Trends in Drug Use - Trends In Drug-related Deaths

SAMHSA's DAWN program also collects data on drug-related mortality. The data are collected and published for metropolitan areas and counties. According to DAWN, its locally collected data cannot be used for national estimates of drug abuse-related mortality because, among other reasons, the samples are skewed toward urban areas and are also incomplete. National data, however, are available from the National Center for Health Statistics (NCHS), a part of the Centers for Disease Control and Prevention, an agency of the U.S. Department of Health and Human Services.

According to NCHS data, in 1979 the death rate related to drugs was 3.2 deaths per one hundred thousand of population, or 7,101 total drug deaths, split about evenly by gender. (See Table 3.7.) The death rate and total deaths have been climbing steadily since 1980,

TABLE 3.6
Selected drug-related emergency department visits, 1995-2002
ED trends from DAWN
SOURCE: Adapted from "Table 2.2.0. ED Mentions for Selected Drug Categories, Total ED Drug Episodes and Mentions, and Total ED Visits: Estimates for the Coterminous U.S. by Year," in Emergency Department Trends from the Drug Abuse Warning Network, Final Estimates 1995-2002, U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies, July 2003, http://dawninfo.samhsa.gov/old_dawn/pubs_94_02/edpubs/2002final/files/EDTrendFinal02AllText.pdf (accessed March 8, 2005)

Drug category	Total	1995	Total 1996	Total 1997	Total 1998	Total 1999	Total 2000	Total 2001	Total 2002	% change* 1995, 2002	% change* 2000, 2002	% change* 2001, 2002
Major substances of abuse		457,773	478,387	510,284	548,582	575,163	623,999	669,340	681,957	49.0
Alcohol-in-combination		166,897	166,166	171,894	184,989	196,178	204,500	217,940	207,395	24.3
Cocaine		135,711	152,420	161,083	172,011	168,751	174,881	193,034	199,198	46.8
Heroin		69,556	72,980	70,712	75,688	82,192	94,804	93,064	93,519	34.5
Marijuana		45,259	53,770	64,720	76,842	87,068	96,426	110,512	119,472	164.0	23.9
Amphetamines		9,581	9,772	10,496	12,183	12,496	17,134	18,555	21,644	125.9		16.6
Methamphetamine		15,933	11,002	17,154	11,486	10,447	13,505	14,923	17,696
MDMA (ecstasy)		421	319	637	1,143	2,850	4,511	5,542	4,026	856.3
Ketamine		…	81	…	209	396	263	679	260
LSD		5,682	4,569	5,219	4,982	5,126	4,016	2,821	891	− 84.3	− 77.8	− 68.4
PCP		5,963	3,441	3,626	3,436	3,663	5,404	6,102	7,648	28.3	41.5	25.3
Miscellaneous hallucinogens		1,463	1,600	1,629	1,849	1,533	1,849	1,788	1,428
Flunitrazepam (Rohypnol)		…	…	…	…	…	…	…	…
GHB		145	638	762	1,282	3,178	4,969	3,340	3,330	2,196.6	− 33.0
Inhalants		736	1,030	1,539	1,735	650	1,141	522	1,496			186.6
Combinations NTA		163	383	201	125	94	127	298	…
*This column denotes statistically significant (p < 0.05) increases and decreases between estimates for the periods noted.
Note: These estimates are based on a representative sample of non-Federal, short-stay hospitals with 24-hour emergency departments in the coterminous U.S. Dots (…) indicate that an estimate with an RSE greater than 50% has been suppressed.
ED=emergency department, GHB=gamma hydroxy butyrate, LSD=lysergic acid diethylamide, MDMA=methylenedioxymethamphetamine, NTA=not tabulated above, PCP=phencyclidine

TABLE 3.7
Drug deaths, by sex and race, 1979–2001
SOURCE: "Table 26. Number of Deaths from Drug-Induced Causes, by Sex and Race, 1979-2001," in National Drug Control Strategy: Data Supplement, TheWhite House, March 2004, http://www.whitehousedrugpolicy.gov/publications/policy/ndcs04/data_suppl_2004.pdf (accessed March 31, 2005)

Year	Both sexes	Male	Female	White	All non- white	Black
1979	7,101	3,656	3,445	6,116	985	897
1980	6,900	3,771	3,129	5,814	1,086	1,006
1981	7,106	3,835	3,271	5,863	1,243	1,152
1982	7,310	4,130	3,180	5,991	1,319	1,212
1983	7,492	4,145	3,347	6,187	1,305	1,194
1984	7,892	4,640	3,252	6,309	1,583	1,480
1985	8,663	5,342	3,321	6,946	1,717	1,600
1986	9,976	6,284	3,692	7,948	2,028	1,906
1987	9,796	6,146	3,650	7,547	2,249	2,101
1988	10,917	7,004	3,913	8,409	2,508	2,395
1989	10,710	6,895	3,815	8,336	2,374	2,236
1990	9,463	5,897	3,566	7,603	1,860	1,703
1991	10,388	6,593	3,795	8,204	2,184	2,037
1992	11,703	7,766	3,937	9,360	2,343	2,148
1993	13,275	9,052	4,223	10,394	2,881	2,688
1994	13,923	9,491	4,432	10,895	3,028	2,780
1995	14,218	9,909	4,309	11,173	3,045	2,800
1996	14,843	10,093	4,750	11,903	2,940	2,682
1997	15,973	10,991	4,982	12,863	3,110	2,816
1998	16,926	11,462	5,464	13,811	3,115	2,831
1998 ICD-10	20,227	13,697	6,529	16,504	3,722	3,383
1998 ICD-10	19,102	12,873	6,229	15,694	3,408	3,094
2000 ICD-10	19,698	13,125	6,573	16,371	3,327	3,032
2001 ICD-10	21,683	14,244	7,439	18,176	3,507	3,163
Note: In 1999, cause of death coding was revised to ICD-10. Modified figures for 1998 were calculated based on comparability ratios for drug-induced deaths according to ICD-9 and ICD-10. The new coding scheme yields 19.5 percent more drug-induced deaths compared to the old system using 1998 data. The implementaion of ICD-10 represents a break in the trend data.

reaching a record high of 7.2 deaths per one hundred thousand in 2001, an increase of 125%. The total number of drug deaths that year was 21,683.

NCHS death rate measurements are not exclusively restricted to the use of illegal drugs or the use of legal drugs in nonmedical applications. NCHS data also include accidental poisonings and assaults by drugs. The anthrax poisoning deaths of late 2001, for instance, would be included, but documented murders by poisoning would not. The inclusion of accidents and chemical assaults where intent is unknown somewhat weaken the data for tracking drug abuse trends, but the majority of cases are related to the use of drugs.

Another possible explanation for sharply rising drug-related deaths is the increasing use of dangerous new synthetic drugs. Along with heroin and cocaine, death rates are often related to use of the new synthetics, or combinations of these, as shown for instance by DAWN's mortality survey, (Mortality Data from the Drug Abuse Warning Network, 2002, Rockville, MD: SAMHSA, January 2004).

According to the above DAWN report, drug-related deaths, more narrowly construed and excluding accidental deaths or "assaults," consist of deaths said to be induced by one or more drugs in combination and of deaths that are said to be drug-related. In the first case, the person dies of an overdose, for instance; in the second, the drug may be responsible for a terminal medical condition, may have made the individual reckless, or may have brought the person to a psychological state that led to suicide. In the 2002 DAWN mortality survey, in twenty-five out of the thirty-one metropolitan areas studied, drug-induced deaths, such as overdoses, accounted for the majority of the drug-related deaths reported to DAWN. Deaths reported to DAWN, however, are not limited to drug overdoses. Reports also include deaths in which drug abuse was a contributing factor, but not the primary cause. In six of the thirty-one metropolitan areas (Birmingham, Buffalo, Kansas City, Miami, Omaha, and St. Louis), drug-related deaths were more commonly reported than drug-induced deaths.