Drug Detail in DAWN  Illicit, prescription, OTC drugs  Specificity depends on medical record –Brand (trade) names – MSContin –Chemical names – morphine sulfate –Generic names – morphine –Classes – opiates –Street names  Multiple drugs per visit – drug “mentions”

5. Mentions of Selected Drugs in ED Visits Related to Drug Abuse Source: Drug Abuse Warning Network

6. ED Mentions of Opiates/Opioids, 2002 Fentanyl 1,506 Morphine 2,775 Unnamed Hydrocodone All others Oxycodone Source: Drug Abuse Warning Network

7. Narcotic Analgesics, by Type Type DrugIRSRUnspecified Unnamed Hydrocodone Hydromorphone Fentanyl Morphine Oxycodone

8. Unnamed Opiates, ED Mentions Source: Drug Abuse Warning Network

9. Hydrocodone, ED Mentions Source: Drug Abuse Warning Network

10. Hydromorphone, ED Mentions Source: Drug Abuse Warning Network

11. Fentanyl, ED Mentions Source: Drug Abuse Warning Network

12. Morphine, ED Mentions Source: Drug Abuse Warning Network

13. Oxycodone, ED Mentions Source: Drug Abuse Warning Network

14. Oxycodone, ED Mentions Source: Drug Abuse Warning Network

15. Oxycodone, ED Mentions Source: Drug Abuse Warning Network

16. Oxycodone, ED Mentions Source: Drug Abuse Warning Network

17. Oxycodone ED Mentions, 1997-2002 1997 IR 2002 SR IR 2001 SR IR 2000 SR IR 1999 SR IR 1998 SR IR

18. Drugs in Combination, 2002 FentanylHydrocodoneMorphineOxycodone Total visits 1,50625,1092,77520,748 Other drugs in visit: Multiple drugs 43%78%66%71% Major substance of abuse 16%43%38%44% Benzodiazepine 21%26%13%21% Other narcotic 17%14%27%18% Source: Drug Abuse Warning Network

19. Limitations of DAWN  Reportable cases of drug abuse, based on patient’s intent  Variable reporting of nonspecific terms  Cannot distinguish diversion vs. abuse with legitimate prescriptions  No information on health