All Drug-Related ED Visits
In 2009, slightly over 120 million visits were made to EDs in general-purpose hospitals in the
United States, and DAWN estimates that at least 4.5 million of these visits were drug related. Drugrelated ED visits have increased by over 80 percent since 2004. This increase primarily reflects
greater numbers of medical emergencies associated with adverse reactions, accidental drug
ingestions, and misuse or abuse of prescription drugs and over-the-counter medications.
D A W N , 2 0 0 9 : N A T I O N A L E D E S T I M A T E S 7
H I G H L I G H T S
This publication presents national estimates of drug-related visits to hospital emergency
departments (EDs) for the calendar year 2009, based on data from the Drug Abuse Warning
Network (DAWN). Also presented are comparisons of 2009 estimates with those for 2004, 2007,
and 2008. DAWN is a public health surveillance system that monitors drug-related ED visits for the
Nation and for selected metropolitan areas. The Substance Abuse and Mental Health Services
Administration (SAMHSA), U.S. Department of Health and Human Services (HHS), is the agency
responsible for DAWN. SAMHSA is required to collect data on drug-related ED visits under section
505 of the Public Health Service Act.
DAWN relies on a nationally representative sample of general, non-Federal hospitals operating
24-hour EDs, with oversampling of hospitals in selected metropolitan areas. In each participating
hospital, ED medical records are reviewed retrospectively to find the ED visits that involved recent
drug use. All types of drugs—illegal drugs, prescription drugs, over-the-counter pharmaceuticals
(e.g., dietary supplements, cough medicine), and substances inhaled for their psychoactive
effects—are included. Alcohol is considered an illicit drug when consumed by patients aged 20 or
younger. For patients aged 21 or older, though, alcohol is reported only when it is used in
conjunction with other drugs.
Between 2004 and 2009, large increases in the involvement of non-illicit drugs (prescription drugs,
over-the-counter medications, and supplements [e.g., herbal remedies]) have been observed in all
types of drug-related ED visits (misuse/abuse, suicide attempts, adverse reactions, and accidental
ingestions). It is likely that there multiple causes contributing to these increases. In respect to
adverse reactions, some portion may be associated with the greater number of prescriptions being
written and more people taking prescription drugs as part of their medical care. People of all ages
are increasingly being prescribed multiple drugs simultaneously, which, in turn, has increased the
possibility of unintended interactions. Polypharmacy is particularly common among older
populations who are placed on long-term medication for chronic conditions, and the number of
older persons in the nation is growing. In respect to misuse and abuse, these same trends have led
to prescription drugs being more accessible and more easily able to be diverted. It is beyond the
scope of this report to explore the causes behind the growing numbers of ED visits involving
pharmaceuticals, and further analysis is needed.
All Drug-Related ED Visits
In 2009, slightly over 120 million visits were made to EDs in general-purpose hospitals in the
United States, and DAWN estimates that at least 4.5 million of these visits were drug related. Drugrelated ED visits have increased by over 80 percent since 2004. This increase primarily reflects
greater numbers of medical emergencies associated with adverse reactions, accidental drug
ingestions, and misuse or abuse of prescription drugs and over-the-counter medications.
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