Post on 17-Dec-2015
transcript
Findings from theDrug 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
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
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
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
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
0
100,000
200,000
300,000
400,000
500,000
600,000
700,000
800,000
900,000
1994 1995 1996 1997 1998 1999 2000
Drugs with High Abuse Potential
Cocaine
Heroin
Marijuana
Benzodiazepines
Antidepressants
Narcotic
Alcohol-in-combination
Other
Analgesics
Source: Drug Abuse Warning Network
Mentions
ED Mentions of Narcotic Analgesics
0
10,000
20,000
30,000
40,000
50,000
60,000
70,000
1994 1995 1996 1997 1998 1999 2000
Mentions
Source: Drug Abuse Warning Network
Narcotic analgesic, NOS
Morphine
Propoxyphene
Oxycodone
Hydrocodone
Codeine
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 Mentions 1998
Source: Drug Abuse Warning Network
n.s.
+32%
+68%
n.s.
n.s.
n.s.
1999% change from
Rising Trends, Narcotic Analgesics
0
5,000
10,000
15,000
20,000
25,000
30,000
1994 1995 1996 1997 1998 1999 2000
Oxycodone
Hydrocodone
Narcotic analgesic, NOS
Source: Drug Abuse Warning Network
Mentions
Trends, Narcotic Analgesics
0
500
1,000
1,500
2,000
2,500
3,000
3,500
4,000
4,500
1994 1995 1996 1997 1998 1999 2000
Morphine
Propoxyphene
Source: Drug Abuse Warning Network
Mentions
Codeine
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
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
0.2
0.4
0.7
0.8
18.0
9.5
10.6
12.4
64.8
21.5
24.6
0 10 20 30 40 50 60 70
San Francisco
San Diego
Miami
Los Angeles
Denver
Boston
Baltimore
Narcotics NOS (rates per 100,000 population)
ED visits
Deaths
Source: Drug Abuse Warning Network
0.3
0.5
1.0
0.2
0.3
0.6
1.1
1.9
3.7
0.6
4.3
5.4
1.8
15.8
0 5 10 15 20
San Francisco
San Diego
Miami
Los Angeles
Denver
Boston
Baltimore
Oxycodone (rates per 100,000 population)
ED visits
Deaths
Source: Drug Abuse Warning Network
0.6
0.9
0.7
0.9
0.4
0.3
0.2
10.3
1.9
5.4
8.0
1.7
9.7
5.3
0 5 10 15 20
San Francisco
San Diego
Miami
Los Angeles
Denver
Boston
Baltimore
Hydrocodone (rates per 100,000 population)
ED visits
Deaths
Source: Drug Abuse Warning Network
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
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