Trends in Drug Use - Trends In Drug Emergencies

Under Section 505 of the Public Health Services Act, SAMHSA is required to collect data on drug episodes as observed in the emergency rooms of the nation's hospitals. The agency does this under a program called the Drug Abuse Warning Network (DAWN). The data collected by DAWN at six-month intervals are not considered to measure prevalence, but the sample of hospitals used has been chosen to produce what SAMHSA calls "representative estimates of FIGURE 3.8
Hallucinogen use by persons aged 12 or older, 2002 and 2003
SOURCE: "Figure 2.3. Numbers (in Millions) of Past Year Users of Selected Hallucinogens among Persons Aged 12 or Older: 2002 and 2003," in Results from the 2003 National Survey on Drug Use and Health: National Findings, U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, 2004, http://www.oas.samhsa.gov/nhsda/2k3nsduh/2k3ResultsW.pdf (accessed February 10, 2005) E[mergency] D[epartment] drug episodes and drug mentions for the coterminous United States and for 21 metropolitan areas" (Emergency Department Trends from the Drug Abuse Warning Network, Preliminary Estimates January–June 2002, DAWN Series: D-22, DHHS Publication No. [SMA] 03-3779, Rockville, MD: SAMHSA, 2002). What DAWN counts, in other words, are the medical emergencies caused by drugs used alone or in combination. Hospitals report to DAWN the emergency room visits involving conditions of intentional drug abuse, addiction, and suicide attempts. Visits that involve chronic health conditions due to drug abuse are also included, as are intentional abuses of prescription and over-the-counter drugs. But DAWN does not include cases that are simply accidents without intentional abuse of a drug.

Patients counted in DAWN's survey usually mention more than one drug. The average is about two different drugs per visit. About a third of cases also involve the use of some drug used in combination with alcohol. Drug episodes and drug mentions are thus a way of tracking the relative importance of different drugs over time, alone or in combination, in causing distress enough to send people to the hospital. Cocaine, marijuana, heroin, and amphetamines are the leading substances DAWN classifies as "major substances of abuse." In most cases that result in death, the leading drugs as of 2002 were heroin and cocaine—usually used in combination with other drugs and alcohol.

DAWN's most recent data (in Table 3.6) provide selected drug-related emergency room visits from 1995-2002. Almost all of the selected major drugs shown display a rising involvement in episodes during this period, though in some cases the change was not statistically significant. The fastest growing hallucinogenic drug has been Ecstasy; related emergency room visits increased by 856.3% between 1995 and 2002, though they tapered off considerably in the final year of that period. Ecstasy is an unusual synthetic drug in that it combines the effects of a stimulant and of a hallucinogen. As episodes involving Ecstasy were growing, the previous leading hallucinogen in terms of emergency room visits, LSD, declined dramatically. PCP ("angel dust"), the second most important of the synthetic hallucinogens in terms of emergency room visits, has been on the rise in recent years, representing about 3,600 more emergency department visits than Ecstasy in 2002.

Marijuana mentions have nearly tripled between 1995 and 2002, a much greater increase than in mentions of cocaine and heroin. While marijuana is very often mentioned, DAWN reporting points out that a mention does not indicate that a drug is the cause of the emergency episode; in the case of marijuana, other drugs are usually also involved. In fact, there is little if any evidence that marijuana is capable at all of causing a medical emergency on its own.

Two other drugs that showed notable growth in mentions were Ketamine and GHB. GHB (gamma hydroxy butyrate) is a depressant but is known as a strength enhancer and a euphoriant. Ketamine hydrochloride is a dissociative anesthetic; it produces hallucinogenic states and impairs perception. Both drugs are synthetics known as date-rape drugs, because they can be used in incapacitating victims who are then sexually assaulted.