Findings from the Drug Abuse Warning Network

1
Findings 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
• 6 May 2008
• http//DAWNinfo.samhsa.gov

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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 fentanyl

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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

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National Estimates
Oversample areas (urban) Remainder area (urban
rural)
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Source of DAWN Estimates, 2004-2006
2004 2005 2006
Eligible hospitals 4,505 4,549 4,568
Sample of hospitals 556 562 544
Responding hospitals 220 224 205
Response rate 39.6 39.9 37.7
Design weight response rate 26.7 25.8 24.9
Weighted response rate 23.9 28.9 26.1
Drug-related ED visits 168,841 268,128 269,339
Drug reports 275,829 420,420 419,438
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DAWN Data Collection Retrospective Review of
Medical Records
charts reviewed 9,837,481
ED visits reviewed
cases found 346,946
Drug-related
ED visits not reviewed
National estimates
Source DAWN, 2006 data, 4/3/2008
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Analysis Domains
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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 suicides
• Includes suicide ideation, plan, gesture

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Drug-Related ED Visit Rates, 2004-2006
Source National estimates from DAWN, 2004-2006
10
Nonmedical Use of Pharmaceuticals, Selected
Opiates/Opioids, 2006
Single- multi-ingredient formulations
Source National estimates from DAWN, 2006
11
Nonmedical Use of Pharmaceuticals, Selected
Opiates/Opioids, 2006
Single- multi-ingredient formulations
Source National estimates from DAWN, 2006
12
Classification of Fentanyl Reports

• Extended release (ER)
• Duragesic (2)
• Duragesic Patch (23)
• Fentanyl Patch (74)
• Alternate terms
• Duragesic-100
• Duragesic-12
• Duragesic-25
• Duragesic-50
• Duragesic-75

• Immediate release (IR)
• bupivacaine-fentanyl
• droperidol-fentanyl
• Innovar
• fentanyl
• Actiq (89)
• Fentora (11)
• Ionsys
• Sublimaze
• fentanyl-ropivacaine

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Classification of Fentanyl Reports (cont'd)

• Unknown release type (UK)
• Fentanyl (95)
• alternate terms
• China white narcotic
• Fentanyl citrate
• Fentanyl lollipop
• Fentanyl metabolite
• Fentanyl pops
• Fentanyl suckers

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Nonmedical Use of Pharmaceuticals, Fentanyl, by
Release Type, 2004
Source National estimates from DAWN, 2004
15
Nonmedical Use of Pharmaceuticals, Fentanyl, by
Release Type, 2005
Source National estimates from DAWN, 2005
16
Nonmedical Use of Pharmaceuticals, Fentanyl, by
Release Type, 2006
Source National estimates from DAWN, 2006
17
Fentanyl, ER vs. IR All Visits
Source DAWN estimates for the U.S., 2004-2006
18
Fentanyl, ER vs. IR Medical Use
Source DAWN estimates for the U.S., 2004-2006
19
Fentanyl, ER vs. IR Nonmedical Use
Source DAWN estimates for the U.S., 2004-2006
20
Fentanyl, IR vs. ER Nonmedical vs. Medical Use
Nonmedical use
Medical use
of visits
Source DAWN estimates for the U.S., 2004-2006
21
Nonmedical Use Disposition from ED,Fentanyl by
Release Type, 2006
of ED visits
Other
Admitted
Treated released
Extended
Unknown
Immediate
Source DAWN estimates for the U.S., 2006
22
Nonmedical Use Number of Drugs,Fentanyl by
Release Type, 2006
of ED visits
Multiple drugs
Extended
Unknown
Immediate
Source DAWN estimates for the U.S., 2006
23
Fentanyl by Release TypeUnweighted Reports to
DAWN, 2007-2008
N21
N648
N1,879
Source DAWN Live!, 4/30/2008
24
Actiq and Fentora Reports to DAWN,by Type,
2007-2008 (unweighted)
N11
N8
Source DAWN Live!, 4/30/2008
25
Actiq and Fentora Reports to DAWN,by
Disposition, 2007-2008 (unweighted)
N11
N8
Actiq
Fentora
Source DAWN Live!, 4/30/2008
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Conclusions

• Reports of immediate release fentanyl too
  infrequent to produce national estimates
• Small number of Fentora reports to DAWN,
  2007-2008 (to 4/30/2008)
• First report in 2006
• Similar numbers of medical- and nonmedical-use
  visits possibly more inpatient admissions

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Important ConsiderationsDAWN and ED Medical
Records

• Link between ED visit and use of drug
• New linkages may need to be discovered for a new
  drug
• Dose levels and source of drug unavailable
• Nonspecific drug reports
• Unknown release-type
• DAWN surveillance can begin with (or before) drug
  approval