Drug Abuse Warning Network

The Drug Abuse Warning Network (DAWN) was created in 1972 to monitor hospital emergency department cases (“episodes”) that were induced by or related to recent illegal drug use in the United States. DAWN is operated by the U.S. Department of Health and Human Services Substance Abuse and Mental Health Services Administration (SAMHSA). DAWN data are among the longest-running time series that are available for more than a single city or state, and DAWN offers substance-specific counts for both illegal drugs and nonmedical use of legal drugs. Substantial redesigns (notably in 1988 and 2003) complicate trend analysis, but properly adjusted, the time series nonetheless offer a poignant perspective on changing patterns of drug use. Cocaine mentions exploded from 3,438 in 1978 to 91,791 a decade later in 1987; mentions of diazepam fell sharply over the same period, from 60,358 to 23,147.

DAWN currently produces city-specific estimates for 13 metropolitan areas in the contiguous United States: Boston, Chicago, Denver, Detroit, Houston, Miami-Dade, Miami-Fort Lauderdale, Minneapolis, New York City, Phoenix, San Diego, San Francisco, and Seattle. Hospitals outside these 21 areas are sampled to allow for national estimates based on a probability sample.

DAWN collects data on all substances deemed relevant, so there can be multiple drug “mentions” associated with a single “episode” or case. Hence, the sum of the annual number of mentions for cocaine (roughly 550,000), marijuana (about 300,000), heroin (190,000), and stimulants such as amphetamine and methamphetamine (about 110,000) exceeds the total number of episodes involving at least one illicit drug (just shy of 1 million in 2006). Episodes involving alcohol alone are only recorded for those under 21 (roughly 75,000), but mentions of adults using “alcohol-in-combination” with another substance (about 450,000 mentions) is second only to cocaine in frequency. The extent to which illegal drug abuse in the United States is dominated by “the big four” (cocaine/crack, heroin, stimulants, and marijuana) is underscored by the fact that the next most commonly detected drug, PCP, registers only just over 20,000 mentions. DAWN also collected data on the user's demographics, mode of administration, and presumed reason for using. There are strong interactions among these variables. For example, over 90 percent of the almost 200,000 episodes judged to be suicide attempts involved pharmaceutical drugs. DAWN received considerable attention in the scholarly [Page 207]literature in the 1990s, but since then a number of other data sources have been commonly used, such as the National Alcohol Surveys and even the National Survey on Drug Use and Health.