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August 2, 2000

Reporting Drug Abuse in the Emergency Department—Reply

Author Affiliations

Stephen J.LurieMD, PhD, Contributing EditorIndividualAuthor

JAMA. 2000;284(5):564. doi:10.1001/jama.284.5.561

In Reply: We applaud SAMHSA for its efforts to redesign DAWN. Improvements in timeliness, sampling strategy, and the criteria used to identify DAWN cases will go a long way toward ensuring that DAWN data provide a more accurate assessment of the health consequences of drug abuse.

We hope that SAMHSA also will consider changes in data collection and reporting procedures. One important data collection limitation is the assignment of only 1 reason (motive) for taking all the drugs that are mentioned as having been ingested in a single episode. The motive assigned to the entire episode may not accurately reflect the specific reason that each drug was ingested. Additionally, the reporting of heroin and morphine as a single category makes it impossible to distinguish between the abuse of an illicit drug and the appropriate use of an essential pain medication. Moreover, the DAWN drug categories should be updated to reflect their pharmacology, eg, moving ibuprofen and naproxen from "other" drugs to "non-narcotic analgesics" and moving hydrocodone from "other/unspecific narcotic analgesics" to "narcotic analgesics." It would also be more appropriate to replace "narcotic" with "opioid."

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