The National Hospital Care Survey (NHCS) collects data on patient care in hospital-based settings to describe patterns of health care delivery and utilization in the United States. Settings currently include inpatient and emergency departments (ED). From this collection, the NHCS contributes data that may inform emerging national health threats such as the current opioid public health emergency. The 2022 - 2024 NHCS are not yet fully operational so it is important to note that the data presented here are preliminary and not nationally representative. The data are from 24 hospitals submitting inpatient and 23 hospitals submitting ED Uniform Bill (UB)-04 administrative claims from October 1, 2022–September 30, 2024. Even though the data are not nationally representative, they can provide insight into the use of opioids and other overdose drugs. The NHCS data is submitted from various types of hospitals (e.g., general/acute, children’s, etc.) and can show results from a variety of indicators related to drug use, such as overall drug use, comorbidities, and drug and polydrug overdose. NHCS data can also be used to report on patient conditions within the hospital over time.

In 2022, around 73,838 people in the United States died from a drug overdose that involved fentanyl. This was the highest number of fentanyl overdose deaths ever recorded in the United States, and a significant increase from the number of deaths reported in 2019. Fentanyl overdoses are now the driving force behind the opioid epidemic, accounting for the majority of overdose deaths in the United States. What is fentanyl? Fentanyl is an extremely potent synthetic opioid similar to morphine, but more powerful. It is a prescription drug but is also manufactured illegally and is sometimes mixed with other illicit drugs such as heroin and cocaine, often without the user’s knowledge. The potency of fentanyl makes it very addictive and puts users at a high risk for overdose. Illegally manufactured fentanyl has become more prevalent in the United States in recent years, leading to a huge increase in drug overdose deaths. In 2022, the rate of drug overdose death involving fentanyl was 22.7 per 100,000 population, compared to a rate of just one per 100,000 population in the year 2013. Fentanyl overdoses by gender and race/ethnicity As of 2022, the rate of drug overdose deaths involving fentanyl in the United States is over two times higher among men than women. Rates of overdose death involving fentanyl were low for both men and women until around the year 2014 when they began to quickly increase, especially for men. In 2022, there were around 19,880 drug overdose deaths among women that involved fentanyl compared to 53,958 such deaths among men. At that time, the rate of fentanyl overdose deaths was highest among non-Hispanic American Indian or Alaska Natives and lowest among non-Hispanic Asians. However, from the years 2014 to 2018, non-Hispanic whites had the highest fentanyl overdose death rates.

Data on use of selected substances in the past 30 days among 12th graders, 10th graders, and 8th graders in the United States, by sex and race. Data are from Health, United States. Source: Monitoring the Future, Institute for Social Research, University of Michigan, supported by National Institutes of Health, National Institute on Drug Abuse. Search, visualize, and download these and other estimates from over 120 health topics with the NCHS Data Query System (DQS), available from: https://www.cdc.gov/nchs/dataquery/index.htm.

Data on prescription drug use in the past 30 days in the United States, by sex, race and Hispanic origin, and age group. Data are from Health, United States. SOURCE: National Center for Health Statistics, National Health and Nutrition Examination Survey. Search, visualize, and download these and other estimates from over 120 health topics with the NCHS Data Query System (DQS), available from: https://www.cdc.gov/nchs/dataquery/index.htm.

1995-2018. Centers for Disease Control and Prevention (CDC). State Tobacco Activities Tracking and Evaluation (STATE) System. E-Cigarette Legislation—Smokefree Indoor Air. The STATE System houses current and historical state-level legislative data on tobacco use prevention and control policies. Data are reported on a quarterly basis. Data include information related to state legislation on smokefree indoor air in areas such as: Bars, Commercial Day Care Centers, Government Multi-Unit Housing, Government Worksites, Home-Based Day Care Centers, Hotels and Motels, Personal Vehicles, Private Multi-Unit Housing, Private Worksites, Restaurants, Bingo Halls, Casinos, Enclosed Arenas, Grocery Stores, Hospitals, Hospital Campuses, Malls, Mental Health Outpatient and Residential Facilities, Prisons, Public Transportation, Racetrack Casinos, Substance Abuse Outpatient and Residential Facilities.

Background. Downs syndrome (DS) is the commonest of the congenital genetic defects. Its incidence has been rising in recent years for unknown reasons. Objective. Investigate the relationship of DS to substance- and cannabinoid- exposure; and causality.

Methods. Observational ecological population-based epidemiological study 1986-2016. Analysis performed January 2020. Geotemporospatial and causal inference analysis. Participants: Patients were diagnosed with DS and reported to state based registries; collated nationally. Data source: annual reports of National Birth Defects Prevention Network of Centres for Disease Control. Exposures: Drug exposure was taken from the National Survey of Drug Use and Health (NSDUH) conducted annually by Substance Abuse and Mental Health Services Administration. Nationally representative sample 67,000 participants annually. Drug exposures: cigarette consumption, alcohol abuse, analgesic/opioid abuse, cocaine use and last month cannabis use. Ethnicity and median household income: US Census Bureau. Maternal age of childbearing: CDC births registries. Cannabinoid concentrations: Drug Enforcement Agency seizures.

Results. NSDUH report 74.1% mean annual response rate. All other data was population-wide. DS rate (DSR) was noted to be rising over time, cannabis use, and cannabis-use quintile. In the optimal geospatial model lagged to four years terms including Δ9-tetrahydrocannabinol and cannabigerol were significant (from β-est.=4189.96 (95%C.I. 1924.74, 6455.17), P=2.9x10-4). Ethnicity, income, and maternal age covariates were not significant. DSR in states where cannabis was not illegal was higher than elsewhere (β-est.=2.160 (1.5, 2.82), R.R.=1.81 (1.51, 2.16), P=4.7x10-10). In inverse probability-weighted mixed models terms including cannabinoids were significant (from β-estimate=18.82 (16.82, 20.82), P<0.0001). EValues in geospatial models ranged up to infinity.

Conclusions. Our data show that the association between DSR and substance- and cannabinoid- exposure is robust to multivariable geotemporospatial adjustment, implicate particularly cannabigerol and Δ9-tetrahydrocannabinol, and fulfil causal crietria. Cannabis legalization was associated with elevated DSR’s. These findings are consistent with those from Hawaii, Colorado, Canada and Australia and concordant with several cellular mechanisms. Given that the cannabis industry is presently in a rapid growth-commercialization phase the present findings linking cannabis use with megabase scale genotoxicity suggest unrecognized DS risk factors, are of public health importance and suggest that re-focussing the cannabis debate on multigenerational and intergenerational health concerns is prudent.