DAWN Report: Illicit Drug-Related Emergency Department Visits in Metropolitan Areas of the United States: 2009, The

2011·0.46 MB·English

December 15, 2011
Illicit Drug-Related Emergency
Department Visits in Metropolitan
Areas of the United States: 2009
P
atterns and types of drug use,
In Brief
misuse, and abuse vary widely
across communities, metro areas,
● Rates of emergency department (ED)
visits involving illicit drugs were higher in regions, and states.1 These differing
Boston (571 per 100,000 pop.), New York patterns across varied geographic areas
City (555 per 100,000 pop.), Chicago
must be understood if appropriate
(507 per 100,000 pop.), and Detroit (462
prevention and treatment interventions
per 100,000 pop.) than in the Nation as a
whole (317 per 100,000 pop.) are to be undertaken. As the front
line of prehospital care for individuals
● In comparison with the national rate
experiencing acute adverse consequences
(69 per 100,000 pop.), the rates of ED
visits involving heroin were higher in of drug use, emergency departments
Boston (251 per 100,000 pop.), Chicago
(EDs) provide valuable insights into the
(216 per 100,000 pop.), New York City
more serious aspects of certain patterns
(153 per 100,000 pop.), Detroit (150
per 100,000 pop.), and Seattle (118 per of drug use.
100,000 pop.) The Drug Abuse Warning Network
(DAWN) is a public health surveillance
● Compared with the national rate (69 per
100,000 pop.), five metropolitan areas system that monitors drug-related ED
showed higher rates of visits involving
visits in the United States. To be a DAWN
illicit drugs in combination with alcohol:
case, the ED visit must have involved a
New York City (223 per 100,000 pop.),
Boston (153 per 100,000 pop.), San drug, either as the direct cause of the
Francisco (150 per 100,000 pop.), visit or as a contributing factor. Data
Chicago (120 per 100,000 pop.), and
are collected on numerous illicit drugs,
Detroit (112 per 100,000 pop.)
including cocaine, marijuana, heroin,
The DAWN Report is published periodically by the Center for Behavioral Health Statistics and Quality (formerly the Office of Applied Studies), Substance Abuse
and Mental Health Services Administration (SAMHSA). All material appearing in this report is in the public domain and may be reproduced or copied without
permission from SAMHSA. Additional copies of this report or other reports from the Center for Behavioral Health Statistics and Quality are available online:
http://oas.samhsa.gov. Citation of the source is appreciated. For questions about this report, please e-mail: [email protected].
DAWN_023
DAWN REPORT: IllIcIT DRUg-RElATED EMERgENcy DEPARTMENT VISITS IN
METROPOlITAN AREAS Of THE UNITED STATES: 2009 December 15, 2011
and stimulants (i.e., amphetamines and
Overview
methamphetamines). This issue of The DAWN
Report focuses on geographic variations in ED In 2009, there were an estimated 973,591 ED
visits involving illicit drug use in 2009, comparing visits involving illicit drug use in the Nation as
11 metropolitan statistical areas (MSAs) or a whole, which occurred at a rate of 317 per
metropolitan divisions with the national rates 100,000 pop. (Figure 1). Four metropolitan areas
(Table 1).2 had significantly higher rates than the Nation for
Table 1. Definitions and Abbreviations for the Drug Abuse Warning Network (DAWN) Metropolitan
Statistical Areas (MSAs) and Divisions
Name of MSA or Report
Areas Included within MSA or Division
Division a,b,c Abbreviation
Boston-Cambridge- Essex County, MA; Middlesex County, MA; Norfolk County, MA; Plymouth County, MA; Boston
Quincy, MA-NH, MSA Suffolk County, MA; Rockingham County, NH; and Strafford County, NH
Chicago-Naperville- Cook County, IL; DeKalb County, IL; DuPage County, IL; Grundy County, IL; Kane County, IL; Chicago
Joliet, IL-IN-WI, MSA Kendall County, IL; Lake County, IL; McHenry County, IL; Will County, IL; Jasper County, IN;
Lake County, IN; Newton County, IN; Porter County, IN; and Kenosha County, WI
Denver-Aurora, CO, Denver, CO; Aurora, CO; Adams County, CO; Arapahoe County, CO; Broomfield County, CO; Denver
MSA Clear Creek County, CO; Denver County, CO; Douglas County, CO; Elbert County, CO; Gilpin
County, CO; Jefferson County, CO; and Park County, CO
Detroit-Warren- Detroit, MI; Warren, MI; Livonia, MI; Dearborn, MI; Farmington Hills, MI; Troy, MI; Southfield, Detroit
Livonia, MI, MSA MI; Pontiac, MI; and Taylor, MI
Miami-Dade County Miami, FL; Miami Beach, FL; and Dade County, FL Miami-Dade
Division
Miami-Fort Fort Lauderdale, FL; Pompano Beach, FL; Deerfield Beach, FL; West Palm Beach, FL; Fort
Lauderdale Division Boca Raton, FL; Boynton Beach, FL; Broward County, FL; and Palm Beach County, FL Lauderdale
Minneapolis-St. Paul- Minneapolis, MN; St. Paul, MN; Bloomington, MN; Plymouth, MN; Eagan, MN; Eden Prairie, Minneapolis
Bloomington, MN-WI, MN; Minnetonka, MN; Anoka County, MN; Carver County, MN; Chisago County, MN; Dakota
MSA County, MN; Hennepin County, MN; Isanti County, MN; Ramsey County, MN; Scott County,
MN; Sherburne County, MN; Washington County, MN; Wright County, MN; Pierce County, WI;
and St. Croix County, WI
New York-5 Boroughs The New York-5 Boroughs Division includes Bronx County, NY [Bronx]; Kings County, NY New York City
Division [Brooklyn]; New York County, NY [Manhattan]; Queens County, NY [Queens]; and Richmond
County, NY [Staten Island]
Phoenix-Mesa- Maricopa County, AZ, and Pinal County, AZ Phoenix
Scottsdale, AZ, MSA
San Francisco Marin County, CA; San Mateo County, CA; and San Francisco County, CA San Francisco
Metropolitan Division
Seattle-Tacoma- Seattle, WA; Tacoma, WA; Bellevue, WA; Everett, WA; Kent, WA; and Renton, WA Seattle
Bellevue, WA, MSA
a Data for each MSA or division are representative of the 24-hour, general purpose EDs in that area.
b Unless otherwise noted, DAWN defines metropolitan areas using the MSA and division definitions issued by the Office of Management and Budget
(OMB) in June 2003 (http://www.whitehouse.gov/omb/bulletins_b03-04). DAWN uses these names and definitions even if the names or composition were
changed by OMB. More detailed information about these areas may be accessed at: http://www.oas.samhsa.gov/2k11/DAWN2009Methods/DAWN2k9_
MethodologyReport.htm
c DAWN reports metropolitan area estimates for 13 metropolitan areas. In this report, two areas were excluded: the Houston-Baytown-Sugar Land, TX, MSA
(or “Houston”) and the San Diego-Carlsbad-San Marcos, CA, MSA (or “San Diego”). Both were excluded because the 2009 estimates were unreliable due
to low representation in those areas for that year.
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DAWN REPORT: IllIcIT DRUg-RElATED EMERgENcy DEPARTMENT VISITS IN
December 15, 2011 METROPOlITAN AREAS Of THE UNITED STATES: 2009
ED visits involving illicit drugs: Boston (571 per in New York City (309 per 100,000 pop.), Boston
100,000 pop.), New York City (555 per 100,000 (244 per 100,000 pop.), Chicago (244 per 100,000
pop.), Chicago (507 per 100,000 pop.), and pop.), and Detroit (217 per 100,000 pop.).
Detroit (462 per 100,000 pop.). The national rate of ED visits involving
heroin was 69 per 100,000 pop. (Figure 1). In
ED Visits Involving Specific Illicit Drugs comparison, the rates of ED visits involving
heroin were significantly higher in Boston (251
Differences by specific illicit drugs were per 100,000 pop.), Chicago (216 per 100,000
examined by metropolitan area, including pop.), New York City (153 per 100,000 pop.),
cocaine, marijuana, heroin, and stimulants (i.e., Detroit (150 per 100,000 pop.), and Seattle (118
amphetamines and methamphetamines). The per 100,000 pop.).
national rate for ED visits involving cocaine Nationally, ED visits involving stimulants
was 138 per 100,000 pop. in 2009 (Figure 1). occurred at a rate of 30 per 100,000 pop. (Figure
Compared with the national rate, the rates of ED 1). Rates of ED visits involving stimulants were
visits involving cocaine were significantly higher significantly higher than those in the Nation
figure 1. Rates of Emergency Department (ED) Visits Involving Illicit Drugs, by Metropolitan Statistical
Area (MSA) or Metropolitan Division: 2009
390 West Midwest 2* 571*
SN e=a 1571tt3l,118*e291009 65* 3251185717136 D46et217*roi150*t 1665* Northeast Bos244*to251*n 17010*
3 Minneapolis N = 20,345 N = 26,189
9
2 N = 10,633 7*
53523269115159* 288 DN e=n 1107v,4e527r712446 CN50 h=i 244*c4a8216*,g6o11311 6* N555*ew309* Y153*ork182 C6*ity
San Francisco 1 36* N = 46,615
8199
N = 9,555 6
Phoenix
N = 12,566
2
2347
1 4
5 15*96*
5
358 Fort Lauderdale
2 5 N = 7,054
17 Rate of ED Visits per 100,000 Population South 13
31386912330 CAlol cIlalicinite D-Inruvgo-lvInevdo ElvDed V EisDits V isits MN i=a m8,8i**-8D5ade6*
Heroin-Involved ED Visits
National
Marijuana-Involved ED Visits
N = 973,591
Stimulant-Involved ED Visits
* The difference between the metropolitan area and the Nation was statistically significant at the .05 level.
** Estimates are suppressed due to low statistical precision.
Source: 2009 SAMHSA Drug Abuse Warning Network (DAWN).
Page 3
DAWN REPORT: IllIcIT DRUg-RElATED EMERgENcy DEPARTMENT VISITS IN
METROPOlITAN AREAS Of THE UNITED STATES: 2009 December 15, 2011
figure 2. Rates of Emergency Department (ED) Visits Involving Illicit Drugs Only in Metropolitan
Areas: 2009
400
Northeast Midwest South West
350 328
313
n
o
ati 300 275
ul 260
p 251
o
P 250 229
0
0
0
0, 200 184
0
er 1 155 146 143 161
p 150
s
sit 112
D Vi 100
E
50
0
Nation BostoNne*w York City* Chicago* Detroit*Minneapolis Fort LauderdaleMiami-Dade Denver PhoeSniaxn Francisco* Seattle
* The difference between the metropolitan area and the Nation was statistically significant at the .05 level.
Source: 2009 SAMHSA Drug Abuse Warning Network (DAWN).
figure 3. Rates of Emergency Department (ED) Visits Involving Illicit Drugs in combination with
Alcohol in Metropolitan Areas: 2009
400
Northeast Midwest South West
350
n
o
ati 300
ul
p
o
P 250
0 223
0
0
0, 200
0
1
er 153 150
p 150
s 120
sit 112 106 111
ED Vi 100 69 50 90 61 84
50
0
Nation BostoNne*w York City* Chicago* Detroit*Minneapolis Fort LauderdaleMiami-Dade Denver PhoeSniaxn Francisco* Seattle
* The difference between the metropolitan area and the Nation was statistically significant at the .05 level.
Source: 2009 SAMHSA Drug Abuse Warning Network (DAWN).
Page 4
DAWN REPORT: IllIcIT DRUg-RElATED EMERgENcy DEPARTMENT VISITS IN
December 15, 2011 METROPOlITAN AREAS Of THE UNITED STATES: 2009
as a whole in San Francisco (159 per 100,000
Discussion
pop.), Phoenix (96 per 100,000 pop.), and Seattle
(65 per 100,000 pop.). Several metropolitan areas The 2011 National Prevention Strategy
(all with rates of 10 per 100,000 pop. or less)— encourages local governments to reduce drug
including Boston, Fort Lauderdale, Miami-Dade, use and its associated negative outcomes and
Chicago, New York City, and Detroit—had lower highlights the accomplishments of the Drug
rates than those in the Nation as a whole. Free Communities Program.3 ED data can
The rates of ED visits involving marijuana help identify how often specific illicit drugs are
ranged from 93 per 100,000 pop. (Phoenix) to involved in medical emergencies; such local
182 per 100,000 pop. (New York City) (Figure 1). information on drug abuse and its negative
None of the metropolitan areas had rates that consequences can be used to plan for prevention
were statistically different from the national rate activities, emergency medical services, and
(123 per 100,000 pop.). treatment needs. As local governments and health
care facilities develop policies and strive to use
Illicit Drugs combined with Other their resources as effectively as possible, ED data
Substances can be used to help officials make decisions about
current and emerging drug abuse-related issues.
ED visits involving illicit drugs in combination
with other substances—including alcohol and
End Notes
pharmaceuticals—were examined to determine
1 Office of Applied Studies. (2010). Substate estimates from the 2006-2008
if there were any geographic differences. National Surveys on Drug Use and Health. Rockville, MD: Substance Abuse
and Mental Health Services Administration. [Available at http://oas.samhsa.
Nationally, the rate of visits involving illicit drugs
gov/substate2k10/toc.cfm]
only was 155 per 100,000 pop. (Figure 2). Five 2 When differences in rates of ED visits between metropolitan areas and
the Nation are described as “higher” or “lower” in this report, the difference
metropolitan areas had significantly higher rates
is statistically significant at the .05 level. Unless otherwise noted, DAWN
than the Nation: San Francisco (328 per 100,000 defines metropolitan areas using the MSA and division definitions issued
by the Office of Management and Budget (OMB) in June 2003 (http://www.
pop.), Chicago (313 per 100,000 pop.), Boston whitehouse.gov/omb/bulletins_b03-04). DAWN uses these names and
definitions even if the names or composition were changed by OMB. More
(275 per 100,000 pop.), New York City (260 per
detailed information about these areas can be found here: http://oas.samhsa.
100,000 pop.), and Detroit (251 per 100,000 pop.). gov/2k11/DAWN2009Methods/DAWN2k9_MethodologyReport.htm
Nationally, ED visits involving illicit drugs in 3 National Prevention Council. (2011). National prevention strategy.
Washington, DC: U.S. Department of Health and Human Services, Office of
combination with alcohol occurred at a rate of the Surgeon General.
69 per 100,000 pop. (Figure 3). Five metropolitan
Suggested citation
areas had significantly higher rates: New York
City (223 per 100,000 pop.), Boston (153 per Substance Abuse and Mental Health Services Administration, Center for
Behavioral Health Statistics and Quality. (December 15, 2011). The DAWN
100,000 pop.), San Francisco (150 per 100,000 Report: Illicit Drug-Related Emergency Department Visits in Metropolitan
Areas of the United States: 2009. Rockville, MD.
pop.), Chicago (120 per 100,000 pop.), and
Detroit (112 per 100,000 pop.).
The national rate for ED visits involving
illicit drugs combined with pharmaceuticals
was 67 per 100,000 pop. There were no
statistically significant differences found when
the metropolitan area rates were compared
against the national rate for ED visits involving
these combinations. Rates of ED visits for these
combinations ranged from 35 per 100,000 pop.
(Miami-Dade) to 92 per 100,000 pop. (Boston).
Page 5
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Findings from SAMHSA’s 2009 Drug Abuse Warning Network (DAWN)
Illicit Drug-Related Emergency Department Visits
in Metropolitan Areas of the United States: 2009
The Drug Abuse Warning Network (DAWN) is a public health surveillance
● Rates of emergency department (ED) visits involving system that monitors drug-related morbidity and mortality. DAWN uses a
illicit drugs were higher in Boston (571 per 100,000 probability sample of hospitals to produce estimates of drug-related emergency
pop.), New York City (555 per 100,000 pop.), department (ED) visits for the United States and selected metropolitan areas
annually. DAWN also produces annual profiles of drug-related deaths reviewed
Chicago (507 per 100,000 pop.), and Detroit (462 per
by medical examiners or coroners in selected metropolitan areas and States.
100,000 pop.) than in the Nation as a whole (317 per
Any ED visit related to recent drug use is included in DAWN. All types of drugs—
100,000 pop.)
licit and illicit—are covered. Alcohol involvement is documented for patients of all
ages if it occurs with another drug. Alcohol is considered an illicit drug for minors
● In comparison with the national rate (69 per 100,000 and is documented even if no other drug is involved. The classification of drugs
pop.), the rates of ED visits involving heroin were used in DAWN is derived from the Multum Lexicon, copyright 2010 Lexi-Comp,
higher in Boston (251 per 100,000 pop.), Chicago Inc., and/or Cerner Multum, Inc. The Multum Licensing Agreement governing
use of the Lexicon can be found at http://dawninfo.samhsa.gov/drug_vocab.
(216 per 100,000 pop.), New York City (153 per
100,000 pop.), Detroit (150 per 100,000 pop.), and DAWN is one of three major surveys conducted by the Substance Abuse
and Mental Health Services Administration’s Center for Behavioral Health
Seattle (118 per 100,000 pop.)
Statistics and Quality (SAMHSA/CBHSQ). For more information on other
CBHSQ surveys, go to http://oas.samhsa.gov. SAMHSA has contracts with
● Compared with the national rate (69 per 100,000 pop.),
Westat (Rockville, MD) and RTI International (Research Triangle Park, NC) to
five metropolitan areas showed higher rates of visits operate the DAWN system and produce publications.
involving illicit drugs in combination with alcohol: New
For publications and additional information about DAWN, go to
York City (223 per 100,000 pop.), Boston (153 per http://DAWNinfo.samhsa.gov/.
100,000 pop.), San Francisco (150 per 100,000 pop.),
U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES
Chicago (120 per 100,000 pop.), and Detroit (112 per Substance Abuse & Mental Health Services Administration
100,000 pop.) Center for Behavioral Health Statistics and Quality
www.samhsa.gov