CDR Andrew Geller, MDMedical Officer, Medication Safety ProgramDivision of Healthcare Quality Promotion,CDCAtlanta GA 30329

Nonmedical Use of Prescription Drugs a Common Cause of Emergency Room Visits

CDR Andrew Geller, MDMedical Officer, Medication Safety ProgramDivision of Healthcare Quality Promotion,CDCAtlanta GA 30329

Dr. Geller Interview with:
CDR Andrew Geller, MD
Medical Officer, Medication Safety Program
Division of Healthcare Quality Promotion,
Atlanta GA 30329 What is the background for this study?

Response: There has been a lot of recent attention on drug overdoses in the United States, particularly fatal overdoses which involve opioids. But the overall frequency with which patients end up in the emergency department (ED) due to nonmedical use of medications across the US is unknown.

  • Nonmedical use refers to a spectrum of circumstances, including intentionally using more medication than is recommended in an attempt to treat a health condition (therapeutic misuse) to using medication to attain euphoria or get “high” (abuse).

With this analysis, we wanted to focus on the acute harms to individual patients from nonmedical use of all medications, in order to help target prevention efforts.

  • Specifically, we used data from a nationally-representative sample of hospital EDs to identify the medications with the highest numbers of emergency visits for harms following nonmedical use of medications and to identify the patient groups with the highest risks. What are the main findings?

Response: In the US, there were nearly 360,000 emergency department visits in 2016 for harms from nonmedical use of medications, most frequently involving:

  • Benzodiazepines (like alprazolam/Xanax®) and prescription opioids (like hydrocodone and oxycodone), often in combinations with other substances such as illicit drugs and alcohol;
  • Adults younger than 35 years of age; and
  • Serious adverse effects (nearly one-quarter of patients were unresponsive or had experienced cardiorespiratory failure, and two-fifths of patients required hospitalization). What should readers take away from your report?

Response: Nonmedical use of prescription drugs is a common cause of ED visits in the U.S. for medication-related harm, particularly among young adults, and represents an important opportunity for prevention.

  • For patients, family members, and healthcare providers, these findings highlight areas in which interventions can likely reduce patient harm.
    • First, patients who have been brought to an ED for overdoses after nonmedical use of opioids (or these patients’ family or friends) may be the most appropriate people to offer naloxone, since we know from previous research that people who survive opioid overdose are at high risk of experiencing a subsequent, sometimes fatal, overdose.
    • Second, because ED visits most often involve nonmedical use of combinations of illicit substances, alcohol, and medications, a fully effective harm reduction strategy should include screening and treatment of polysubstance use.
  • For researchers, although other medications are involved in far fewer ED visits for nonmedical use than prescription opioids or benzodiazepines, ongoing surveillance remains important to identify emerging trends. What recommendations do you have for future research as a result of this work? 

Response: Future studies could assess rates of other harms from nonmedical use treated in settings outside of the emergency room (e.g., home, or at an outpatient clinic or urgent care setting). Also, as efforts to recognize and get treatment for overdoses early, improve opioid and benzodiazepine prescribing, and increase access to substance use disorder treatment continue to gain momentum, we would hope that the frequency and severity of ED visits for overdoses and other harms from nonmedical use of medications would decline. We will continue to use these national data on emergency department visits for harms from nonmedical use of medications to monitor progress, and assess for emerging trends. Is there anything else you would like to add?

Response: This study likely underestimates the frequency of harms from nonmedical use of medications, because:

  • Only the acute harms that are treated and diagnosed in the emergency department setting were studied (harms from nonmedical use treated in other settings – for example, urgent care or physician’s offices – or in which no healthcare treatment was sought, were not included);
  • Adverse events that are less likely to be diagnosed in the emergency department setting are not reliably included (e.g., infectious hepatitis, HIV); and
  • This study of acute medical harms does not address harms to the economy, communities, or families.

 No dislosures


U.S. Emergency Department Visits Resulting From Nonmedical Use of Pharmaceuticals, 2016
Geller, Andrew I. et al.
American Journal of Preventive Medicine , Volume 0 , Issue 0 ,

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Last Updated on March 20, 2019 by Marie Benz MD FAAD