Medical Emergencies and Death from Drug Abuse

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Medical Emergencies and Death from Drug Abuse

Each year, thousands of individuals of all ages visit hospital emergency departments due to medical problems stemming from drug abuse. Sometimes they die as a result of these problems. Efforts to keep track of these visits give scientists a clue as to the scope of drug abuse in the United States and which drugs are responsible for medical emergencies. These figures can also help experts spot emerging trends in the use of new drugs.

The Drug Abuse Warning Network

The Drug Abuse Warning Network (DAWN) was created in 1972 by the U.S. Department of Justice as a surveillance system for new drugs of abuse. It is a voluntary national data collection system that gathers information on substance abuse resulting in visits to hospital emergency departments in the continental United States. DAWN does not measure prevalence, or the frequency of drug use in the population. Instead, it relies on a number of hospitals that give a representative sample of emergency department visits due to drug use. This data can than be interpreted for the population at large.

DAWN uses drug episodes and drug mentions to organize the information it provides. A drug-related episode is an emergency department visit that was caused by or related to the use of an illegal drug or the nonmedical use of a legal drug. This is when individuals take prescription or over-the-counter medications for uses for which they were not intended, and they become ill as a result. A drug mention refers to a substance that an individual mentioned during a drug-related visit. Since up to four drugs are sometimes reported for each drug abuse episode, there are more mentions than episodes reported.

It is important to keep in mind that while DAWN data are widely used to monitor patterns and trends of drug abuse, the information represents only individuals who go to an emergency department because of their drug use. These are the most serious cases. There are many individuals who take drugs and become ill but do not visit a hospital emergency department. However, they are not represented in the DAWN report. In addition, DAWN keeps track of different types of cases. Many cases are due to overdose, but also included are cases where the individual is seeking detoxification (treatment to help stop drug abuse), or those suffering from medical problems brought on by chronic drug use. DAWN cases do not include accidental inhalation or ingestions of a drug, or negative reactions to prescription or over-the-counter drugs that were taken at the proper dosage.

Trends in Emergency Department Visits

In 2000 the most recent year for which data are available, there were 601,563 drug-related emergency department episodes reported through DAWN. On average, 1.8 drugs were reported per episode for a total of 1,099,306 drug mentions. These figures are similar to results for 1999.

From 1999 to 2000, mentions of heroin increased 15 percent, mentions of amphetamines increased 37 percent and those for methamphetamines increased by 29 percent. Cases of alcohol in combination with other drugs, cocaine and marijuana, were unchanged. Several newer substances of abuse had substantial increases from 1999 to 2000: ecstasy (MDMA) went up 58 percent and PCP went up 48 percent. By looking at these numbers, one can begin to see how DAWN helps health experts and policymakers understand emerging trends in drug abuse.

In addition to the major substances of abuse mentioned above, DAWN tracks nonmedical use of prescription and over-the-counter drugs. These accounted for 43 percent of total drug mentions in 2000. It is not known whether these visits were for the person for whom the drug was prescribed or for someone else. The drugs that fall into this category were mainly of two types in 2000: drugs used to treat psychological problems (such as antidepressants , drugs that treat addiction, and drugs for panic disorder) and central nervous system drugs (such as analgesics, or pain relievers).

From 1994 to 2000, mentions of narcotic analgesic drugs rose 85 percent. This represents a 40 percent increase from 1998 to 2000 and a 19 percent increase from 1999 to 2000. The most frequently mentioned narcotic analgesics were: hydrocodone (Vicodin), oxycodone (OxyContin), methadone (used to treat heroin addiction), propoxyphene (Darvon), codeine, and meperidine (Demerol). In particular, use of hydrocodone, oxycodone, and methadone has increased substantially not just over the last two years, but over the last several years. Since 1994, use of these drugs has increased 100 percent or more.

The majority of drug-related episodes (56%) involved more than one drug. In nearly half the episodes involving heroin, it was the only drug used, whereas cocaine and marijuana episodes tended to involve other drugs. By far the most common reason for an emergency department visit was overdose, which involved 44 percent of these cases. About half of drug-related emergency department visits resulted in admission to the hospital.

While visits to emergency departments due to alcohol use by itself are not included in DAWN, alcohol in combination with other drugs was mentioned in 34 percent of drug episodes in 2000. Alcohol remains the most common substance reported. Its use in combination with other drugs was virtually unchanged between 1998 and 2000.

The most frequently mentioned illegal substance in emergency department visits is cocaine, accounting for 29 percent of episodes, followed by marijuana and heroin. Almost one-quarter of the cocaine mentions in 2000 were attributed to crack cocaine, which showed no significant change since 1994. It is possible, however, that since most cocaine episodes are reported as simply cocaine, a portion of these might in fact be due to crack.

From 1999 to 2000, there was a 20 percent increase in emergency department visits due to drug use for patients age 12 to 17. Patients between the ages of 18 and 34 had the highest rates of emergency department visits, followed by those in the 12- to 17-year-old range. Patients in this group had the lowest rates of cocaine and heroin mentions. Among adolescents aged 12 to 17, there was a sharp increase in mentions of marijuana or hashish (a drug related to marijuana) between 1990 and 1999. In addition, long-term data suggest that methamphetamine (speed), cocaine, heroine, and morphine use is on the rise in this age group.

What do the Trends Indicate?

For the period between 1994 and 2000, there has been a 16 percent rise in drug-related emergency department visits and a 22 percent increase in drug mentions. Among illegal substances of abuse, several showed increased usage from 1999 to 2000: heroin, amphetamines, methamphetamines, ecstasy, PCP, and combinations of these. In 1994, emergency department mentions of so-called club drugs such as ecstasy and GHB were extremely low, but recently they have shown tremendous growth. This probably indicates an important emerging trend, which has already been documented in the media.

Although emergency department visits are an important factor to keep in mind when tracking drug abuse, they do not necessarily give the whole picture. Individuals who seek treatment at a hospital may be quite different from other drug-using individuals in the rest of the community. According to the 2000 National Household Survey on Drug Abuse (NHSDA), 8.8 million Americans over the age of 12 have used prescription drugs in the previous year for purposes other than those for which they were intended. The types of drugs they used were pain relievers, tranquilizers , stimulants , and sedatives .

By tracking uses of particular drugs, DAWN is an indicator of which drugs are declining in use and which are on the rise. For example, certain types of antidepressants and codeine played a role in emergency department visits more often several years ago than they are today. Other drugs, such as the club drugs and certain analgesics, have seen a dramatic rise, suggesting a growing problem. While some of these, for example OxyContin, have received considerable media attention, others, such as Vicodin, have not.

Common Reasons for Hospital Visits

Individuals seek treatment for drug abuse because of overdoses or because of the chronic effects of habitual drug use. Below are some of the commonly abused drugs and the intoxication effects that might prompt a hospital visit.

Marijuana/hashish: respiratory infections, cough, increased heart rate, anxiety, panic attacks
Depressants, such as barbiturates, GHB, methaqualone (Quaalude), benzodiazepines (such as Valium, Xanax, and Halcion): slow pulse and breathing, lowered blood pressure, respiratory depression and arrest (slowed or stopped breathing), loss of consciousness, dizziness, nausea/vomiting, coma
PCP: Increased heart rate and blood pressure, impaired motor functioning (uncoordination), numbness, nausea/vomiting
LSD, mescaline: sleeplessness, numbness, weakness, increased heart rate and blood pressure
Codeine, heroin, morphine, opium, fentanyl: respiratory depression and arrest, nausea, loss of consciousness, coma
Amphetamine, cocaine, ecstasy, methamphetamine, methylphenidate (such as Ritalin): increased heart rate and blood pressure, rapid or irregular heart beat, respiratory failure, heart failure
Inhalants: headache, vomiting, nausea/vomiting, loss of motor coordination, loss of consciousness

Deaths Due to Drug Abuse

According to the Centers for Disease Control and Prevention, almost 17,000 people died of drug-induced causes in the United States in 1998. This excludes accidents, homicides, newborn deaths due to a mother's drug use, and other causes indirectly related to drug use. DAWN also collects data on both drug-induced and drug-related deaths. In 2000 overdose deaths accounted for more than half of all deaths reported to DAWN in thirty cities. In some cities, however, deaths were more commonly drug-related rather than actual overdoses. Individuals under twenty-five accounted for fewer than 20 percent of DAWN cases across all metropolitan areas. In about half the cities, this group accounted for fewer than 10 percent of drug abuse deaths.

See Organizations of Interest at the back of Volume 2 for address, telephone, and URL.

Since multiple drugs are commonly involved in a drug death, it is often impossible to attribute it to any particular substance. The most common combinations of drug use that resulted in death were alcohol and cocaine, alcohol and heroin/morphine, cocaine and heroin/morphine, or all three, sometimes in combination with narcotic analgesics. Narcotic analgesics, which include drugs such as methadone, oxycodone, and codeine, were almost always mentioned in connection with other drugs. These substances were rarely the sole cause of death in reported cases.

Typical cases in 2000 and previous years involved between two and four different drugs, with the majority of cases involving three substances. The most common ones were heroin, cocaine, and alcohol. In many cities, these three drugs accounted for 40 percent or more of all drug deaths. Club drugs accounted for very few deaths in any of the DAWN metropolitan areas.

Clearly, medical problems and death due to drug abuse represent a major problem in American society. While data tracking systems such as DAWN give a numerical value to the toll of drug abuse in terms of medical issues, they cannot convey the pain and suffering of drug abuse victims, including the friends and family of those who take drugs and are harmed by them. However, by tallying hospital records of medical visits and deaths related to drug use, it is hoped that experts will gain a better understanding of the cost to society.

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