MARCH 2004

Highlights From DAWN: Baltimore, 2002
This special report presents findings based on data submitted by 20 hospitals in the Baltimore metropolitan area for 2002. s Of the 1.1 million visits to Baltimore area emergency departments (EDs) in 2002, about one percent (12,904) were related to drug abuse. s During 2002, the most common drugs involved in these ED visits were cocaine, heroin, narcotic analgesics (pain relievers), alcohol in combination with other drugs, and marijuana. s Heroin-related ED visits in Baltimore increased 4 percent between 2001 and 2002, but have decreased 45 percent since 1995. s Among the 21 DAWN areas, Baltimore ranked in the top 3 in terms of ED visits involving heroin, cocaine, and pain relievers. Top 5 drugs in drug abuse-related ED visits in Baltimore, 2002
10,000

7,500 Number of visits

5,969
5,000

4,715 3,848 3,189

2,500

2,044

0
Cocaine Heroin Narcotic Alcohol-in- Marijuana analgesics combination (pain relievers)

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 Baltimore to reveal emerging drug problems Denver San Francisco Washington St. Louis before they become widespread. DAWN detects new drugs, new drug Los Angeles combinations, new health consequences Atlanta Phoenix Dallas of drug use, and changing patterns involving San old drugs. Facilities participating in DAWN Diego can use this information to train staff and New improve patient care. Communities can use this information to Orleans Miami plan, target resources, and act more effectively. Today, hospitals in Baltimore 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/.

Rate per 100,000100,000 Rate per population population

2

400 300 H I G H L I G H T S F R O M DA W N : BA LT I M O R E 2 0 0 2 Cocaine 300 200 200 100

Baltimore Baltimore U.S. U.S.

Trends in Top 4 Drugs, 1995-2002 Cocaine
Cocaine
s

100 0 400 0 200 300 200 150 200 150 100 100 100 50 0 50 0 200 0

1995 1995

1996 1996

1997 1997

1998 1998

1999 1999

2000 2000

2001 2001

2002 2002

s

Rate per 100,000100,000 Rate per per 100,000 Rate population population population

s

Cocaine-related ED visits in Baltimore increased 20 percent (to 257 visits per 100,000 population) between 2001 and 2002, but decreased 33 percent since 1995. Cocaine More than 80 percent of cocaine-related ED visits in Baltimore also involved other drugs. Marijuana Less than 5 percent of cocaine-related ED visits Marijuana were attributed to "crack" in Baltimore.

Baltimore

Baltimore U.S. U.S. Baltimore
1995 1995 1995 1996 1996 1996 1997 1997 1997 1998 1998 1998 1999 1999 1999 2000 2000 2000 2001 2001 2001 2002 U.S. 2002 2002

Heroin
s
Rate per 100,000100,000100,000 Rate per Rate per population population population

s

Heroin-related ED visits in Baltimore increased 4 percent (to 203 visits per 100,000 population) between 2001 and 2002, but decreased 45 Marijuana percent since 1995 heroin 366 visits per 100,000). (from More than half (55 percent) of the heroinrelated ED visits inheroin Baltimore also involved other drugs.

400 150 400 300 100 300 200 50 200 100 0 100 0 400 0 200 300 200 150 200 400 150 100 100 300 100 50 0 200 50 0 200 100 0 150 0 100 200 50 150 0 100 1995 1996 1997 1998 1999 2000 2001

Baltimore Baltimore U.S. Baltimore
1995 1995 1995 1996 1996 1996 1997 1997 1997 1998 1998 1998 1999 1999 1999 2000 2000 2000 2001 2001 2001

U.S. 2002 U.S. 2002
2002

Pain Relievers
Rate per 100,000 Rate per 100,000 Rate per 100,000 per 100,000 Rate population population population population

Baltimore Baltimore Baltimore

s

s

From 1995 implicated in drug abuse-related ED visits increased more Narcotic Baltimore than 400 percent in analgesics... (from 30 to 165 mentions per 100,000 population). The increase nationally was 139 percent (from 19 to 46 mentions per 100,000). Cocaine Oxycodone and methadone were the most frequently named pain relievers in drug-related ED visits in Baltimore in 2002.
Narcotic analgesics...

heroin to 2002,analgesics... Narcotic pain relievers

U.S. U.S. Baltimore
1995 1995 1995 1996 1996 1996 1997 1997 1997 1998 1998 1998 1999 1999 1999 2000 2000 2000 2001 2001 2001 2002 U.S. 2002

U.S. Baltimore
2002

Rate per 100,000 population

Marijuana
s

1995

1996

1997

1998

1999

2000

2001

2002

s

From 1995 to 2002, marijuana-related ED visits in Baltimore rose over 100 percent (from 42 to 88 visits per 100,000 population). The national rate (47 visits per 100,000 in 2002) increased Marijuana almost 140 percent over the same 8-year period. Marijuana was reported in about 16 percent of all drug abuse-related ED visits in Baltimore and was usually reported in combination with other drugs.

U.S.

Rate per 100,000 population

Baltimore U.S.

2002

50

0

1995

1996

1997

1998

1999

2000

2001

2002

400

00

300

H I G H L I G H T S F R O M DA W N :

BA LT I M O R E 2 0 0 2

3

??? Comparisons

Across 21 Metropolitan Areas

The following figures show Baltimore 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 Cocaine visits
Rate per 100,000 100,000 population, 2002 Rate per population, 2002
Total U.S. Total U.S. 220 Chicago Chicago 214 Philadelphia Philadelphia 203 Baltimore Baltimore Miami Miami 186 182 171 166 164 156 153 150 145 108 82 71 59 55 32 300 300 55 46 59 82 71 108 Atlanta Atlanta Newark Newark Detroit Detroit Buffalo Buffalo New York New York Seattle Seattle Boston Boston St. LouisSt. Louis San Francisco San Francisco New Orleans Orleans New Los Angeles Angeles Los Denver Denver Washington, DC Washington, DC Phoenix Phoenix Minneapolis Minneapolis Dallas 32 San Diego Diego San 225 0 0 78 78 275 274 257 240 239 186 182 171 166 164 156 153 150 145 240 239 275 274 257

Cocaine visits Rate perHeroin visits 100,000 population, Heroin visits 2002
Rate per 100,000 100,000 population, 2002 Rate per population, 2002
Total U.S. Total U.S. Total U.S. 36 Chicago Chicago Philadelphia Chicago Newark Baltimore Newark Baltimore Baltimore Miami San Francisco San Francisco Atlanta Seattle Newark Seattle New York New York Detroit Boston Buffalo Boston Philadelphia Philadelphia New York Buffalo Buffalo Seattle Detroit Boston Detroit St.Miami Louis Miami 53 51 43 38 8238 New Orleans New San Francisco Orleans NewSt. LouisSt. Louis Orleans Denver Los Angeles Denver Washington, DC Washington, DC Denver 93 93 85 53 51 43 108 78 36 275 220 274 257 214 240 203 171 239 128 186 128 123 182 123 111171 111 109 166 109 93 164 93 156 85 153 150 145 171 220 214 203

H

Ra

171

S

N

Was

Los Angeles Washington, Los Angeles 29 7129 DC San Diego Diego 28 59 28 San Phoenix 23 55 23 Phoenix Minneapolis Phoenix 20 Atlanta Atlanta 46 20 Dallas 16 32 Minneapolis Minneapolis San Diego 10 Dallas 0 Dallas 0 0 16 10 300 225 225

Dallas 46

Pain Reliever visits Rate per 100,000 population, 2002 Marijuana visits Marijuana visits
Rate per 100,000 100,000 population, 2002 Rate per population, 2002
Total U.S. 102 95 Total U.S. Total U.S. Baltimore Philadelphia Buffalo Philadelphia Detroit Orleans New Detroit St. LouisSt.Detroit Louis Boston Boston Boston Miami Miami Seattle Atlanta Atlanta Philadelphia Baltimore St. Louis Baltimore Chicago Chicago Newark New Orleans Orleans New Phoenix Seattle Chicago Seattle Los AngelesNew York Los Angeles BuffaloFrancisco San Buffalo Washington, DC Washington, DC San Diego Newark Newark Minneapolis New York Denver New York Minneapolis Atlanta Minneapolis San Diego Angeles San Los Diego Phoenix Phoenix Dallas San Francisco San Francisco Washington, DC Denver Denver Miami 130 Dallas 0 Dallas 0 27 0 47 46 47 106 98 97 97 95 81 96 68 88 6478 62 72 65 61 64 55 56 52 46 55 40 54 47 34 30 47 28 46 46 28 39 26 38 22 27 160 55 54 47 47 46 46 39 38 225 160 56 65 64 78 72 124 119 111 96 88 165 150 146 124 119 111 150 146

Marijuana visits Rate perBenzodiazepines visits 100,000 population, 2002 Benzodiazepines visits
Rate per 100,000 100,000 population, 2002 Rate per population, 2002
Total U.S. Total U.S. Total U.S. Philadelphia Boston Boston Detroit Philadelphia Philadelphia St. Louis New Orleans Orleans New Boston St.MiamiSt. Louis Louis Detroit Atlanta Detroit Baltimore Baltimore Newark Chicago Newark New Phoenix Phoenix Orleans Seattle Seattle Miami Los Angeles Miami Chicago Chicago Buffalo San Diego San Washington, DC Diego San Francisco San Francisco Newark Buffalo New York Buffalo Atlanta Minneapolis Atlanta San Dallas Diego Dallas Los Phoenix Angeles Angeles Los Minneapolis Minneapolis San Francisco Denver Denver New York New York Dallas 0 60 82 78 88 60 47 41 41 102 150 102 146 95 124 95 82 119 78 111

B PainPain Re Ra

Rate per 100,0 Rate p

Total U.S. T

Baltimore B

Buffalo N New Orleans New

Detroit

69 96 69 5778 57 5372 53 50 65 49 64 47 56 45 55 50 49 47 45

Boston

Seattle

Philadelphia Phil

St. Louis

Newark

Phoenix

Chicago

42 42 54 35 35 47 34 34 47 30 46 30 28 46 28 2639 26 38 26 26 22 21 160 130

New York N Sa San Francisco San F

San Diego Sa

Minneapolis Min

Denver

Atlanta

Los Angeles Los

Dallas

22 27 Washington, DC 0 Washington, DC 21 0

Washington, DC Washin Was Miami 130

4

H I G H L I G H T S F R O M DA W N :

BA LT I M O R E 2 0 0 2

??? 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