DAWN mortality data are collected in participating medical examiner and coroner (ME/C) offices through a retrospective review of case records for every death investigated by the ME/C. Families are never interviewed. The review of source records is performed by a trained DAWN reporter in each participating facility. Depending on the needs of the facility, the DAWN reporter may be an employee of the death investigation jurisdiction or an employee of the DAWN operations contractor.
Within each facility that participates in DAWN, the designated DAWN reporter reviews all death records to identify deaths related to drug use. The DAWN reporter submits an electronic case report to the DAWN system for each death that meets the specific case selection criteria.
A DAWN case is any death related to recent drug use. DAWN includes deaths associated with substance abuse and misuse, both intentional and accidental. This also includes the use of drugs for legitimate therapeutic purposes. To be a DAWN case, the relation between the death and the drug need not be causal; the drug needs only to be implicated in the death. Only recent drug use is included, and the reason that a patient used a drug is irrelevant.
The case criteria are intended to be broad and inclusive and to have few exceptions. Broad criteria take into account the fact that documentation in death records varies in clarity and comprehensiveness across ME/Cs. Broad criteria minimize the potential for judgments that could cause data to vary systematically and unexpectedly across reporters and jurisdictions. In addition, broad criteria are designed to capture a very diverse set of drug-related deaths, which can be aggregated and disaggregated to serve a variety of analytical purposes and the interests of multiple audiences.
There are some clearly delineated exceptions to the DAWN case criteria. A death is not a DAWN case if:
The information collected on DAWN deaths and suicide deaths falls into four general categories:
Depending on the data item, the DAWN data collection system, eMERS, allows for entering categorical responses (including "Not documented" or "Could not be determined") and open-ended responses. Additional information on the data items collected by DAWN, particularly as may be pertinent to analysis, appears in the Glossary of Terms (Appendix B to this publication). Further details on the data items and how they are collected can be found in the DAWN Medical Examiner Reference Guide.1
DAWN covers a wide range of drugs and substances, including the following:2
In general, DAWN includes nonpharmaceutical substances that are consumed by inhalation, sniffing, or snorting and have a psychoactive effect when inhaled. There are two noteworthy exceptions: (1) deaths involving inhalation of carbon monoxide, and (2) deaths involving accidental inhalation of nonpharmaceuticals (e.g., exposure to paint fumes while painting a closet).
Several methods are used to improve the quality and reliability of DAWN data. These include:
ME/Cs participate in DAWN on a voluntary basis and constitute neither a sample nor a census of ME/Cs in the United States. ME/Cs are invited to join DAWN based on their location in selected metropolitan areas. Recruitment efforts focus primarily on areas where DAWN data are also collected from hospital emergency departments. In addition to recruitment targeted at metropolitan areas, DAWN has added States with centralized ME/C systems to gain a better understanding of drug-related mortality outside of the targeted metropolitan areas.
In this publication, the terms "death investigation jurisdiction" (or, simply, "jurisdiction") and "county" are used interchangeably because ME/Cs' offices are typically organized by county. One exception occurs in Niagara County, NY, which is divided into four districts. For reporting purposes, the four districts that make up Niagara County, NY, are treated collectively as a single jurisdiction. For participating states, every county or jurisdiction within each state is included in DAWN.
The metropolitan area definitions used in this publication are those established by the Office of Management and Budget (OMB) based on the 2000 U.S. Census, as updated in 2003.3 OMB issues annual updates to the boundaries and names of metropolitan areas. DAWN Area Mortality reports use the name that was current during the data collection year. While there have been several name changes, changes in metropolitan statistical area boundaries since 2003 have not altered the metropolitan areas reported on in this publication.
This glossary defines terms used in data collection activities, analyses, and publications associated with the mortality component of DAWN.
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Document revised April 1, 2003
1 Substance Abuse and Mental Health Services Administration, Office of Applied Studies. (2006). DAWN Medical Examiner Reference Guide. (Available at http://dawninfo.samhsa.gov/files/collect_2006-2008/me_reference_guide_2006-2008.pdf.)
2 The classification of drugs used by DAWN is derived from the Multum Lexicon, © 2008, Multum Information Services, Inc. The classification has been modified to meet DAWN's unique requirements. The Multum Licensing Agreement governing use of the Lexicon is provided in Appendix C. (Also available at http://www.multum.com/.)
3 Office of Management and Budget, Revised Definitions of Metropolitan Statistical Areas, New Definitions of Micropolitan Statistical Areas and Combined Statistical Areas, and Guidance on Uses of the Statistical Definitions of These Areas, Bulletin No. 03-04, June 6, 2003. (Available at http://www.whitehouse.gov/omb/bulletins/b03-04.html.)
4 National Association of Medical Examiners. (2006). Forensic Autopsy Performance Standards. (Available at http://thename.org/.)