These reports serve as indications of the extent of emergency room admissions for drug-related episodes. The nature of the reporting data can be confusing. A visit to the emergency room is referred to, and counted, as an episode. Drug related episodes can involve one, or combinations of different drugs. Every time a drug is involved in an episode is a mention, and several drugs can be mentioned in a single episode. In this context a drug-related episode indicates the use of an illegal drug or the non-medical use of a prescription drug which results in an emergency room visit.

The DAWN network collects reports from a large sample of hospitals and provides data on the number of episodes and mentions, and on the number of mentions per 100,000 population or 100,000 emergency room visits.

In 1993 there were 466,897 drug-related episodes reported, and 808,233 mentions. Marijuana was the subject of 29,200 mentions, each a separate episode. Marijuana related episodes have increased 46% from 1988 to 1993, 22% from the 1990 to 1993. (12)

However 50% of marijuana episodes included use in combination with alcohol. Use with cocaine was involved in 40% of the marijuana-related episodes, though some of those also involved alcohol. Of the 29,166 marijuana-related episodes, 50% or 14,853 were also alcohol related, 30% or 8750 involved the use of another drug besides marijuana, and only 20% or 5883 were the result of the use of marijuana alone. The number of marijuana alone episodes was similar to the number of episodes involving over the counter sleep aids (5,514). (In 1991 marijuana alone accounted for 20.3% of the marijuana-related episodes, and 41.5% of the episodes involved 2 or more other drugs in addition to marijuana.) Only 23% of the increase in marijuana mentions from 1990 to 1993 was due to the use of marijuana alone.

Table 6. Summary of selected mentions during emergency room visits from reporting sample in 1993.

* aspirin, acetaminophen and ibuprofen

** alprazolam (Xanax), diazapam (Valium) and lorazepam

Source: DAWN, SAMSHA Advanced Report #8. 12/94.

According to the National Household Survey, there were an estimated 186 marijuana users per 100,000 people in the U.S. in 1993, and 2.5 of them (1.3%) had to go to the emergency room because of marijuana use alone. Marijuana use with other drugs, but not alcohol, resulted in 4.3 visits to the emergency room per 100,000 users. The Household Survey also estimates 1,378 users of alcohol per 100,000 people, and 63.5 of them (4.6%) had to go to the emergency room for various reasons as well.

Unlike alcohol and many other drugs, marijuana is non-toxic. It is impossible for someone to die from an overdose of marijuana; the drug has little effect on the heart or lungs. Excessively large doses produce long periods of sleep. Ironically, many marijuana-related visits to the emergency room involved perceived harm, such as unexpected reactions, rather than actual harm to the individual, such as life-threatening overdose.

Compare with acetaminophen, which alone accounted for 35,000 episodes, 7% of the total and 15.3 visits per 100,000 population. Acetaminophen alone accounted for 42% of the episodes, 21% involved alcohol. Suicide attempts were the motive for 79% of the incidents, and an overdose was responsible for 90% of the emergency room visits. Aspirin alone accounted for 8.4 visits per 100,000 and Ibuprofen accounted for 7.9 episodes.

The use of marijuana alone results in relatively few emergency room visits. The use of marijuana with alcohol, or with other drugs, still provides relatively few visits in comparison to benzodiazipines, common household pain relievers, alcohol, cocaine, and heroin.

DAWN tracks the reasons patients give for taking the drugs responsible for their emergency room visit, and the reasons given for the visit. The reasons given for marijuana-related episodes is hard to interpret because only 20% of the visits were for marijuana alone. Nonetheless, the data is provided in Table 7, along with data for cocaine, heroin, and the entire group of emergency room visits.

Table 7. Reasons for Use of Drug and Subsequent Visit to Emergency Room as Percentage of Reasons Given. Data for 1993 except where noted.

Source: DAWN SAMSHA Advance Report #8, 12/94.

Further evidence that present policy and scheduling regarding marijuana is based on inaccurate or outdated data about marijuana are these comments describing the significance of the DAWN data.

"1993 Drug Abuse Warning Network, or DAWN survey . . .sends a clear message to our children. If you start doing drugs early -- there's a chance it will eventually lead you to the emergency room. . .young people [must] understand the serious health effects of marijuana and other drugs so they don't end up like so many of the long-term drug users in the DAWN survey -- chronically ill, in need of detoxification. . . This isn't hyperbole. . .The more young people know that all drugs -- including marijuana -- are harmful, the less likely they are to engage in the self-destructive behaviors that we see culminating in the DAWN data."(13)

A reality check is in order at this point in the discussion, and the reader can refer to the data cited above in reference to the following statements.

Marijuana used in conjunction with alcohol, or with other drugs, increases the possibility of adverse reactions and consequences, such as accidents, for the user.

Even when considered in combination with alcohol and other drugs, marijuana produces fewer visits to the emergency room per 100,000 population than alcohol, heroin, cocaine, benzodiazipines (tranquilizers), and common household pain killers.

Suicide is the most frequent reason (42.5%) given by emergency room patients in drug-related episodes, and overdose is the most frequent reason (55.7.% for an emergency room visit. While some people don't fully understand this, marijuana is non-toxic and can not produce death through overdose. Visits to the emergency room on account of marijuana use do not tend to be life-threatening.

Only 20% of marijuana mentions involve the use of marijuana alone, and over 3/4 of regular marijuana users do not use other drugs. Yet 40% of marijuana emergency room episodes also involve cocaine. A minority of marijuana users account for a majority of marijuana mentions in emergency room reports.

The majority of marijuana related visits to emergency rooms (30.1%) result from unexpected reactions to the drug. Novice users sometimes experience anxiety or panic attacks; the pharmacological literature refers to these episodes as self-correcting, meaning they are unlikely to reoccur in the same individual. (14)

Marijuana users are no more likely to seek emergency treatment for chronic effects of their use than any other visitor to ER for a drug-related episode.

Individuals seeking detoxification or other drug treatment services at an emergency room are there because they have no where else to turn for medical assistance. This is an indication of problems with the availability of treatment. Since 80% of marijuana related mentions involve the mention of other drugs (50% involve alcohol and 40% involve cocaine) it is impossible for DAWN data to support the argument that marijuana users are going to emergency rooms for detoxification in significant numbers.

When the DAWN data is rated against alcohol and marijuana drug using populations, marijuana with or without any drug except alcohol produces slightly less emergency room visits (4.3) per 100,000 users than alcohol (4.6). There is no evidence in the DAWN data to support the claim that marijuana use is a self-destructive behavior. Like most users of alcohol, most users of marijuana are responsible and engage in moderate use of their drug under safe conditions.

Marijuana use does produce unexpected reactions, including accidents, which result in emergency room visits. Compared to other drugs, and considering marijuana's low or non-existent toxicity, it is difficult to use the DAWN data to support an argument that a danger index for marijuana exists and is on the increase.

If the theory that marijuana is too dangerous for un-supervised use is true, than one would expect there would be a greater incidence of marijuana-alone mentions in the DAWN data. Instead a closer examination of the DAWN data reveals that only a minority of marijuana users end up in the emergency, just as only a minority of marijuana users are actually polydrug users.