DECEMBER 2003

Highlights From DAWN: Boston, 2002

This special report presents findings based on data submitted by 22 hospitals in the Boston metropolitan area for 2002. ■ Of the approximately 1.6 million visits to Boston area emergency departments (EDs) in 2002, about one percent (17,965) were related to drug abuse. ■ During 2002, the most common drugs involved in these ED visits were alcohol, cocaine, marijuana, heroin, and benzodiazepines. ■ From 1995 to 2002, the rate of drug abuse-related ED visits remained relatively stable in Boston. ■ Among the 21 DAWN areas, Boston has ranked consistently in the top two for ED visits involving benzodiazepines and drug abuse in every year since 1995. Top 5 drugs in drug abuse-related ED visits in Boston, 2002
10,000

7,500 Number of visits

5,916
5,000

5,611 4,273

3,999

3,665

2,500

0
Alcohol-in- Cocaine combination Marijuana Heroin Benzodiazepines

DAWN: The Warning Network
Local information is essential to Seattle support local action, and drugs, drug use, and drug-related morbidity can Detroit Minneapolis differ dramatically across communities. Buffalo DAWN focuses on metropolitan areas Chicago to reveal emerging drug problems Baltimore Denver San Francisco Washington St. Louis before they become widespread. DAWN detects new drugs, new drug Los Angeles combinations, new health consequences Atlanta Phoenix of drug use, and changing patterns involving Dallas old drugs. Facilities participating in DAWN San Diego can use this information to train staff and New improve patient care. Communities can use this Orleans Miami information to plan, target resources, and act more effectively. Today, hospitals in Boston and 20 other metropolitan areas serve their communities by participating in DAWN. Expansion to other areas is underway.

Boston New Y ork Newark Philadelphia

DAWN serves a diverse audience. In addition to participating facilities, users include researchers and policy analysts; pharmaceutical firms; State and local substance abuse agencies; community coalitions; and Federal agencies, including the White House Office of National Drug Control Policy, the Food and Drug Administration, and the National Institute on Drug Abuse. For more information, go to http://DAWNinfo.samhsa.gov/.

2

T H E DA W N R E P O RT

DECEMBER 2003

Trends in Top 4 Drugs, 1995-2002
Cocaine

Cocaine-related ED visits in Boston remained stable from 1995 to 2002. While the national
rate was 78 cocaine-related visits per 100,000 population in 2002, Boston’s rate was 156 visits,
twice the national rate. More than three-quarters (76%) of cocaine-
related visits in Boston involved other drugs, most frequently alcohol or marijuana.

200

Boston
Rate per 100,000 population

150

100

U.S.

50

0

1995

1996

1997

1998

1999

2000

2001

2002

Marijuana

In 2002, Boston had one of the highest rates
of marijuana-related ED visits among the 21
DAWN metropolitan areas. However, while
the national rate of marijuana-related ED visits
increased 139 percent from 1995 to 2002, the
rate in Boston was relatively stable.
ED visits involving marijuana usually involve other drugs as well (67%).

200

Rate per 100,000 population

150

Boston
100

U.S.
50

0

1995

1996

1997

1998

1999

2000

2001

2002

Heroin

Boston did not experience the increase in heroin-related ED visits that occurred nationally between 1995 and 2002. Nonetheless, Boston’s rate of heroin-related visits (111 visits per 100,000 population) was three times the national rate (36) in 2002. In more than half (52%) of heroin-related ED visits, heroin was the only drug reported.

200

Rate per 100,000 population

150

Boston
100

50

U.S.

0

1995

1996

1997

1998

1999

2000

2001

2002

Benzodiazepines

Nationally, the rate of benzodiazepine-related ED visits rose 25 percent from 1995 to 2002. By contrast, the rate in Boston, while not increasing, has been consistently double or triple the national rate over the entire 8-year period. During 2002, clonazepam, alprazolam, and lorazepam were the most frequently named benzodiazepines in drug abuse-related ED visits in Boston.

200

Rate per 100,000 population

150

Boston
100

U.S.
50

0

1995

1996

1997

1998

1999

2000

2001

2002

T H E DA W N R E P O RT

DECEMBER 2003

3

??? Comparisons

Across 21 Metropolitan Areas

The following figures show Boston in relation to the Nation and 20 other metropolitan areas represented in DAWN for selected drugs in 2002. Comparisons across areas are possible because the number of visits for each drug is represented in terms of a rate per 100,000 population. Not all differences in rates are statistically significant.

Cocaine visits
Rate per 100,000 population, 2002
Total U.S. Chicago Philadelphia Baltimore Miami Atlanta Newark Detroit Buffalo New York Seattle Boston St. Louis San Francisco New Orleans Los Angeles Denver Washington, DC Phoenix Minneapolis Dallas San Diego 0 32 300 55 46 59 82 71 108 186 182 171 166 164 156 153 150 145 240 239 78 275 274 257

Heroin visits
Rate per 100,000 population, 2002
Total U.S. Chicago Newark Baltimore San Francisco Seattle New York Boston Philadelphia Buffalo Detroit Miami New Orleans St. Louis Denver Washington, DC Los Angeles San Diego Phoenix Atlanta Minneapolis Dallas 0 29 28 23 20 16 10 225 38 53 51 43 93 93 85 128 123 111 109 171 36 220 214 203

Marijuana visits
Rate per 100,000 population, 2002
Total U.S. Philadelphia Detroit St. Louis Boston Miami Atlanta Baltimore Chicago New Orleans Seattle Los Angeles Buffalo Washington, DC Newark New York Minneapolis San Diego Phoenix San Francisco Denver Dallas 0 27 160 55 54 47 47 46 46 39 38 56 65 64 78 72 96 88 124 119 111 47 150 146

Benzodiazepines visits
Rate per 100,000 population, 2002
Total U.S. Boston Philadelphia New Orleans St. Louis Detroit Baltimore Newark Phoenix Seattle Miami Chicago San Diego San Francisco Buffalo Atlanta Dallas Los Angeles Minneapolis Denver New York Washington, DC 0 34 30 28 26 26 22 21 130 35 50 49 47 45 42 60 57 53 69 82 78 41 102 95

4

T H E DA W N R E P O RT

DECEMBER 2003

??? About

DAWN

The Drug Abuse Warning Network (DAWN) is a national surveillance system that monitors drug-related morbidity and mortality. Section 505 of the Public Health Service Act assigns this responsibility to the Substance Abuse and Mental Health Services Administration (SAMHSA), an agency of the U.S. Department of Health and Human Services. The Act requires SAMHSA to report annually on drug-related visits to hospital emergency departments and on drug-related deaths reviewed by medical examiners and coroners. SAMHSA has a contract with Westat, a private research firm based in Rockville, MD, to operate the DAWN system. DAWN collects data from a scientific sample of hospital emergency departments and a set of medical examiners and coroners from across the U.S., with concentrations in selected metropolitan areas. Each participating facility has a DAWN Reporter who is specially trained to identify DAWN cases by retrospectively reviewing emergency department medical records or death investigation case files. No patient, family member, or physician is ever interviewed. No direct identifiers for individual patients or decedents are collected. Beginning in 2003, DAWN cases include any emergency department visit or death that was related to drug use. Reportable cases include drug abuse, misuse, overmedication, accidental and malicious poisonings, and adverse drug reactions. For each case, the DAWN Reporter submits a case report detailing the specific drugs involved, and characteristics of the patient or decedent and event (visit or death). Patient and decedent characteristics include demographics (age, gender, race/ethnicity) and ZIP code. Other data items include date/time, chief complaint, diagnoses, and disposition for each emergency department visit; and date, cause, manner, and place of death for each decedent.

U.S. DEPARTMENT OF HEALTH & HUMAN SERVICES Substance Abuse and Mental Health Services Administration Office of Applied Studies 5600 Fishers Lane, Room 16-105 Rockville, MD 20857 Official Business Penalty for Private Use $300

FIRST CLASS MAIL POSTAGE & FEES PAID SAMHSA PERMIT NO. G-283