Findings from the 2009 Drug Abuse Warning Network (DAWN) have been released and show that there were nearly 4.6 million drug-related emergency department (ED) visits in 2009. About half (49.8 percent, or 2.3 million) of the 4.6 million were due to adverse reactions to pharmaceuticals. Almost one half (45.1 percent, or 2.1 million) of the 4.6 million were attributed to drug misuse or abuse. DAWN is one of three major surveys conducted by the Substance Abuse and Mental Health Services Administration's (SAMHSA's) Center for Behavioral Health Statistics and Quality. DAWN is a public health surveillance system that monitors drug-related visits to hospital emergency departments and deaths attributed to drugs reported by selected medical examiners and coroner's offices across the country. Any emergency department visit that is related to recent drug use is included in the DAWN study. All types of drugs, licit and illicit, alcohol involvement for patients under the age of 21, and alcohol involvement in combination with other substances for those over the age of 21. Here are some of the other highlights of the 2009 DAWN findings: \tOf the 2.1 million ED visits involving drug misuse or abuse: \t1.2 million involved the misuse or abuse of pharmaceuticals. \tAlmost 1.0 million were related to illicit drugs. \tAbout 200,000 ED visits were associated with underage drinking. \tAlcohol was involved in more than 650,000 visits, or slightly less than one-third (31.8 percent) of visits involved with drug misuse or abuse. \tPatients aged 20 or younger accounted for 19.1 percent, or 877,802 visits, of all drug-related visits to EDs in 2009. \tAbout half of these visits, 415,351, involved drug misuse or abuse. \tThe majority of drug-related visits to EDs were made by patients aged 21 or older (80.9 percent, or 3.7 million visits). \tOf these, slightly less than one half (1.7 million visits) involved drug misuse or abuse. Misused or Abused Drugs Most Commonly Involved What were the most commonly involved drugs misused or abused, according to the 2009 DAWN findings? Among illicit drugs, cocaine led the list of ED visits at 422,896, followed by marijuana at 376,467 visits and heroin at 213,118 visits. About half of the ED visits misuse or abuse of pharmaceuticals involved pain relievers, of which the most commonly involved drugs were narcotic pain relievers (such as hydrocodone and oxycodone products). More than one third of misused or abused pharmaceuticals involved anxiety or insomnia drugs, primarily benzodiazepines such as diazepam, clonazepam, and alprazolam. Drug Misuse or Abuse By Age and Drug In 2009, the majority of ED visits that were drug-related were made by patients aged 21 or older. Of the 4.6 million drug-related visits, 3.7 million (80.9 percent) were made by individuals aged 21 or older. Looking at the differences per drug by age, per 100,000 populations, the following data was gleaned: Among those aged 21 or older, cocaine, marijuana and heroin accounted for the highest number of ED visits per 100,000 patients, at 181.6, 121.5 and 89.4, respectively. This was followed by stimulants (i.e., amphetamines and methamphetamines) at 37.2, PCP at 13.9 and ecstasy (MDMA) at 5.4. Those patients aged 20 or younger had the highest number of ED visits involving marijuana, at 125.3 visits per 100,000 population. Cocaine was a distant second at 28.0, followed by heroin at 19.4, stimulants at 13.5, and ecstasy (MDMA) at 12.6. Drug Use Trends Drug-related ED visits increased 81 percent from 2004 (2.5 million visits) to 2009 (4.6 million visits). ED visits related to misuse or abuse of pharmaceuticals increased 98.4 percent between 2004 and 2009, from 627,291 visits in 2004 to 1.2 million visits in 2009. Unlike pharmaceuticals, illicit drug use-related ED visits was generally stable across the 2004-2009 time period. Rates for ED visits involving alcohol involvement with drug use and underage drinking were also stable. Relative to ED visits for adverse reactions to drugs, the majority were made by patients over the age of 21. Among those aged 65 or older, in particular, there was an 89.2 percent increase in ED visits for adverse drug reactions since 2004. The types of drugs most commonly involved in these adverse drug reactions for those aged 65 or older were for blood modifiers, such as coumarin, accounting for 405.8 visits per 100,000 population, and cancer drugs, 117.1 visits per 100,000 population. Take-Away What does all this data mean to the normal individual? For one thing, it is evident that pharmaceuticals are involved in an increasing number of drug-related ED visits. Twice as many people visited EDs as a result of misuse or abuse of pharmaceuticals in 2009 as 2004. Pharmaceuticals, since they don't carry the stigma of being illegal, are only safe when taken as prescribed by a doctor for a particular patient for a particular condition. They are not safe to be taken for recreational uses. Yet the perception lingers that prescription drugs are safe, certainly safer than taking illicit drugs. So this is a difference in perception that must be changed, largely by educating the public. There is also a challenge in making sure that there are pharmaceuticals available to be dispensed to patients who legitimately need them and depend upon them. At the same time, it is necessary to limit access to people who would abuse or misuse them. First responders and emergency room medical personnel need to become more aware of the nonmedical use of pharmaceuticals, since these are the first individuals who come in contact with people who need intervention and treatment. Another area of concern is the increased adverse interactions to drugs when taken as prescribed or directed. In line with this, there has been a recent effort to refine drug warning labels, involving both icons and language, so that patients can gain a better understanding of the drugs' potential side effects and possible interaction with other drugs and alcohol. This needs to be easily understood across all literacy levels. Increasing drug safety also means increasing use of technology in pharmacies, such as software to keep track of patient medications and potential interactions or contraindications.