Drug Abuse Warning Network Research Articles

397 Regulations and Marketing of Energy Drinks in the United States: A Survey of University Student Beliefs about Caffeine Consumption

OBJECTIVES/GOALS: To understand how energy drinks are marketed and regulated and the effects of these policies on adolescent consumption and perceptions of the product. METHODS/STUDY POPULATION: A review of research studies using the PubMed database (PubMed.gov); clinical trials (clinicaltrials.gov); FDA Recall, Market Withdrawals, and Safety Alerts (FDA.gov); and emergency department (ED) visits from reports from the Drug Abuse Warning Network (DAWN) were conducted. A survey is being designed and will be sent to undergraduate and graduate university students through advertised QR codes and university email chains sent out to student organizations and courses. The survey will determine the percentage of respondents who consume caffeine, the frequency in which individuals consume caffeine, and reasons for consuming caffeine. The survey also seeks to understand perceptions and thoughts on energy drinks and caffeine regulation and consumption. RESULTS/ANTICIPATED RESULTS: From January 1st, 2000, to August 5th, 2022, 112 research studies investigated the physiological impact of energy drinks on adolescents, and 13 clinical trials from the age group of 0-17 were conducted. No FDA recalls have been observed for energy drinks or the top 4 brands within the US (by sales; Red Bull, Monster, Bang Energy, Rockstar), though some recalls regarding container manufacturing were made outside the US. ED visits from energy drinks doubled from 2007 to 2011 with 1/10 of them resulting in hospitalization. 58% of the total ED visits were exclusively related to energy drinks. It is anticipated that survey results will indicate trends of frequent caffeine/energy drink consumption among college students for studying, but students will not have a clear understanding of recommended caffeine intake. DISCUSSION/SIGNIFICANCE: Due to the lack of regulations and studies surrounding energy drinks, the dangers (as seen from ER visits) to public health are concerning. Regulatory agencies should invest in developing new protocols or regulations regarding the content of energy drinks as well as find ways to monitor the marketing strategies more closely behind them.

Alcohol far outpaces other drugs in emergency department visit data

The latest Drug Abuse Warning Network (DAWN) report on drug‐related emergency department (ED) visits serves as yet another reminder that alcohol remains our most broadly dangerous drug. Preliminary findings for 2021 show alcohol to be by far the most prevalent substance involved in drug‐related ED visits, at nearly triple the number for all opioids — a category that includes the much‐discussed fentanyl.

New DAWN data shows rise of methamphetamine

For the first time since 2011, the field has seen Drug Abuse Warning Network (DAWN) data. It's not complete, the way it used to be when it was when it was fully funded, but it's something. The Substance Abuse and Mental Health Services Administration Center for Behavioral Health Statistics and Quality released the first report and drug profiles from its reinstated Drug Abuse Warning Network. It abstracted data from 49 hospitals and shows, via unweighted data, trends in methamphetamine, marijuana, alcohol, heroin and nonmedical use of prescription opioids. “Among the 49 currently participating DAWN hospitals, the proportion of emergency department [ED] visits attributable to substance use, illicit or otherwise, was 4.6% during the period April 1, 2019 to October 15, 2020,” the report noted. “This proportion was somewhat higher, at 5.3%, in the DAWN hospitals in urban areas,” it continued, adding that “preliminary results also suggest that public health interventions may need to focus on methamphetamine since it appears to be the illicit substance most commonly associated with substance use‐related DAWN ED visits (16,446 of the 49,773 or 33.0% of ED visits involving illicit substances and/or alcohol).” Methamphetamine, whether by itself or as part of polysubstance use, prompted the most ED visits to a DAWN hospital, the results found. For the report, go to https://www.samhsa.gov/data/report/preliminary‐dawn‐data‐review.

COCAINE-INDUCED THROMBOTIC STORM

SESSION TITLE: Monday Medical Student/Resident Case Report Posters SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/21/2019 02:30 PM - 03:15 PM INTRODUCTION: Cocaine is associated with a wide array of complications through a number of different mechanisms. Although majority of cocaine related morbidity has been attributed to complications in arterial vasculature, the deleterious impact of venous complications appears to be largely unrepresented in current literature as well as clinical practice despite emerging evidence of the high prevalence and annual incidence of DVT in illicit drug users CASE PRESENTATION: 27-year-old previously healthy male presented to the ED with new onset difficulty speaking and facial droop hours after using cocaine. He was afebrile with vitals 98.5 °F, BP 142/97, HR 94 and RR 16. Examination was remarkable for expressive aphasia and right facial droop with no other focal neurological finding. CT scan of head showed thrombosed left MCA with infarct in left frontal lobe and basal ganglia. Labs were significant for a troponin of 14 md/dl and CK-MB 34. CBC and metabolic panel were unremarkable. Urine toxicology was positive for cocaine and opiates. EKG showed T wave inversion with ST depression in V1-V4 II and aVF. CTA of chest revealed bilateral segmental and subsegmental PE without any acute pulmonary disease. CTA of head and neck showed complete abrupt occlusion of proximal left internal carotid artery with distal reconstitution at the segment M1 of MCA and an intraluminal thrombus in the M1 segment. A doppler of lower extremities revealed deep venous thrombosis in left peroneal and posterior tibial veins. An ECHO failed to reveal an intracardiac shunt precluding the possibility of paradoxical thrombosis. He was continued on heparin for 10 days before being switched to Xarelto. He experienced improvement in word finding ability and is currently in rehab. Hypercoagulability work-up including prothrombin gene mutation, factor V Leiden deficiency, APLA and anti-thrombin deficiency was negative. DISCUSSION: This case illustrates an uncharacteristic presentation of cocaine-related widespread thrombotic cascade involving both arterial and venous circulations causing significant morbidity. The complex pathophysiology of widespread prothrombotic state caused by cocaine includes endothelial damage promoting increase of fibrinogen and Von Willebrand factor to platelet aggregation and clot formation. It is important to identify the impact cocaine induced venous thrombosis can mount, especially in the form of potentially fatal complications like pulmonary embolism. CONCLUSIONS: Although recent studies have focused on increased incidence and prevalence of venous thrombosis in setting of cocaine abuse, ours is the first case of documented pulmonary embolism caused by cocaine related venous thrombosis. Further studies are needed to identify patients at higher risk for this complication like rare thrombotic disorders Reference #1: 1. Substance Abuse and Mental Health Services Administration, Drug Abuse Warning Network, 2011: National Estimates of Drug-Related Emergency Department Visits. HHS Publication No. (SMA) 13-4760, DAWN Series D-39. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2013. Reference #2: Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality (formerly the Office of Applied Studies). The DAWN Report: Highlights of the 2009 Drug Abuse Warning Network (DAWN) Findings on Drug-Related Emergency Department Visits. Rockville, MD, December 28, 2010. Reference #3: . Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Drug Abuse Warning Network: Detailed Tables: National Estimates, Drug-Related Emergency Department Visits for 2004–2009. Rockville, MD, December 28, 2010. DISCLOSURES: no disclosure on file for Erika Cappelluti; No relevant relationships by Manish Kumar, source=Web Response No relevant relationships by Alain Rizkallah, source=Web Response No relevant relationships by Nihar Shah, source=Web Response No relevant relationships by Toishi Sharma, source=Web Response

Emergency department visits involving benzodiazepines and non-benzodiazepine receptor agonists

ObjectiveSedative-hypnotic medications (e.g., Benzodiazepines [BZDs] and non-benzodiazepine receptor agonists [nBZRAs]) are associated with adverse events, especially in the elderly, that may require emergency department (ED) treatment. This study assessed outcomes from ED visits attributed to BZDs and/or nBZRAs, and variations in these associations by age group. MethodsData came from the 2004–2011 waves of the Drug Abuse Warning Network (DAWN). Visits were categorized as involving: (1) BZDs-only, (2) nBZRAs-only, (3) combination of BZDs and nBZRAs, or (4) any other sedative-hypnotic medication. DAWN also recorded the disposition (i.e., outcome) of the visit. Analyses focused on outcomes indicating a serious disposition defined as hospitalization, patient transfer or death. Using logistic regression, the association of BZD and nBZRA use with visit disposition was assessed after applying sample weights so as to be nationally representative of ED visits in the United States involving medications or illicit substances. ResultsNineteen percent of visits involving other sedative-hypnotics, 28% involving BZDs-only, 20% involving nBZRAs-only and 48% involving a combination of BZDs and nBZRAs resulted in a serious disposition. Compared to visits involving other sedative-hypnotics, visits involving BZDs-only had 66% greater odds (Odds Ratio [OR]=1.66, 95% Confidence Interval [CI]=1.37–2.01), and visits involving a combination of BZDs and nBZRAs had almost four times increased odds of a serious disposition (OR=3.91, 95% CI=2.38–6.41). Results were similar across age groups. ConclusionsFindings highlight the need for clinical and regulatory initiatives to reduce BZD use, especially in combination with nBZRAs, and to promote treatment with safer alternatives to these medications.

Location of fatal prescription opioid-related deaths in 12 states, 2008–2010: Implications for prevention programs

IntroductionPrescription opioid pain reliever overdose is a major public health issue in the United States. To characterize the location of drug-related deaths, we examined fatal prescription opioid and illicit drug-related deaths reported in 12 states. MethodsData are from the Substance Abuse and Mental Health Services Administration's Drug Abuse Warning Network (DAWN). Medical examiners or coroners in 12 states (MA, MD, ME, NH, NM, OK, OR, RI, UT, VA, VT, WV) reported details of state-wide drug-related mortality during 2008–2010. DAWN data included location and manner of death, age, race, and drugs involved. Deaths were coded into three categories: prescription opioid-related, illicit drug-related, and cases that involved both a prescription opioid and an illicit drug. ResultsDuring a 3-year period, there were 14,091 opioid or illicit drug-related deaths in 12 states. More than half of the prescription opioid-related deaths in all states, except Maryland, occurred at home, rather than in public or in a health care facility. Although it was still the predominant category, lower percentages of illicit drug-related deaths occurred at home. ConclusionPrescription opioid overdoses have increased substantially, and the location of the person at the time of death can have important public health implications for interventions. Practical applicationsThis paper highlights that bystander support can be a critical lifesaving factor in drug related deaths but may be more likely for illicit drug-related deaths than for prescription opioid-related deaths.

Gender Differences in Emergency Department Visits and Detox Referrals for Illicit and Nonmedical Use of Opioids.

IntroductionVisits to the emergency department (ED) for use of illicit drugs and opioids have increased in the past decade. In the ED, little is known about how gender may play a role in drug-related visits and referrals to treatment. This study performs gender-based comparison analyses of drug-related ED visits nationwide.MethodsWe performed a cross-sectional analysis with data collected from 2004 to 2011 by the Drug Abuse Warning Network (DAWN). All data were coded to capture major drug categories and opioids. We used logistic regression models to find associations between gender and odds of referral to treatment programs. A second set of models were controlled for patient “seeking detox,” or patient explicitly requesting for detox referral.ResultsOf the 27.9 million ED visits related to drug use in the DAWN database, visits by men were 2.69 times more likely to involve illicit drugs than visits by women (95% CI [2.56, 2.80]). Men were more likely than women to be referred to detox programs for any illicit drugs (OR 1.12, 95% CI [1.02–1.22]), for each of the major illicit drugs (e.g., cocaine: OR 1.27, 95% CI [1.15–1.40]), and for prescription opioids (OR 1.30, 95% CI [1.17–1.43]). This significant association prevailed after controlling for “seeking detox.”ConclusionWomen are less likely to receive referrals to detox programs than men when presenting to the ED regardless of whether they are “seeking detox.” Future research may help determine the cause for this gender-based difference and its significance for healthcare costs and health outcomes.

Emergency Department Visits Involving Misuse and Abuse of the Antipsychotic Quetiapine: Results from the Drug Abuse Warning Network (DAWN).

Case reports in medical literature suggest that the atypical antipsychotic quetiapine, a medication not previously considered to have abuse potential, is now being subject to misuse and abuse (MUA; ie, taken when not prescribed for them or used in a way other than instructed by their health professional). Here we present systematic, nationally representative data from the 2005 to 2011 Drug Abuse Warning Network (DAWN) for prevalence of emergency department (ED) visits among the U.S. general population involving quetiapine and related to MUA, suicide attempts, and adverse reactions. Nationally, quetiapine-related ED visits increased 90% between 2005 and 2011, from 35,581 ED visits to 67,497. DAWN data indicate that when used without medical supervision for recreational/self-medication purposes, quetiapine poses health risks for its users, especially among polydrug users and women. These findings suggest that the medical and public health communities should increase vigilance concerning this drug and its potential for MUA.

Opioid use disorders: Trends and correlates

Aims: The aims of this poster are to (1) explore the trends in opioid use disorders overall, by age and geography and (2) examine differences in the liability for addiction based on age of onset. Methods: Data are from the 2011 National Survey on Drug Use and Heath (NSDUH), 2011 Drug AbuseWarning Network (DAWN), and 2011 Treatment Episode Data Set (TEDS). Results: From 2002 to 2011 the number of people with opioid usedisorders rose38%. Thenumberofpeoplewithprescriptionopioid use disorders is 3 times higher than heroin use disorders, but the increase of heroin use disorders was higher (104%). Over half the peoplewith prescription opioid use disorderswere over the age of 25, but the rate of growth was highest (+55%) among those age 18–25. From 2004 to 2010, this has been a 42% rise in drug related emergency room admissions, with the rates particularly high for prescription opioid alone (132%), prescription opioid +other illicit drugs (139%), prescription opioid + alcohol (+63%) or prescription opioid + illicit drugs +Alcohol (+94%). From 2000 to 2010, there has been a 44% increase in opioid related treatment admissions overall, including 352% for prescription opioids. The rate of growth of prescription Opioid Treatment admissions are growing even more rapidly for young adults ages 18–24 (+489%). Conclusions: The rapid growth in opioid use disorders is being driven by prescription opioid use disorders. While most people are adults, the rate of growth among young adults is much faster and also raises the potential for years of problems ahead. Geographic variation in the rates of disorders suggest that availability and local practices are significant, and that it may be feasible to stop the further rates of disorder or even reverse it. The returnof opioids also has important implications for the need to have detoxification and medication assisted treatment services available as part of health care reform. Financial support: NIDA Grant no. R37 DA011323.

Gender and prescription opioid misuse in the emergency department.

To the best of the authors' knowledge, gender differences in nonmedical opioid presentations to the emergency department (ED) have not been studied. The objective was to explore gender differences in ED visits related to nonmedical prescription opioid use in a nationally representative sample. Data from the 2011 U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration's Drug Abuse Warning Network (DAWN) were analyzed to compare visit characteristics between women and men. Logistic regression models were developed to examine the association between gender and specific drug presentations and clinical outcomes. There were an estimated 426,010 DAWN-defined visits involving prescription opioid use in 2011. The prevalence of drugs in opioid-involved visits was similar between women and men. Ingestion of another drug along with opioids was associated with increased odds of hospital admission for both women and men, and types of opioids ingested were similar between women and men. However, gender differences were noted in clinical outcomes, depending on the specific drug combination. Gender differences exist in ED presentations related to prescription opioids. Further research is needed to understand these differences and any implications for gender-specific emergency care and brief interventions.

The association of injury with substance use disorder among women of reproductive age: an opportunity to address a major contributor to recurrent preventable emergency department visits?

Substance use disorder (SUD) among women of reproductive age is a complex public health problem affecting a diverse spectrum of women and their families, with potential consequences across generations. The goals of this study were 1) to describe and compare the prevalence of patterns of injury requiring emergency department (ED) visits among SUD-positive and SUD-negative women and 2) among SUD-positive women, to investigate the association of specific categories of injury with type of substance used. This study was a secondary analysis of a large, multisource health care utilization data set developed to analyze SUD prevalence, and health and substance abuse treatment outcomes, for women of reproductive age in Massachusetts, 2002 through 2008. Sources for this linked data set included diagnostic codes for ED, inpatient, and outpatient stay discharges; SUD facility treatment records; and vital records for women and for their neonates. Injury data (ICD-9-CM E-codes) were available for 127,227 SUD-positive women. Almost two-thirds of SUD-positive women had any type of injury, compared to 44.8% of SUD-negative women. The mean (±SD) number of events also differed (2.27 ± 4.1 for SUD-positive women vs. 0.73 ± 1.3 for SUD-negative women, p < 0.0001). For four specific injury types, the proportion injured was almost double for SUD-positive women (49.3% vs 23.4%), and the mean (±SD) number of events was more than double (0.72 ± 0.9 vs. 0.26 ± 0.5, p < 0.0001). The numbers and proportions of motor vehicle incidents and falls were significantly higher in SUD-positive women (22.5% vs. 12.5% and 26.6% vs. 11.0%, respectively), but the greatest differences were in self-inflicted injury (11.5% vs. 0.8%; mean ± SD events = 0.19 ± 0.9 vs. 0.009 ± 0.2, p < 0.0001) and purposefully inflicted injury (11.5% vs 1.9%, mean ± SD events = 0.18 ± 0.1 vs. 0.02 ± 0.2, p < 0.0001). In each of the injury categories that we examined, injury rates among SUD-positive women were lowest for alcohol disorders only and highest for alcohol and drug disorders combined. Among 33,600 women identified as using opioids, 2,132 (6.3%) presented to the ED with overdose. Multiple overdose visits were common (mean ± SD = 3.67 ± 6.70 visits). After adjustment for sociodemographic characteristics, psychiatric history, and complex/chronic illness, SUD remained a significant risk factor for all types of injury, but for the suicide/self-inflicted injury category, psychiatric history was by far the stronger predictor. The presence of SUD increases the likelihood that women in the 15- to 49-year age group will present to the ED with injury. Conversely, women with injury may be more likely to be involved in alcohol abuse or other substance use. The high rates of injury that we identified among women with SUD suggest the utility of including a brief, validated screen for substance use as part of an ED injury treatment protocol and referring injured women for assessment and/or treatment when scores indicate the likelihood of SUD.

Assessment of the Trends in Medical Use and Misuse of Opioid Analgesics from 2004 to 2011

Background: The epidemic of medical use and abuse of opioid analgesics is linked to the economic burden of opioid-related abuse and fatalities in the United States. Multiple studies have estimated the extent to which prescription opioid analgesics contribute to the national drug abuse problem; studies also assessing the trends in medical use and abuse of opioid analgesics have confirmed the relationship between increasing medical use of opioids and increasing fatalities. The available data is limited until 2002.. Study Design: Retrospective analysis of data from 2004 to 2011 from 2 databases: Automation of Reports and Consolidated Orders System (ARCOS) for opioid use data and Drug Abuse Warning Network (DAWN) for drug misuse data. Objective: To determine the proportion of drug abuse related to opioid analgesics and the various trends in the medical use and abuse of 8 opioid analgesics commonly used to treat pain: buprenorphine, codeine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, and oxycodone. Methods: The data obtained from DAWN is a nationally representative sample of hospital emergency department admissions resulting from drug abuse. Main outcome measure was the identification of trends in the medical use and misuse of opioid analgesics from 2004 to 2011. Results: From 2004 to 2011, there was an increase in the medical use of all opioids except for a 20% decrease in codeine. The abuse of all opioids including codeine increased during this period. Increases in medical use ranged from 2,318% for buprenorphine to 35% for fentanyl, including 140% for hydromorphone, 117% for oxycodone, 73% for hydrocodone, 64% for morphine, and 37% for methadone. The misuse increased 384% for buprenorphine with available data from 2006 to 2011, whereas from 2004 to 2011, it increased 438% for hydromorphone, 263% for oxycodone, 146% for morphine, 107% for hydrocodone, 104% for fentanyl, 82% for methadone, and 39% for codeine. Comparison of opioid use showed an overall increase of 1,448% from 1996 to 2011, with increases if 690% from 1996 to 2004 and 100% from 2004 to 2011. In contrast, misuse increased more dramatically: 4,680% from 1996 to 2011, with increases of 1,372% from 1996 through 2004 and 245% from 2004 to 2011. The number of patients seeking rehabilitation for substance abuse also increased 187% for opioids, whereas it increased 87% for heroin, 40% for marijuana, and decreased 7% for cocaine. Limitations: Limitations of this assessment include the lack of data from 2003, lack of data available on meperidine, and that the aggregate data systems used in the study did not identify specific formulations or commercial products. Conclusion: The present trend of continued increase in the medical use of opioid analgesics appears to contribute to increases in misuse, resulting in multiple health consequences. Key words: Medical use of opioids, inappropriate use of opioids, abuse of opioids, opioid-related fatalities, Automation of Reports and Consolidated Orders System (ARCOS), Drug Abuse Warning Network (DAWN), International Narcotics Control Board (INCB)

The Downside of Upscheduling

Intercontinental Marketing Services (IMS) data estimate 130 million hydrocodone prescriptions were written in 2006, up approximately 50% from 88 million in 2000 [1]. This greater availability is thought to have contributed, at least in part, to hydrocodone's illicit use. In 2012, hydrocodone ranked 1st on the RADARS poison center list and the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS) System college survey list [2]. The January 2012 Drug Abuse Warning Network (DAWN) report showed, among pain reliever-related emergency department (ED) visits involving drug misuse or abuse by adolescents, oxycodone and hydrocodone were the most commonly involved opioids [3]. On March 20, 2012, legislation was proposed to reschedule hydrocodone products and the Food and Drug Administration (FDA) Drug Safety and Risk Management Advisory Committee voted “yes”, recommending rescheduling of hydrocodone from Schedule 3 to Schedule …

Using poison center exposure calls to predict prescription opioid abuse and misuse‐related emergency department visits

Prescription drug abuse is a critical problem in the USA and has been linked to more deaths than automobile accidents. Despite this growing epidemic, the USA lacks a timely early warning system. Poison centers (PCs) have the potential to act as sentinel reporting entities for prescription drug abuse and misuse due to near-real-time data reporting and abundant coverage in the USA. Data from the Researched Abuse, Diversion and Addiction-Related Surveillance (RADARS®) System PC program were compared with data from the Drug Abuse Warning Network (DAWN) from 2004 through 2010. Population rates of PC call mentions regarding abuse and misuse of prescription opioids were compared with population rates of emergency department visit mentions of the same using linear regression. Products included in the analysis were the following: buprenorphine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, and oxycodone. The strength of association between RADARS System PC data and DAWN emergency department visits regarding all opioids in aggregate was strong (R² = 0.81, p < 0.001). The correlations between the two programs at the drug class level also were strong for buprenorphine, hydrocodone, hydromorphone, methadone, and oxycodone (all R² > 0.70, all p < 0.01), significant for fentanyl (p = 0.05), and moderate for morphine (p = 0.09). Data on prescription opioid drug abuse from the RADARS System PC program correlates well with emergency room data from DAWN. Due to timeliness of data, geographic coverage and strong associations with other warning systems, PC data can be used for sentinel reporting on prescription drug abuse and misuse in the USA.

Opioid addiction agonist therapy and the QT prolongation phenomenon: state of the science and evolving research questions

Opioid addiction agonist therapy and the <scp>QT</scp> prolongation phenomenon: state of the science and evolving research questions

FDA Opioid Safety Plan Promotes Patient, Physician Education to Prevent Abuse

A PROPOSAL FROM THE US FOOD and Drug Administration (FDA) to curb overdoses of longacting and extended-release opioid medications calls on drug makers to provide voluntary clinician and patient safety education, despite earlier statements from the agency that such steps would provide little improvement over existing safety efforts. In February 2009, the agency first announced it would require the makers of this class of drugs to develop a joint plan to reduce unintentional overdoses involving their products. The announcement was a response to increasing rates of overdose and abuse of opioid pain medications. Data from the Substance Abuse and Mental Health Services Administration’s Drug Abuse Warning Network (DAWN) show that emergency department visits involving nonmedical use of prescription opioids increased 111% between 2004 and 2008, with the estimated number of visits rising from 144 644 to 305 885 per year (MMWR Morb Mortal Wkly Rep. 2010;59[23]:705-709). “The misuse and abuse of longacting and extended-release opioid drug products have resulted in a widespread and serious public health crisis of addiction, overdose, and death,” said Bob A. Rappaport, MD, director of the FDA division of anesthesia and analgesia products, in a June letter to advisors to the FDA, who assessed the proposal in July. Despite the urgency, the process— which has taken more than a year and a half—hasbeencontentious. In response topressure fromclinicianorganizations, drug makers shelved initial plans to requiremandatoryprescribertraininginfavor of voluntary training on safe use of theseproducts.Theorganizationsargued that cliniciansmightoptoutofprescribingthesemedicationsifdoingsorequired special training, leaving patients to go withoutpaintreatmentortomanagepain less effectively with short-acting drugs. AtaDecember2009meetingbetweenthe drug makers and the FDA, agency rep-

Historical Parallel Evolution of Injury Prevention and Control Science and Emergency Medicine

Historical Parallel Evolution of Injury Prevention and Control Science and Emergency Medicine

Active surveillance of abused and misused prescription opioids using poison center data: A pilot study and descriptive comparison

Background. Prescription opioids are abused throughout the United States. Several monitoring programs are in existence, however, none of these systems provide up-to-date information on prescription opioid abuse. This article describes the use of poison centers as a real-time, geographically specific, surveillance system for prescription opioid abuse and compares our system with an existing prescription drug abuse monitoring program, the Drug Abuse Warning Network (DAWN). Methods. Data were collected from eight geographically dispersed poison centers for a period of twelve months. Any call involving buprenorphine, fentanyl, hydrocodone, hydromorphone, methadone, morphine, and oxycodone was considered a case. Any case coded as intentional exposure (abuse, intentional misuse, suicide, or intentional unknown) was regarded as misuse and abuse. Comparative data were obtained from DAWN. Results. Poison center rates of abuse and misuse were highest for hydrocodone at 3.75 per 100,000 population, followed by oxycodone at 1.81 per 100,000 population. DAWN emergency department (ED) data illustrate a similar pattern of abuse with most mentions involving hydrocodone and oxycodone. Poison center data indicate that people aged 18 to 25 had the highest rates of abuse. DAWN reported the majority of ED mentions among 35 to 44-year-olds. Geographically, Kentucky had the uppermost rates of abuse and misuse for all opioids combined at 20.69 per 100,000 population. Conclusions. Comparing poison center data to DAWN yielded mostly comparable results, including hydrocodone as the most commonly mentioned drug. Our results suggest poison center data can be used as an indicator for prescription opioid abuse and misuse and can provide timely, geographically specific information on prescription drug abuse.

Dextromethorphan Abuse in Adolescence

To analyze the trend of dextromethorphan abuse in California and to compare these findings with national trends. A 6-year retrospective review. California Poison Control System (CPCS), American Association of Poison Control Centers (AAPCC), and Drug Abuse Warning Network (DAWN) databases from January 1, 1999, to December 31, 2004. All dextromethorphan abuse cases reported to the CPCS, AAPCC, and DAWN. The main exposures of dextromethorphan abuse cases included date of exposure, age, acute vs long-term use, coingestants, product formulation, and clinical outcome. Main Outcome Measure The annual proportion of dextromethorphan abuse cases among all exposures reported to the CPCS, AAPCC, and DAWN databases. A total of 1382 CPCS cases were included in the study. A 10-fold increase in CPCS dextromethorphan abuse cases from 1999 (0.23 cases per 1000 calls) to 2004 (2.15 cases per 1000 calls) (odds ratio, 1.48; 95% confidence interval, 1.43-1.54) was identified. Of all CPCS dextromethorphan abuse cases, 74.5% were aged 9 to 17 years; the frequency of cases among this age group increased more than 15-fold during the study (from 0.11 to 1.68 cases per 1000 calls). Similar trends were seen in the AAPCC and DAWN databases. The highest frequency of dextromethorphan abuse occurred among adolescents aged 15 and 16 years. The most commonly abused product was Coricidin HBP Cough & Cold Tablets. Our study revealed an increasing trend of dextromethorphan abuse cases reported to the CPCS that is paralleled nationally as reported to the AAPCC and DAWN. This increase was most evident in the adolescent population.

Emergency Rooms See More Teens Who Have Abused ADHD Meds

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessEmergency Rooms See More Teens Who Have Abused ADHD MedsJim RosackJim RosackSearch for more papers by this authorPublished Online:20 Oct 2006https://doi.org/10.1176/pn.41.20.0018aAn analysis released last month indicates that young adults aged 18 to 25 appear to have a higher rate of nonmedical use of stimulant medications than those aged 12 to 17, but the younger group may be at greater risk for adverse effects, particularly from nonmedical use.The report, from the Substance Abuse and Mental Health Services Administration's (samhsa) Drug Abuse Warning Network (DAWN), shows that during 2004 nearly 8,000 visits to an emergency room (ER) involved methylphenidate or amphetamine-dextroamphetamine, the two drugs most commonly prescribed to treat attention-deficit/hyperactivity disorder (ADHD). The rates of ER visits resulting from use of either of these drugs by patients aged 12 to 17 were higher in 2004 than the rates for patients aged 18 or older. In addition, the data suggest that polydrug use—one or more drugs being used in addition to ADHD medication— was common in ER visits involving the misuse of ADHD medication.“These findings suggest an alarming level of nonmedical use that could have life-threatening consequences, such as heart attack or stroke,” Assistant Surgeon General Eric Broderick, D.D.S., M.P.H., SAMHSA's acting deputy administrator, said in a press release. “Parents need to help break this dangerous pattern of behavior by carefully monitoring their child's use of ADHD medication.”Although other SAMHSA research indicates that the diversion of ADHD medications to nonmedical use has increased in recent years, data show that overall nonmedical use of ADHD medications remains relatively low at 0.3 percent of the population aged 12 or older.The latest DAWN report shows that the most frequent reason for an ER visit associated with ADHD medications was “nonmedical use” (48 percent)—defined as “cases where a higher than prescribed dose was used, a drug prescribed for another person was used, or there was other evidence in the medical record of drug misuse or abuse.”Nonmedical use of amphetamine drugs was significantly more likely to result in an ER visit for all age groups, according to the report, compared with medical use of amphetamine drugs (see chart). With methylphenidate, however, nonmedical use was just as likely as medical use to result in an ER visit for the 12-17 age group, while nonmedical use was more common in young adults and those over 35.About two-thirds (68 percent) of ER visits involving nonmedical use also involved another substance. Other pharmaceuticals were combined with ADHD medications in 57 percent of ER visits, followed by illicit drugs in 26 percent and alcohol in 20 percent.Adverse reactions associated with medical use of the medications accounted for 34 percent of ER visits, followed by accidental ingestion (10 percent) and suicide attempt (8 percent).The SAMHSA DAWN report is posted at<https://dawninfo.samhsa.gov/files/TNDR09ADHDmedsForHtml.pdf>.▪ ISSUES NewArchived