Drug Abuse Warning Network (DAWN) Report Drug-Related Suicide Attempts by Adoles

April 12, 2006

Drug Abuse Warning Network (DAWN) Report Drug-Related Suicide

Attempts by Adolescents 2004

ALLIANCE FOR HUMAN RESEARCH PROTECTION (AHRP)

Promoting Openness, Full Disclosure, and Accountability

http://www.ahrp.org/cms/

FYI

" Disposition of Emergency Department Visits for Drug-Related Suicide

Attempts by Adolescents: 2004, " a report by the Drug Abuse Warning

Network (DAWN), reveals some sobering facts about teenage suicide

attempts that involve drugs.

Of those admitted to hsopital following a suicide attempt, 52% took

painkillers (24% opiate analgesiacs, 32% anti-inflammatory drugs).

" Psychotherapeutic drugs were implicated in over 40

percent….Antidepressants were the most frequently used

psychotherapeutic, involved in 27 percent of these suicide attempts.

Approximately 16 percent of the suicide attempt cases that were

admitted involved an illicit drug. "

That means, 96% of the teenagers who attempted suicide were

prescribed mind altering drugs--56% painkillers and 40% psychotropic

drugs--only 16% involved illicit drugs tken together with an

prescription drug.

These statistics don't support the unsubstantiated widely

disseminated claims made by those who argue that untreated depressed

children are at high risk of sucide.

These statistics don't support mental screening followed by

treatment --mostly using psychotropic drugs. These statistics don't

support the claims that psychotropic drugs are a " life-saving "

effective means for " suicide prevention. "

DAWN reports are one of three major surveys conducted by the

Substance Abuse and Mental Health Services Administration's Office of

Applied Studies (SAMHSA/OAS).

Contact: Vera Hassner Sharav

212-595-8974

veracare@... <mailto:veracare@...>

http://dawninfo.samhsa.gov/files/Suicide_Attempts_%

20Adolescents2004_edited.htm

Drug Abuse Warning Network (DAWN) REPORT

Issue 6, 2006

Disposition of Emergency Department Visits for Drug-Related Suicide

Attempts by Adolescents: 2004

In Brief

According to the Drug Abuse Warning Network (DAWN):

* In 2004, there were over 15,000 emergency department (ED)

visits by adolescents aged 12 to 17 whose suicide attempts involved

drugs.

* Almost three quarters of these drug-related suicide attempts

were serious enough to merit the patient's admission to the same

hospital or transfer to another health care facility.

* Pain medications were involved in about half of the suicide

attempts.

* Antidepressants or other psychotherapeutic medications were

involved in over 40 percent of the suicide attempts by adolescents

who were admitted to the hospital. DAWN data do not distinguish which

of the patients had been prescribed antidepressants to treat a

preexisting condition.

Suicide in adolescence is a major public health problem. According to

the Centers for Disease Control and Prevention (CDC), 9 percent of

students in public and private high schools in 2003 had attempted

suicide in the past year, and 3 percent of students reported needing

medical treatment after their suicide attempt.1

Given approximately 15.6 million high school students in the United

States, this translates to over 1.3 million suicide attempts,

thousands of which would have been handled in hospital emergency

departments (EDs).2 Therefore, EDs are an important setting for

interventions, as well as for referrals and medical treatment of

suicidal adolescents.

This report uses 2004 data from the Drug Abuse Warning Network (DAWN)

to examine the outcome (i.e., disposition) of ED visits caused by

drug-related suicide attempts by persons aged 12 to 17. DAWN is a

public health surveillance system that measures drug-related ED

visits in the United States. Data are collected from a nationally

representative sample of short-term, general, non-Federal hospitals

across the Nation. Specialty hospitals, including children's

hospitals, are not included in the DAWN sample.

To be a DAWN case, the ED visit must have involved a drug, either as

the direct cause of the visit or as a contributing factor. For each

drug-related ED visit, information is gathered about the number and

types of drugs involved, including illicit drugs, prescription and

over-the-counter medications, nutritional supplements, inhalants, and

alcohol (which is an illegal drug for persons under age 21). DAWN

also collects demographic information about the patients, their

diagnoses, and their disposition after discharge from the ED.

An examination of the disposition of ED visits caused by drug-related

suicide attempts can provide insights into the severity of the

attempts and help to identify the need for services to address

adolescent suicide attempts.

Incidence and Types of Disposition

In 2004, there were an estimated 15,299 ED visits associated with

drug-related suicide attempts among persons aged 12 to 17 in the

United States. These suicide attempts involved an average of 1.7

drugs, with half of the suicide attempts involving only one drug, and

7 percent involving four or more drugs. The majority of the

adolescent patients were either admitted to the same hospital or were

transferred to another health care facility after discharge from the

ED (Table 1).

Attempts by Adolescents Aged 12 to 17: 2004

Note: Three dots (...) indicate that an estimate with an RSE greater

than 50% or an estimate less than 30 has been suppressed.

*Does not sum to total due to rounding.

Source: Office of Applied Studies, SAMHSA, Drug Abuse Warning

Network, 2004 (09/2005 update).

According to DAWN, very few adolescents treated in EDs for drug-

related suicide attempts died in the ED. In 2004, DAWN received

no reports of deaths in the ED for drug-related suicide attempts

involving adolescents. However, this is based solely on ED records,

which do not include patients who died before coming to the ED or

after leaving the ED.

Table 1. Disposition of ED Visits Involving Drug-Related Suicide

Patients Treated and Released

An estimated 3,940 (26 percent) of adolescents whose suicide attempt

involved drugs were released after treatment in the ED (Table 1). Of

these, 77 percent were discharged home, while 21 percent were

referred to a detoxification/substance abuse treatment program.

On average, 1.9 drugs were involved in the suicide attempts of

adolescent patients who were treated and released. Half of these

suicide attempts involved at least one pain medication. The pain

medications containing opiates (i.e., opioid analgesics), such as

hydrocodone and oxycodone, were involved in 36 percent of these

visits (Table 2). They were followed by nonsteroidal anti-

inflammatory agents (NSAIDs) (29 percent), such as ibuprofen.

Table 2. Selected Substances Involved in Adolescent Suicide-Related

ED Visits, by Disposition:

2004

Source: Office of Applied Studies, SAMHSA, Drug Abuse Warning

Network, 2004 (09/2005 update).

Psychotherapeutic medications were involved in 38 percent of cases

that were treated and released.

Antidepressants were the most frequent, involved in 28 percent of the

visits.

The DAWN data do not distinguish which of the patients had been

prescribed antidepressants to treat preexisting depression and other

mental health problems.

Additionally, 18 percent of the cases that were treated and released

involved at least one illicit drug, which was almost always alcohol

or marijuana.

In 97 percent of the cases involving alcohol, it was combined with

another drug.

Patients Admitted to the Hospital

In an estimated 5,097 (33 percent) of the drug-related suicide

attempts, the patient was admitted to the hospital upon discharge

from the ED (Table 1). Almost half of these patients were moved to an

intensive care unit (ICU) or critical care unit.

The suicide attempts of adolescents who were admitted to the hospital

involved an average of 1.7 drugs. Pain relievers were implicated in

over half of these cases. These were primarily opioid analgesics (24

percent) and pain medications containing acetaminophen (32 percent)

(Table 2). NSAIDs and aspirin compounds also were involved to a

lesser extent. Pain medications containing opioids are obtainable

only by prescription. Analgesics containing acetaminophen, ibuprofen,

or aspirin, while widely available, can be toxic if misused.

Psychotherapeutic drugs were implicated in over 40 percent of the

suicide attempts by adolescents who were admitted to the hospital.

Antidepressants were the most frequently used psychotherapeutic,

involved in 27 percent of these suicide attempts.

Approximately 16 percent of the suicide attempt cases that were

admitted involved an illicit drug. Alcohol was involved in most of

these visits, almost always used in combination with another drug.

The interaction between alcohol and medications can increase the

medication's toxicity, especially if it is a central nervous system

depressant.3 Marijuana was involved in only 5 percent of the cases

that were admitted to the hospital.

All Other Dispositions

Other dispositions accounted for an estimated 6,263 (41 percent) of

the adolescent suicide-related ED visits that involved drugs. Almost

all (96 percent) of these patients were transferred to another health

care facility (Table 1).

Patients transferred to another facility. Thirty-nine percent of

adolescent drug-related suicide attempt cases were transferred to

another health care facility after discharge from the ED. The suicide

attempts of these patients involved, on average, 1.7 drugs. Pain

medications were involved in over half of these visits. The

prevalence of pain medications among transferred patients was similar

to the prevalence among patients with other dispositions. The most

commonly involved pain medications were the NSAIDs (21 percent),

followed by the acetaminophen/combination drugs (18 percent) (Table

2).

Psychotherapeutic drugs were involved in 29 percent of the suicide

attempts by adolescent patients who were transferred to another

medical facility. The anti-anxiety/sedative medications were involved

in as many visits as the antidepressants (12 percent).

One quarter of all the suicide-related ED visits that were

transferred to another facility involved at least one illicit

substance, primarily alcohol (17 percent) or marijuana (8 percent).

The majority of patients whose suicide attempt involved alcohol as

the only drug were transferred to another facility.

Notes

1. Grunbaum, J. A., Kann, L., Kinchen, S., Ross, J., Hawkins, J.,

Lowry, R., , W. A., McManus, T., Chyen, D., & , J.

(2004). Youth risk behavior surveillance-United States, 2003.

Morbidity and Mortality Weekly Report CDC Surveillance Summaries, 53

(SS02), 1-96.

2. U.S. Department of Education, National Center for Education

Statistics. Digest of Education Statistics, 2004. Retrieved February

1, 2006, from Table 2 at

http://nces.ed.gov/programs/digest/d04/tables/dt04_002.asp

<http://nces.ed.gov/programs/digest/d04/tables/dt04_002.asp> .

3. National Institute on Alcohol Abuse and Alcoholism. Harmful

Interactions: Mixing Alcohol with Medicines. Retrieved February 3,

2006, from

http://pubs.niaaa.nih.gov/publications/Medicine/medicine.htm

<http://pubs.niaaa.nih.gov/publications/Medicine/medicine.htm> .

The Drug Abuse Warning Network (DAWN) is a public health surveillance

system that monitors drug-related morbidity and mortality. DAWN uses

a probability sample of hospitals to produce estimates of drug-

related emergency department (ED) visits for the United States and

selected metropolitan areas annually. DAWN also produces annual

profiles of drug-related deaths reviewed by medical examiners or

coroners in selected metropolitan areas and States.

Any ED visit or death related to recent drug use is included in DAWN.

All types of drugs—licit and illicit—are covered. Alcohol is included

for adults when it occurs with another drug. Alcohol is always

included for minors. DAWN's method of classifying drugs was derived

Services, Inc. The Multum Licensing Agreement can be found in DAWN

annual publications and at http://www.multum.com/license.htm

<http://www.multum.com/license.htm> .

DAWN is one of three major surveys conducted by the Substance Abuse

and Mental Health Services Administration's Office of Applied Studies

(SAMHSA/OAS). For information on other OAS surveys, go to

http://www.oas.samhsa.gov/ <http://www.oas.samhsa.gov/> . SAMHSA has

contracts with Westat (Rockville, MD) and RTI International (Research

Triangle Park, NC) to operate the DAWN system and produce

publications.

For publications and additional information about DAWN, go to

http://dawninfo.samhsa.gov/ <http://dawninfo.samhsa.gov/> .

The DAWN Report is published periodically by the Office of Applied

Studies (OAS), Substance Abuse and Mental Health Services

Administration (SAMHSA).

This issue was written by Crane (SAMHSA/OAS) with

assistance from Mindy Herman-Stahl (RTI International, a trade name

of Research Triangle Institute). All material in this report is in

the public domain and may be reproduced or copied without permission

from SAMHSA. Citation of the source is appreciated.

FAIR USE NOTICE

This email contains copyrighted material the use of which has not

always been specifically authorized by the copyright owner. I am

making such material available in my efforts to advance understanding

of environmental, political, human rights, economic, democracy,

scientific, and social justice issues, etc.

I believe this constitutes a 'fair use' of any such copyrighted

material as provided for in section 107 of the US Copyright Law. In

accordance with Title 17 U.S.C. Section 107, the material in this

email is distributed without profit to those who have expressed a

prior interest in receiving the included information

for research and educational purposes. For more information go to:

http://www.law.cornell.edu/uscode/17/107.shtml

If you wish to use copyrighted material from this update for purposes

of your own that go beyond 'fair use', you must obtain permission

from the copyright owner.

_______________________________________________

April 12, 2006