Emergency Room Visits Climb for Misuse of Prescription and Over-the-Counter Drugs

Emergency room visits related to the nonmedical use of pharmaceuticals, including prescription and over-the-counter drugs, increased 21 percent from 2004 to 2005, according to the latest estimates from the Drug Abuse Warning Network, 2005: National Estimates of Drug-Related Emergency Department Visits. Visits related to illicit drug use or alcohol were unchanged for the same time period.

The DAWN report, published by the Substance Abuse and Mental Health Services Administration, shows that the total number of drug-related emergency room visits remained stable from 2004 to 2005. However, visits involving the nonmedical use of prescription or over-the-counter drugs increased from 495,732 to 598,542. The majority of these visits involved multiple drugs.

“When people show up at emergency rooms as a result of drug misuse or abuse, it provides an opportunity that is too often missed to reach out with counseling or other options that could help prevent further consequences,” said Terry Cline, PhD, SAMHSA Administrator. “Our Screening, Brief Intervention, Referral and Treatment initiative is designed to take advantage of the opportunity in emergency department and other settings by preventing progression toward addiction.”

Anti-anxiety drugs (benzodiazepines, up 19 percent), prescription pain relievers (up 24 percent) and methadone (up 29 percent) were among those most frequently implicated in nonmedical use. DAWN does not distinguish between methadone in pill form, which is prescribed for pain, and methadone in liquid form, which is used for the treatment of heroin addiction.

The 2005 estimates from DAWN provide the first opportunity since the redesign of the survey to examine changes over time in drug-related emergency room visits. Because of the changes, only 2004 and 2005 can be compared.

“We are in danger of becoming a nation of pill poppers,” said John Walters, Director of National Drug Control Policy. “The data released today put in stark relief the message we've been trying to get out in recent years: Prescription drugs can be lifesaving medicines when used properly, but their misuse can lead to addiction, suffering, and even death. The increase in the abuse of prescription drugs has been fueled worldwide by misperceptions of the potential harms of these powerful drugs, making it more critical than ever that we raise public awareness about the dangers of their misuse.”

Of the 1.4 million emergency room visits associated with drug misuse or abuse recorded by DAWN in 2005, 31 percent involved illicit drugs only and 27 percent involved pharmaceuticals only. An additional 36 percent involved combinations of illicit drugs, alcohol, and/or pharmaceuticals. Overall, there were 108 million emergency room visits in U.S. hospitals during the year.

DAWN shows that over half of all the drug-related visits during 2005 involved an illicit drug alone or in combination with another drug. Cocaine was the most frequently cited, with 448,481 visits; marijuana was involved in 242,200 visits; heroin, in 164,572 visits; and stimulants, such as amphetamines and methamphetamine, in 138,950 visits. The numbers for heroin and stimulants were similar when the margin of error is considered. Other illicit drugs, such as PCP, Ecstasy, and GHB, were involved much less frequently.

About one-third of all drug-related visits involved alcohol in combination with another drug (all ages) or alcohol alone (for patients under 21). Since DAWN does not account for emergency room visits involving alcohol alone in adults, the actual number of visits involving alcohol is higher. Alcohol, when it is the only drug implicated in a visit, is included in the DAWN estimates for patients younger than age 21; when alcohol is present in combination with another drug, it is included for patients of all ages.

For patients ages 12 to 17 years old, 56,978 visits involved alcohol, and for patients ages 18 to 20, the number of visits climbs to 88,781. The rate of alcohol-only visits for the 18- to 20-year-olds was 3.5 times that for patients ages 12 to17.

DAWN estimates that 27 percent of emergency room visits were related to the use of alcohol in combination with another drug. Alcohol was most frequently combined with cocaine (86,482 visits), marijuana (33,643 visits), cocaine and marijuana (22,377 visits) and heroin (12,797).

DAWN relies on a national sample of general, non-Federal hospitals operating 24-hour emergency rooms. Estimates for 2005 are based on data submitted by 355 hospitals. In each participating hospital, medical records are reviewed retrospectively to find the emergency room visits that were related to recent drug use.

Drug Abuse Warning Network, 2005: National Estimates of Drug-Related Emergency Department Visits is available on the Web at http://dawninfo.samhsa.gov. Copies may be obtained free of charge by calling SAMHSA’s Health Information Network at 1-877-SAMHSA-7 (1-877-726-4727). Request inventory number SMA 07-4256. For related publications and information, visit http://www.samhsa.gov/.