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