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Abstract
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An analysis of final 2021 DAWN data presents: (1) nationally representative weighted estimates, including percent and unadjusted rates per 100,000, for all drug-related emergency department (ED) visits, (2) nationally representative weighted estimates for the top five drugs in drug-related ED visits, (3) the assessment of monthly trends and drugs involved in polysubstance ED visits in a subset of sentinel hospitals, and (4) the identification of drugs new to DAWN’s Drug Reference Vocabulary.
The Substance Abuse and Mental Health Services Administration's (SAMHSA's) dedication to promoting mental health and preventing substance misuse is supported by data collection efforts aimed at understanding the magnitude of these problems. The collection of data on drug-related emergency department (ED) visits, including those related to alcohol, from the Drug Abuse Warning Network (DAWN) supports SAMHSA's commitment to data and evidence and its use to inform programs to aid in preventing overdose and substance misuse issues, especially those facing youth and adolescents, and assessing circumstances around drug-related suicide attempts. DAWN is a nationwide public health surveillance system that captures data on ED visits related to recent substance use and misuse directly from the electronic health records of participating hospitals.
In 2021, the DAWN identified 149,021 (unweighted) drug-related ED visits from 52 participating hospitals. These data were analyzed to (1) generate nationally representative weighted estimates for all drug related ED visits, (2) generate nationally representative weighted estimates for the top five drugs in drug-related ED visits, (3) assess monthly trends and drugs involved in polysubstance ED visits in a subset of sentinel hospitals1, and (4) identify drugs new to DAWN's Drug Reference Vocabulary (DRV) in 2021.
1.A Weighted National Estimates for All Drug-Related ED Visits
KEY FINDINGS BY AGE, SEX, RACE, ETHNICITY, AND CENSUS REGION
› Patients aged 26 to 44 had the highest percentage (40.16%) and rate (3,412 per 100,000) of all drug-related ED visits, followed by patients aged 45 to 64 (31.69% and 2,728 per 100,000).
› Male patients accounted for 61.12 percent of all drug-related ED visits with a rate of 2,672 per 100,000.
› White patients accounted for the highest proportion of all drug-related ED visits at 60.90 percent followed by Black or African American patients at 15.27 percent. Black or African American patients had the highest rate of all drug-related ED visits at 2,435 per 100,000 followed by Native Hawaiian/Pacific Islander patients at 1,747 per 100,000.
› The majority of drug-related ED visits occurred among not Hispanic or Latino (75.14%) patients. After accounting for population differences, the rates were 2,006 per 100,000 among not Hispanic or Latino versus 1,400 per 100,000 in Hispanic or Latino patients.
› The percentage of all drug-related ED visits was relatively even among all four census regions, with the South (26.22%), and West regions (24.65%) accounting for the highest percentage. 1.B Weighted National Estimates for the Top Five Drugs in Drug-Related ED Visits
KEY FINDINGS BY DRUGS
› The top five drugs involved in drug-related ED visits in 2021 were alcohol (41.70% of all drug-related ED visits), opioids (14.79%), methamphetamine (11.29%), marijuana (11.19%), and cocaine (4.77%).
› Fentanyl-related ED visits rose throughout 2021, peaking in quarter 4. Heroin-related ED visits rose from quarter 1 through quarter 3, and declined in quarter 4. ED visits related to other opioids peaked in quarter 2, and declined in quarters 3 and 4.
KEY FINDINGS BY AGE, SEX, RACE, ETHNICITY, AND CENSUS REGION
› Patients aged 18 to 25 had the second highest percentage of ED visits related to marijuana (26.77%) and fentanyl (16.77%).
› Male patients had a higher percentage of ED visits for all top five drugs as compared to females, however, the difference was much smaller (55.02% males vs. 44.96% females) for ED visits related to other opioid pain medications and their combinations.
› Black or African American patients had the highest percentage of ED visits related to cocaine (44.21%), and the second highest percentage of ED visits related to marijuana (24.27%) and heroin (20.43%).
› More than one-third of ED visits related to fentanyl were from the West census region alone (39.68%). The West and South census regions combined accounted for more than two-thirds of ED visits related to methamphetamine (70.97%). The West and South regions combined accounted for the majority of visits related to other opioid pain medications and their combinations (59.35%)
1.C Key Findings from Sentinel Hospitals, March 2021 – December 2021
› Analysis of unweighted data from DAWN sentinel hospitals from March to December 2021 identified alcohol, methamphetamine, marijuana, cocaine, and heroin as the top five drugs involved in drug-related ED visits. Alcohol accounted for more than half of these drug-related ED visits.
› Monthly trend analysis revealed decreasing trends of alcohol, methamphetamine, marijuana, and heroin-related ED visits, and increasing trends of fentanyl and unspecified narcotic analgesics.
› The top six drugs involved in polysubstance ED visits (i.e., visits related to more than one drug) in sentinel hospitals were alcohol, methamphetamine, marijuana, cocaine, heroin, and fentanyl. While the majority of alcohol-related ED visits were due to alcohol alone, a significant percentage of methamphetamine-, marijuana-, cocaine-, heroin-, and fentanyl-related ED visits involved at least one other drug.
› Alcohol was the most common additional drug involved in methamphetamine-, marijuana-, and cocaine-related polysubstance ED visits, while methamphetamine was the most common additional drug involved in heroin- and fentanyl-related polysubstance ED visits.
1.D Drugs New to DAWN's Drug Reference Vocabulary
› In-depth analysis of 2021 data identified 50 substances related to ED visits that were new to DAWN's DRV. All of these substances were added to the DRV's existing drug categories. Of the 50 substances, roughly one-third were illicit drugs, and the other two-thirds were non-illicit substances.
DAWN is comprised of eligible hospitals selected from the 2016 American Hospital Association (AHA) file. All hospitals located in the United States and the District of Columbia that are non-federal, short-stay, general surgical and medical hospitals, with at least one 24-hour ED, and at least 100 annual ED visits, were eligible for selection (N = 4,310). DAWN uses a hybrid design of sentinel hospital-based surveillance and probability sample-based surveillance to better assess the epidemiology of substance use- and misuse-related ED visits.
Hospitals included in the sentinel-based surveillance were selected by SAMHSA from key urban areas with the goal of serving as an early warning system (Part A). Sentinel hospitals are expected to yield cases of concern, allowing for the collection and analysis of data quickly so a plan of action for addressing key and emerging problems can be developed. Sentinel hospitals were selected from counties that had the highest counts and rates for opioids, cocaine, and psychostimulant-related overdose deaths and ED visits |