Drug War Distortions: Emergency Room Visits

Distortion 6: In Wisconsin, marijuana overdose visits in emergency rooms equal to heroin or morphine, twice as common as Valium. (cited: Wisconsin Department of Justice)
Notably there are no numbers given, only comparisons. The rates in Wisconsin are similar to national averages as reported by the Drug Abuse Warning Network of the US Substance Abuse and Mental Health Services Administration. The federal DAWN report itself notes that reports of marijuana do not mean people are going to the hospital for a marijuana overdose, it only means that people going to the hospital for a drug overdose mention marijuana as a drug they use. Since marijuana is the most widely used illegal drug it is the most mentioned illicit drug when people come to the hospital for any reason. Also, alcohol-in-combination is a larger problem than any of the illicit drugs.

[Substance Abuse and Mental Health Services Administration, US Dept. of Health and Human Services, DAWN Emergency Room Data Report, 2001]

First an explanation of terminology: the federal entity which collects data on drug mentions in emergency department and medical examiner reports, the Drug Abuse Warning Network or DAWN, explains the difference between emergency room visits and emergency room drug mentions thus:

"Drug Episodes vs. Drug Mentions

"Drug-Related Episode: A drug or ED episode is an ED visit that was induced by or related to the use of an illegal drug(s) or the nonmedical use of a legal drug for patients age 6 years and older.

"Drug Mention: A drug mention refers to a substance that was mentioned during a drug-related ED episode. Because up to 4 drugs can be reported for each drug abuse episode, there are more mentions than episodes cited in this report." (p. 1)

Source: "Year-End 2000 Emergency Department Data from the Drug Abuse Warning Network," Office of Applied Studies, Substance Abuse and Mental Health Services Administration, US Dept. of Health and Human Services, July 2001.

Important Note: Mention of a drug in an emergency department visits does not mean that the drug was the *cause* of the visit. The DAWN report for 2000 says, regarding mentions of marijuana/hashish:

"Marijuana/hashish mentions related to all motives were stable from 1999 to 2000 (Table 26). ED contacts due to chronic effects increased 25 percent (from 6,891 to 8,621), and contacts due to patients seeking detoxification increased 18 percent (from 11,908 to 14,110). However, 2 important caveats must be kept in mind. First, the drug use motive and reason for ED contact were frequently unknown or reported as ‘other’ (24% and 23% of mentions, respectively). Second, drug use motive and reason for ED contact pertain to the episode, not a particular drug. Since marijuana/hashish is frequently reported in combination with other drugs, the reason for the ED contact may be more relevant to the other drug(s) involved in the episode." (p. 21)

Nationally, the number of marijuana/hashish mentions is nearly equal to that of heroin/morphine. The DAWN year-end 2000 report indicates that:

"In 2000, there were 601,776 drug-related ED episodes in the coterminous U.S. with 1,100,539 drug mentions (on average, 1.8 drugs per episode). There was no statistically significant change between 1999 and 2000 in the number of ED episodes (from 554,932 to 601,776) or ED drug mentions (from 1,015,206 to 1,100,539) (Table 2 and Figure 1).

"In 2000, drug abuse-related ED visits occurred at the rate of 243 ED episodes per 100,000 population in the coterminous U.S. (Table 30).

"Cocaine continued to be the most frequently mentioned illicit drug, comprising 29 percent of episodes (174,896 mentions) in 2000. Cocaine was followed in frequency by heroin/morphine (16%, 97,287 mentions), marijuana/hashish (16%, 96,446 mentions), amphetamine (3%, 16,189 mentions), and methamphetamine/speed (2%, 13,513 mentions) (Table 2 and Figure 2).

"During 2000, the highest rates of ED drug mentions occurred for: alcohol-in-combination (83 mentions per 100,000 population), cocaine (71), heroin/morphine (39), and marijuana/hashish (39) (Table 30).

"Alcohol-in-combination was mentioned in 34 percent (204,524) of ED drug episodes in 2000 and remains the most common substance reported by DAWN EDs (Table 2). Note that alcohol is only reported to DAWN when present in combination with another reportable drug.

"Mentions of the narcotic analgesics oxycodone and hydrocodone are relatively infrequent (mentioned in 2% and 3% of episodes, respectively), but revealed significant increases. From 1999 to 2000, mentions of drugs containing oxycodone increased 68 percent (from 6,429 to 10,825), and mentions of drugs containing hydrocodone increased 31 percent (from 14,639 to 19,221). Mentions of oxycodone were 108 percent higher in 2000 than in 1998, and mentions of hydrocodone were 53 percent higher than in 1998." (p. 11)

Additionally:

"Mentions of the antidepressants trazodone (9,798, 2% of episodes), amitriptyline (6,446, 1%), fluoxetine (7,938, 1%), doxepin (1,552, 0.3%), and imipramine (564, 0.1% of episodes) showed no statistically significant changes between 1999 and 2000 (Table 2).

"Mentions of the benzodiazepines alprazolam (22,105, 4% of episodes), clonazepam (18,005, 3%), diazepam (12,090, 2%), lorazepam (10,671, 2%), and triazolam (362, 0.1%) remained stable from 1999 to 2000 (Table 2). Since 1993, mentions of clonazepam have increased 77 percent, and mentions of triazolam have decreased 71 percent." (p. 26)

According to DAWN, nationally in 2000 there were a total of 264,240 emergency room department drug episodes arising from overdose (table 18, p. 77), in which there were 518,654 drug mentions (table 20, p. 79). There were 18,734 marijuana/hashish 'mentions' in emergency room visits attributed to overdose in 2000 (table 26, p. 85), cocaine accounted for 27,794 such mentions (table 22, p. 81), and heroin another 16,999 (table 24, p. 83).

Distortion 6: Emergency Room Visits