1. Findings from the Drug Abuse Warning Network Narcotic Analgesics Judy K. Ball, Ph.D., M.P.A. Office of Applied Studies, Substance Abuse and Mental Health Services Administration 31 January 2002

2. DAWN ED Sample Stratified probability sample Short-term, general, non-Federal hospitals operating 24-hour emergency departments Representative estimates for: –Coterminous U.S. –21 major metropolitan areas

3. DAWN Cases Age 6-97 treated in ED ED visit related to drug abuse –Illicit drugs –Non-medical use of Rx/OTCs Motive for drug use –Dependence –Psychic effects –Suicide attempt/gesture

4. Drug Detail in DAWN Varies, based on detail in source record –Brand (trade) names – MSContin –Chemical names – morphine sulfate –Generic names – morphine –Nonspecific names – opiates –Street names No estimates by brand (trade) name

5. DAWN National Estimates, 2000 Drug-related ED visits Drug "mentions" Drugs per visit ED visits, any reason Responding hospitals 601,563 1,099,306 1.8 96,163,000 466

6. Drugs with High Abuse Potential Cocaine Heroin Marijuana Benzodiazepines Antidepressants Narcotic Alcohol-in-combination Other Analgesics Source: Drug Abuse Warning Network Mentions

7. ED Mentions of Narcotic Analgesics Mentions Source: Drug Abuse Warning Network Narcotic analgesic, NOS Morphine Propoxyphene Oxycodone Hydrocodone Codeine

8. Narcotic Analgesics, 2000 NOS Hydrocodone Oxycodone Propoxyphene Codeine Morphine 25,935 20,098 10,825 5,485 5,295 2,483 +40% +48% +108% n.s. -20% n.s. ED Mentions1998 Source: Drug Abuse Warning Network n.s. +32% +68% n.s. 1999 % change from

9. Rising Trends, Narcotic Analgesics Oxycodone Hydrocodone Narcotic analgesic, NOS Source: Drug Abuse Warning Network Mentions

10. Trends, Narcotic Analgesics Morphine Propoxyphene Source: Drug Abuse Warning Network Mentions Codeine

11. DAWN Mortality Component Data from medical examiners/coroners –Drug-induced deaths (overdoses) –Drug-related deaths Not a probability sample –No statistical estimates –Partial/full participation in 40 metropolitan areas –Review criteria vary across jurisdictions –No national estimates

12. Metropolitan Areas, ED & Mortality –Baltimore –Boston –Denver –Los Angeles –Miami –San Diego –San Francisco Consistent DAWN coverage in 2000: Rates/100,000 population for comparisons

13. Narcotics NOS (rates per 100,000 population) ED visits Deaths Source: Drug Abuse Warning Network

14. Oxycodone (rates per 100,000 population) ED visits Deaths Source: Drug Abuse Warning Network

15. Hydrocodone (rates per 100,000 population) ED visits Deaths Source: Drug Abuse Warning Network

16. Limitations of DAWN Intent to abuse drug must be documented in source record Cannot distinguish diversion vs. abuse of legitimate prescriptions Variable reporting of nonspecific terms No information on health status, presenting complaint, diagnoses

17. Strengths of DAWN Extensive drug detail –Illicit, prescription, and over-the-counter –High and low frequency events –New and old drugs –Statistically valid ED estimates, trends Timely Major changes planned for next 5 years