ER Visits: Illness or Intoxication? How Drug Use Drives Up Medical Costs
How Many Visits Occur?
Until 2011, the federal government used a project called the Drug Abuse Warning Network (DAWN) to track the number of people in the U.S. who go to the emergency room as a result of consuming alcohol, illicit drugs or prescription medications. Today, the final 2011 DAWN report still provides us with the most comprehensive information on this subject. In that year, more than 5 million of the nation’s 125 million-plus emergency room visits were related to drug use. Roughly half of these drug-related visits involved cases where abuse or misuse led to a clear medical emergency.
Approximately 1.25 million of the medical emergencies treated in ERs in 2011 stemmed from the abuse/misuse of an illegal or illicit drug. The most common reason for these visits was cocaine use (with more than 500,000 cases logged); marijuana use followed closely behind (with more than 450,000 cases logged). Other drugs responsible for triggering a medical emergency included PCP (“angel dust”), synthetic marijuana, MDMA (Ecstasy or Molly), makeshift inhalants (e.g., paint thinner and gasoline), various types of hallucinogens, the “date rape” drug GHB and the animal tranquilizer ketamine. In addition, more than 10,000 emergencies involved the abuse of more than one illicit drug.
Another 1.2 million medical emergencies were related to the misuse or abuse of a prescription medication. Almost half (46%) of these cases involved an opioid painkiller or some other form of pain-relieving medication. Taken together, medications classified as sedatives, tranquilizers or anti-anxiety drugs accounted for another 34% of all ER visits. Other prescription medications responsible for triggering a medical emergency included antidepressants, antipsychotics, ADHD stimulants, muscle relaxants and anticonvulsants.
What’s the Emergency Room Cost of Drug Use?
There’s no easy way to determine exactly how much America’s drug use affects the bottom line of emergency room costs. That’s true, in part, because any measurement of cost must include financial information gathered from thousands of facilities across the country. In addition, any answer to this question must break down each ER visit and look for coding that indicates the use of an illegal drug. Finally, anyone investigating this subject must track down payments made through private insurance companies and payments made through Medicare and other public resources, as well as the impact of nonpayment by people who can’t afford treatment.
One of the better available estimates of the ER-related financial costs of drug abuse comes from the U.S. Department of Justice’s National Drug Intelligence Center. In 2011, this agency issued a report called The Economic Impact of Illicit Drug Use on American Society. The data included in the report actually covers the year 2007, and includes only 76,754 drug-related ER visits from that year. Still, the overall cost for just this small sample of cases was a whopping $158,432,000. When we adjust estimates of cost to cover more than 5 million visits instead of just 76,000-plus, it’s easy to see how the total financial impact almost certainly falls in the range of billions of dollars annually. This makes sense since, in 2016, the nation’s overall healthcare bill for people who use illicit drugs will be approximately $11 billion.
Impact of Frequent ER Users
People with serious drug-related problems sometimes end up making multiple visits to the emergency room in any given year. Current estimates show that these frequent visitors account for a disproportionately high percentage of America’s overall ER costs. Still, as the American College of Emergency Physicians (ACEP) notes, people with drug problems make repeated visits to the ER far less often than people with heart disease, cancer or other serious chronic conditions. The ACEP also emphasizes the fact that, overall, ER expenses only account for roughly 4% of the nation’s total healthcare costs.
Substance Abuse and Mental Health Services Administration: Drug Abuse Warning Network, 2011 – National Estimates of Drug-Related Emergency Department Visits http://www.samhsa.gov/data/sites/default/files/DAWN2k11ED/DAWN2k11ED/DAWN2k11ED.pdf
U.S. Department of Justice – National Drug Intelligence Center: The Economic Impact of Illicit Drug Use on American Society
American College of Emergency Physicians: Frequent Users of the ER Fact Sheet http://newsroom.acep.org/fact_sheets?item=30011
National Institute on Drug Abuse: Trends & Statistics