Original Contribution
ED visits for drug-related poisoning in the United States, 2007,☆☆

https://doi.org/10.1016/j.ajem.2010.11.031Get rights and content

Abstract

Background

Fatal drug-related poisoning has been well described. However, death data only show the tip of the iceberg of drug-related poisoning as a public health problem. Using the 2007 Nationwide Emergency Department Sample, this study described the characteristics of emergency department visits for drug-related poisoning in the United States.

Methods

Any ED visit that had an International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code of 960-979 was defined as a drug-related poisoning case. Intentionality of poisoning was determined by E-codes. Weighted estimates of ED visits were calculated by patient and hospital characteristics, intentionality of poisoning, and selected drug classes. Population rates by sex, age, urban/rural classification, median household income in patient's zip code, and hospital region were calculated.

Results

An estimated 699 123 (95% confidence interval, 666 529-731 717) ED visits for drug-related poisoning occurred in 2007. Children 0 to 5 years old had the highest rate for unintentional poisoning (male, 237 per 100 000; female, 218 per 100 000). The rate of drug-related poisoning in rural areas (684 per 100 000) was 3 times higher than the rates in other areas. Psychotropic agents and analgesics were responsible for 43.7% of all drug-related poisoning. Women 18 to 20 years old had the highest ED visit rate for suicidal poisoning (245 per 100 000). The estimated ED charges were $1 394 051 262, and 41.1% were paid by Medicaid and Medicare.

Conclusion

Antidepressants and analgesics were responsible for nearly 44% of ED visits for drug-related poisoning in the United States. Interventions and future research should target prescription opioids, rural areas, children 0 to 5 years old for unintentional drug-related poisoning, and female ages 12 to 24 years for suicidal drug-related poisoning.

Introduction

Drug-related poisoning cases have been consistently rising in the United States in the past decade, which can largely be attributed to the increased use of prescription opioid analgesics [1], [2], [3]. Statistics from death certificates in 2007 indicated that 27 658 unintentional drug-related poisoning deaths occurred in the United States, which is an increase of roughly 5-fold since 1990 [4]. Drug-related poisoning deaths are currently second only to motor vehicle crash deaths among the leading causes of injury death in the United States [4], [5]. Unlike previous epidemics of drug-related poisoning deaths in the United States, current fatal drug-related poisoning have spread to rural areas and are primarily due to prescription drugs rather than illicit drugs [6].

Although there is a considerable amount of literature describing fatal drug-related poisoning, death data only show a fraction of the drug-related poisonings in the United States [7] Local health agencies are aware of the drug-related poisoning problem but cite insufficient data as one of the major barriers to address drug-related poisoning [8]. Emergency department (ED) visits are a potential data source for monitoring nonfatal drug poisoning. According to the Drug Abuse Warning Network (DAWN) operated by the Substance Abuse and Mental Health Services Administration, the number of ED visits associated with the nonmedical use of over-the-counter and prescription drugs increased from 0.5 million in 2004 to 1 million in 2008 [9]. Meanwhile, the number of ED visits involving illicit drugs was stable at 1 million from 2004 to 2008 [10].

The goal of this study is to describe the epidemiology of ED visits for drug-related poisoning in the United States using the data from the Nationwide Emergency Department Sample (NEDS), one of the Health Care Utilization Project data sets from the Agency for Healthcare Research and Quality. Understanding the epidemiology of drug-related poisoning can help to identify high-risk groups for whom tailored interventions can be developed.

Section snippets

Data sources

This study examined ED visits for drug poisoning using discharge data from the 2007 NEDS. The NEDS is the largest all-payer ED database that is publicly available in the United States [11]. It selects a 20% stratified probability sample of all US community, nonrehabilitation hospital-based EDs. The 5 hospital characteristics used for stratification are United States census region, teaching status, ownership, trauma-level designation, and urban-rural location. The NEDS data enable analyses of ED

Demographics and overall characteristics

According to the drug-related poisoning definition in this study, the NEDS data set included 153 219 drug-related poisoning ED visits, representing 699 123 (95% CI, 666 529-731 717) visits nationwide in 2007. Of these cases, 79.2 % had one drug class involved, 14.3 % had 2 classes of drugs involved, 4.7 % had 3 classes of drugs involved, and 1.8 % had 4 or more classes of drugs involved. Alcohol was involved in 90 886 of these drug-related poisoning cases (13.0%).

More than half of drug-related

Discussion

With the NEDS data, we estimated that there were 699 123 drug-related poisoning ED visits in the year 2007. The DAWN and National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP) are 2 other databases that could be used to monitor and study drug-related poisoning ED visits in the United States [9], [16]. They are both probability samples of data from hospital EDs nationally and have been used to study poisoning. However, estimates of the numbers of poisoning cases differ

Conclusions

This study identified almost 700 000 visits to the United States hospital EDs due to drug-related poisoning in 2007. This underscores the importance of drug-related poisoning as a major public health problem in the United States. Our study adds new evidence that the current epidemic of drug-related poisoning is fueled by prescription opioids, and rural areas have higher rates of drug-related poisoning than urban areas. Prevention programs should target prescription opioids, and rural areas, as

Acknowledgments

We thank Ms Krista Wheeler (Center for Injury Research and Policy, The Research Institute at Nationwide Children's Hospital) for her great effort in editing the text during the revision of the manuscript.

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    This study was supported by a grant from the National Center for Injury Prevention and Control, Centers for Disease Control and Prevention (Grant No. R49/CE001172-01).

    ☆☆

    The views expressed here are solely the responsibility of the authors and do not necessarily reflect the official views of the Centers for Disease Control and Prevention.

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