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1 National Estimates from the Drug Abuse Warning Network Judy K. Ball, Ph.D., M.P.A. Office of Applied Studies Substance Abuse and Mental Health Services.

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Presentation on theme: "1 National Estimates from the Drug Abuse Warning Network Judy K. Ball, Ph.D., M.P.A. Office of Applied Studies Substance Abuse and Mental Health Services."— Presentation transcript:

1 1 National Estimates from the Drug Abuse Warning Network Judy K. Ball, Ph.D., M.P.A. Office of Applied Studies Substance Abuse and Mental Health Services Administration 5 May 2008 http://DAWNinfo.samhsa.gov

2 SAMHSA/OAS 2 Today's Agenda  No conflicts of interest  Overview of DAWN  Key findings from 2006 –Nonmedical use of opiates/opioids –2004-2005 comparisons –Extended- vs. immediate-release oxycodone

3 SAMHSA/OAS 3 DAWN Methods  Stratified probability sample of hospitals –Short-term, general, nonFederal hospitals with 24-hour emergency departments (EDs) –Oversample areas –Remainder area  National estimates account for: –Sample design –Unit nonresponse –Partial nonresponse in responding hospital Entire U.S.

4 SAMHSA/OAS 4 National Estimates Oversample areas (urban) + Remainder area (urban & rural)

5 SAMHSA/OAS 5 Source of DAWN Estimates, 2004-2006 200420052006 Eligible hospitals4,5054,5494,568 Sample of hospitals556562544 Responding hospitals220224205 Response rate39.639.937.7 Design weight response rate26.725.824.9 Weighted response rate23.928.926.1 Drug-related ED visits168,841268,128269,339 Drug reports275,829420,420419,438

6 SAMHSA/OAS 6 DAWN Data Collection: Retrospective Review of Medical Records Source: DAWN, 2006 data, 4/3/2008 National estimates charts reviewed 9,837,481 cases found 346,946 Drug-related ED visits reviewed ED visits not reviewed

7 SAMHSA/OAS 7 Analysis Domains Drug-related ED visits Medical use Pharmaceuticals Nonmedical use Pharmaceuticals Illicit drugs Alcohol

8 SAMHSA/OAS 8 Definition: Nonmedical Use of Pharmaceuticals  Based on retrospective chart review –Exceeded prescribed or recommended dose –Used drugs prescribed for another –Malicious poisoning –Substance abuse –Excludes drug-related suicide attempts –Includes suicide ideation, plan, gesture

9 SAMHSA/OAS 9 Drug-Related ED Visit Rates, 2004-2006 Source: National estimates from DAWN, 2004-2006 No significant change*Significant change, 2004 vs. 2006 2005 vs. 2006

10 SAMHSA/OAS 10 Nonmedical Use of Pharmaceuticals, Selected Opiates/Opioids, 2006 Source: National estimates from DAWN, 2006 * Single- & multi-ingredient formulations CI lower bound estimate CI upper bound

11 SAMHSA/OAS 11 Nonmedical Use of Pharmaceuticals, Selected Opiates/Opioids, 2006 Source: National estimates from DAWN, 2006 * Single- & multi-ingredient formulations CI lower bound estimate CI upper bound

12 SAMHSA/OAS 12 Classification of Oxycodone Reports  Extended release (ER) –OxyContin (99%) alternate terms: –Generic OxyContin –Teva OxyContin –Impax OxyContin –Oxycodone CR –Oxycodone ER –Oxycodone SR  Immediate release (IR) –acetaminophen-oxy e.g., Percocet (91%) –aspirin-oxy e.g., Percodan –ibuprofen-oxy e.g., Combunox –oxycodone e.g., Roxicodone

13 SAMHSA/OAS 13 Classification of Oxycodone Reports (cont'd)  Unknown release type (UK) –Oxycodone (97%) alternate terms: –Free oxycodone –M-Oxy –Oxycodone hydrochloride –Oxycodone metabolites

14 SAMHSA/OAS 14 Nonmedical Use of Pharmaceuticals, Oxycodone, by Release Type, 2004 Source: National estimates from DAWN, 2004 CI lower bound estimate CI upper bound

15 SAMHSA/OAS 15 Nonmedical Use of Pharmaceuticals, Oxycodone, by Release Type, 2005 Source: National estimates from DAWN, 2005 CI lower bound estimate CI upper bound

16 SAMHSA/OAS 16 Nonmedical Use of Pharmaceuticals, Oxycodone, by Release Type, 2006 Source: National estimates from DAWN, 2006 CI lower bound estimate CI upper bound

17 SAMHSA/OAS 17 Oxycodone, ER vs. IR – All Visits Source: DAWN estimates for the U.S., 2004-2006 No significant change*Significant change, 2004 vs. 2006 2005 vs. 2006

18 SAMHSA/OAS 18 Oxycodone, ER vs. IR – Medical Use Source: DAWN estimates for the U.S., 2004-2006 No significant change*Significant change, 2004 vs. 2006 2005 vs. 2006

19 SAMHSA/OAS 19 Oxycodone, ER vs. IR – Nonmedical Use Source: DAWN estimates for the U.S., 2004-2006 No significant change*Significant change, 2004 vs. 2006 2005 vs. 2006

20 SAMHSA/OAS 20 Oxycodone, IR vs. ER Source: DAWN estimates for the U.S., 2004-2006 % of visits Nonmedical useMedical use

21 SAMHSA/OAS 21 Nonmedical Use: Hydrocodone and Oxycodone by Release Type, 2004-2006 Source: DAWN estimates for the U.S., 2004-2006 Hydrocodone UK ER IR Oxycodone:

22 SAMHSA/OAS 22 Nonmedical Use: All Opiates/Opioids, ED Visit Rates, 2006 ED visits per 100K population Age Source: DAWN estimates for the U.S., 2006 * * *

23 SAMHSA/OAS 23 Nonmedical Use: All Hydrocodone, ED Visit Rates, 2006 ED visits per 100K population Age Source: DAWN estimates for the U.S., 2006 * *

24 SAMHSA/OAS 24 Nonmedical Use: All Oxycodone, ED Visit Rates, 2006 ED visits per 100K population Age Source: DAWN estimates for the U.S., 2006 * * * *

25 SAMHSA/OAS 25 Nonmedical Use: Oxycodone ER, ED Visit Rates, 2006 ED visits per 100K population Age Source: DAWN estimates for the U.S., 2006 * * * * *

26 SAMHSA/OAS 26 Nonmedical Use: Oxycodone IR, ED Visit Rates, 2006 ED visits per 100K population Age Source: DAWN estimates for the U.S., 2006 * * *

27 SAMHSA/OAS 27 Nonmedical Use: Oxycodone UK, ED Visit Rates, 2006 ED visits per 100K population Age * Source: DAWN estimates for the U.S., 2006

28 SAMHSA/OAS 28 Nonmedical Use: Disposition from ED, Oxycodone by Release Type, 2006 Source: DAWN estimates for the U.S., 2006 % of ED visits ExtendedUnknownImmediate Some follow-up No evidence of follow-up care

29 SAMHSA/OAS 29 Nonmedical Use: Number of Drugs, Oxycodone by Release Type, 2006 Source: DAWN estimates for the U.S., 2006 % of ED visits ExtendedUnknownImmediate 1 drug Multiple drugs

30 SAMHSA/OAS 30 Nonmedical-Use ED Visits: Conclusions  Opioid analgesics nearing 250,000 visits –¼ Oxycodone ¼ Hydrocodone –  in immediate and unknown release types –Polydrug use is typical  Highest visit rates in patients aged 21-54  Majority of patients treated and released

31 SAMHSA/OAS 31 Important Considerations: DAWN Depends on ED Medical Records  Link between ED visit and use of drug  Dose levels and source of drug unavailable  Nonspecific drug reports –Opiates/opioids, unspecified (unnamed) –Unknown release-type  Unique names enable better surveillance –Generics –Proposed new OxyContin® formulation

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