VOLUME I: HIGHLIGHTS AND EXECUTIVE SUMMARY
DECEMBER 1999
COMMUNITY EPIDEMIOLOGY WORK GROUP National Institute on Drug Abuse
NATIONAL INSTITUTES OF HEALTH
Division of Epidemiology, Services and Prevention Research National Institute on Drug Abuse 6001 Executive Boulevard Bethesda, Maryland 20892 The National Institute on Drug Abuse (NIDA) Inc., under subcontract to CDM Group, Inc., acknowledges the contributions made by the contract number N01DA-65054, for the members of the Community Epidemiology National Institute on Drug Abuse. Work Group (CEWG) who voluntarily have invested their time and resources in preparing All material in this volume is in the public the reports presented at the meetings. domain and may be reproduced or copied without permission from the Institute or the The data in Volume I (this volume) of this authors. Citation of the source is appreciated. publication were extracted from 20 city The U.S. Government does not endorse or drug abuse indicator trend presentations. The favor any specific commercial product. full edited text from those reports appears in Volume II. Volume II also contains the full Trade or proprietary names appearing in this edited text of reports on specialized topics. publication are used only because they are considered essential in the context of the This publication was developed by Marcia studies reported herein. Meth and staff of Johnson, Bassin & Shaw,
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National Institute on Drug Abuse NIH Publication No. 00-4739
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ii CEWG December 1999 The Community Epidemiology Work Group of the Los Angeles County Sheriffs Office (CEWG) is a network of researchers from who also is President of Badge 2 Badge, a major metropolitan areas of the United program to assist Officers with substance States and from selected foreign countries. abuse problems. In addition, Dr. Gregory The primary mission ofthe CEWG is to Austin of WestEd presented findings from provide ongoing community-level sur- recent Los Angeles and California statewide veillance of drug abuse through collection student surveys. and analysis of quantitative and qualitative research data. During biannual meetings, These differing presentations underscore the CEWG participants present and discuss the wide impact of drug abuse on society. They most current epidemiologic information also serve to point out the international concerning the nature and patterns of drug scope of drug abuse and the regional abuse, emerging trends, characteristics of relationships of substance abuse problems. vulnerable populations, and social and health Many of the problems facing countries of consequences of drug abuse in the United North America have emerged as serious States. problems in Asia and the Pacific. Abuse of marijuana and inhalants, especially by youth, The 47th meeting of the CEWG was held in appears to be a worldwide problem. Los Angeles, California, on December Indicators of heroin abuse appear to be 14–17, 1999, and provided an assessment of increasing in various parts of the world, drug abuse in 20 metropolitan areas of the including the United States. And the United States. Presentations also were made problem of methamphetamine, which had on current and emerging patterns and trends been increasing in the United States during of drug abuse in Mexico and in Asia and the recent years, is also becoming more Pacific, specifically in China, Japan, and in prevalent in countries of Asia and in the American Samoa, the Commonwealth of the Island Nations of the Pacific. Northern Mariana Islands, the Federated States of Micronesia, Guam, Palau, and The data presented at this meeting Papua New Guinea. In addition, special demonstrate, once again, the value of an presentations were made on the use of effective and efficient national system for epidemiologic data to improve drug abuse drug abuse surveillance. They highlight the treatment and on current trends in HIV/ need to link epidemiologic information to AIDS and other infectious diseases among preventive intervention, treatment, and other injecting drug users. public health actions and research decisions.
The venue also provided the opportunity to be informed about the Employee Assistance Programs within law enforcement agencies in Nicholas J. Kozel Los Angeles through presentations by Division of Epidemiology, Services and Officer Bud Nowell of the Los Angeles Prevention Research Police Academy and Sergeant Ray Terhorst National Institute on Drug Abuse
... CEWG December 1999 iii
... FOREWORD ...... 111
LIST OF REPORTS IN VOLUME II ...... vi
INTRODUCTION ...... 1
HIGHLIGHTS
Drug Highlights ...... 3
Regional Highlights ...... 8
CityHighlights ...... 12
EXECUTIVE SUMMARY
Cocaine and Crack ...... 15
Heroin ...... 32
Opiates Other Than Heroin ...... 5 1
Marijuana ...... 54
Stimulants ...... 67
Depressants ...... 83
Hallucinogens ...... 90
Other Drugs ...... 94
Infectious Diseases Related to Drug Abuse ...... 95
CEWG December 1999 V LIST OF REPORTS IN VOLUME II
Atlanta: Metropolitan Atlanta Drug Abuse Minneapolis/St. Paul: Drug Abuse Trends in Trends the Minneapolis/St. Paul Metropolitan Area Claire E. Sterk and Danielle German Carol L. Falkowski
Baltimore: Drug Use in the Baltimore Newark: Drug Abuse Differentials in Newark Metropolitan Area: Epidemiology and Trends Abate Mammo Leigh A. Henderson and Alisa Male New Orleans: Drug Abuse Indicators in New Boston: Drug Use Trends in Greater Boston Orleans and Massachusetts Gail Thornton-Collins Thomas W. Clark, Elsa A. Elliott, and Stephen Soldz New York City: Current Drug Use Trends in New York City Chicago: Patterns and Trends of Drug Abuse Blanche Frank and John Galea in Chicago Wayne Wiebel, Kamran Niaz, and Philadelphia: Drug Use in Philadelphia, Afsaneh Rahimian Pennsylvania Samuel J. Cutler and Mark R. Denver: Drug Use Trends in Denver and Bencivengo Colorado Bruce Mendelson and Lee Hoffer Phoenix: Drug Abuse Trends in Phoenix and Arizona Honolulu: Illicit Drug Use in Honolulu and Ilene L. Dode the State of Hawaii D. William Wood St. Louis: Drug Trends in St. Louis Heidi Israel and James Topolski Los Angeles: Update on Illicit Drug Use in Los Angeles County San Diego: Indicators of Drug Abuse in San T. Kiku Annon and M.Douglas Anglin Diego County Michael Ann Haight Miami: Drug Use in Miami-Dade County, Florida San Francisco: Patterns and Trends of Drug James N. Hall, Joe Spillane, and Abuse in the San Francisco Bay Area Madeline Camejo John A. Newmeyer Contents
Seattle: Recent Drug Abuse Trends in the Texas: Substance Abuse Trends in Texas Seattle-King County Area Jane C. Maxwell T. Ron Jackson, Norma D. Jaegar, Arnold F. Wrede, L. David Murphy, Washington, DC: Patterns and Trends of Michael Hanrahan, Holly Thiede, Holly Drug Abuse in Washington, DC Hagan, Richard Harruff, Kris Nyrop, Felicia Gray Cerbone, Alfred Pach, and Steve Freng, and Michael Gorman Marianna T. Toce
China: Drug Abuse in the Past Decade, PACIFIC ISLANDS Recent Situation and Trends in China Liu Zhimin, Cai Zhiji, and Cao Jiaqui American Samoa: Alcohol and Other Drug Abuse Treatment in American Samoa Europe: Improving Psychiatric Treatment Norma Lagafuaina-Smith in Residential Programs for Emerging Dependency Groups: Approach and Federated States of Micronesia: Alcohol Epidemiological Findings and Drug Use in The Federated States of Charles Kaplan, Eric Broekaert, Ove Micronesia Frank. and Sebastien Reichmann Francis X. Hezel
Japan: Drug Abuse in Japan: A Brief Guam: An Overview of Current Drug History and The Current Situation Problems in Guam and the Commonwealth Kiyoshi Wada of the Northern Mariana Islands Amelia M.Arria and Mamie C. Mexico: Update of the Epidemiological Balajadia Surveillance System of Addictions (SISVEA) in Mexico Papua New Guinea: Drug Abuse in Papua Roberto Tapia-Conyer, Patricia New Guinea (PNG) Cravioto, Pablo Kuri, Arturo Michael Anis Winmarang Revuelta, and Mario Cortes Republic of Palau: A Summary of the Substance Abuse Needs Assessment In the Republic of Palau A. Futterman-Collier and A. Lyman
CEWG December 1999 vii
EPIDEMIOLOGIC TRENDS IN DRUG ABUSE INTRODUCTION TO VOLUME I
The 47th meeting ofthe Community Epidemiology Work Group (CEWG) was heldDecember 14–17, 1999, in Los Angeles, California. During this meeting, 20 CEWG representatives reported on current drug trends and patterns in U.S. cities. The following highlights and executive summary are based on these reports.
To assess drug abuse patterns and trends, city- Primary substance of abuse of clients at and State-specific data are gathered and admission to treatment programs, as compiled from a variety of health and other reported by State drug abuse agencies drug abuse indicator sources. Such sources include public health agencies, medical and Arrestee urinalysis results based on data treatment facilities, criminal justice and collected by the Arrestee Drug Abuse correctional offices, law enforcement agencies, Monitoring (ADAM)System of the surveys, and other sources unique to local National Institute of Justice areas, including: Seizure, price, purity, prescription/ Drug-related deaths reported on death distribution, and arrest data obtained from the Drug Enforcement Administration certificates, by medical examiner (ME)/lo- (DEA) and from State and local law cal coroner offices, or by State public enforcement agencies health agencies Additionally, these quantitative Drug-related emergency department data are enhanced with infor- (ED) mentions (estimated mentions and mation obtained through field estimated rates per 100,000 population) reports, focus groups, inter- reported by the Drug Abuse Warning views, and other qualitative Network (DAWN) of the Substance Abuse methodologies. Such obser- vations are interspersed and Mental Health Services Administration throughout executive summary (SAMHSA) (Note: Mentions differ from discussions of indicator data; episodes-each ED episode may involve these excerpts and extracts are one or more mentions of specific drugs.); set off in indented, bold italics. and ED mentions reported by local poison control centers
The highlights, executive summary, and 20 that multiple-drug abuse is the normative U.S. city report summaries are organized by pattern among a broad range of substance specific drug of abuse. Please note, however, abusers. Furthermore, most indicators do not Introduction differentiate between cocaine hydrochloride calculated based on admissions excluding and crack. Finally, local comparisons are alcohol-only but including alcohol-in- limited, especially for the following indicators: combination. Comparisons are generally for first-half- 1998 versus first-half-1999 data, Mortality-Definitions associated with unless otherwise specified. drug deaths vary. Common reporting terms include "drug-related," "drug-induced," Percentage-point increases or declines "drug-involved," and "drug detections''— between reporting periods are generally these terms have different meanings in noted only when they are points. different areas of the country. Row percentages in tables do not always Treatment admissions-Many variables add up to 100 percent, often because of affect treatment admission numbers, in- rounding or large numbers in the "un- cluding program emphasis, slot capacity, known" or "other" categories. data collection methods, and reporting periods. While most areas report citywide Comparisons of ADAM arrestee urinalysis data, Hawaii and Texas report statewide data are based on full-year-1998 and first- data. half- 1999 figures.
Arrest/seizure data-The number of Heroin purity levels per milligram were arrests/seizures and quantity of drugs con- obtained from the DEA Domestic Monitor fiscated often reflect enforcement policy Program, Intelligence Division, Domestic rather than levels of abuse. Unit. Comparisons are for full-year-1998 versus first-half- 1999 figures. The following methods were applied to facili- tate local area comparisons in the highlights Cumulative totals of acquired immuno- and executive summary: deficiency syndrome (AIDS) cases for the total United States are based on the HIV/- Most ED data are based on data files run by AIDS Surveillance Report 11(1):6,8,1999, SAMHSA in July 1999. These data reflect from the Centers for Disease Control and weighted estimates of the number of Prevention (CDC). mentions based on a sample of hospital emergency departments. Local areas vary in their reporting periods. Many indicators reflect fiscal periods that may Long-term ED trend data cover 1991–98. differ between local areas. In addition, the Short-term comparisons are based on either timeliness of data varies, particularly for full-year data for 1997 versus 1998 or full- mortality indicators. year data for 1996 versus 1998. Increases or decreases are noted only when they meet Some indicator data are unavailable in certain standards of precision at p<0.05. areas. The symbol "NR" in tables refers to data not reported. Unless otherwise specified, all percentages for treatment program admissions are
2 CEWG December 1999 DRUG HIGHLIGHTS
Following several reporting periods of stable or declining trends, some cocaine abuse indicators show rebounds in a number of cities; increases among younger age groups in some indicators warrant watching. Other indicators, however, continue to suggest declining or stable trends. Heroin indicators are mixed. Younger populations continue to initiate heroin use in several cities, and some are shifting from snorting to injecting. Marijuana indicators suggest generally increas- ing or leveling trends in most cities; in some cities, however, there are signs that prevention efforts targeted at youth may be paying off. Declines in methamphetamine consequences are reported in most cities, especially as reflected in emergency department (ED) data. “Club drugs,” especially GHB, GBL, and MDMA, continue to spread across the country.
Following several reporting periods of stable or show generally declining or stable trends. declining cocaine trends, mortality, ED, and female Generally declining or stable trends were also arrestee urinalysis indicators suggest slight in- found in cocaine-positive urinalysis percentages4 creases in many cities. Mortality figures’ increas- among adult male arrestees, except in Miami and ed in three cities (Philadelphia, Phoenix, and Washington, DC, where levels increased; the drug Seattle) and declined or remained stable in four is now surpassed by marijuana in all but six cities. (Honolulu, Miami, Minneapolis/St. Paul, and San By contrast, among female arrestees, cocaine is Diego). Cocaine ED mentions’ increased signi- still the most commonly detected drug in all but ficantly in five cities (Dallas, Los Angeles, one city (San Diego); levels increased in six cities Philadelphia, Phoenix, and Washington, DC), with (Dallas, Detroit, Minneapolis, Philadelphia, the largest increase in Dallas. Nonsignificant ED Phoenix, and San Diego) and declined in two increases were reported in the majority of the other (Houston and Los Angeles). Crack injection cities; no significant declines were noted. Distur- continues to be reported in some cities, including bingly, cocaine ED mentions per 100,000 popula- Boston, New York, and Washington, DC. tion in the 12–17 age group increased sharply in Increased availability of cocaine hydrochloride four cities (Baltimore, Boston, Dallas, and (HCl) is reported in some cities, including Boston, Denver). By contrast, treatment admission figures3 Dallas, Denver, Philadelphia, and Phoenix.
Heroin indicators show mixed trends. Mortality males in 10 of 16 cities where females are tested. figures’ declined slightly in five cities (Honolulu, Among adult males, opiate-positive levels re- Minneapolis/St. Paul, Philadelpha, San Diego, and mained relatively low and stable in most cities, Seattle) and increased only in Phoenix. Heroin ED excluding Washington, DC, where levels in- mentions2 declined significantly in only one city creased. Among adult females, opiate-positive (San Francisco) and increased significantly in four levels declined notably in two cities (Chicago and (Miami, Newark, New Orleans, and Washington, Detroit) and increased in four (Minneapolis, New DC). Heroin is the top primary drug treatment Orleans, Phoenix, and Seattle). Heroin purie5 problem3 in 6 of 18 reporting sites (Baltimore, declined in eight cities, particularly in Denver and Boston, Los Angeles, Newark, New York City, Houston, and increased in five (Atlanta, Los and San Francisco). Males outnumber females in Angeles, Newark, New Orleans, and Philadelphia). most indicators, except for arrestee urinalysis Younger populations are increasingly initiating data4, with females testing higher for opiates than heroin use in many CEWG cities, including Highlights
Atlanta, Baltimore (especially among sub- Miami, new and younger users are reportedly urbanites), Boston (where ethnographic sources progressing from snorting to injecting. While report high school students snorting heroin, and smoking remains comparatively rare, it is more treatment providers report increased injection common in the West than in other regions, with an among teens), Chicago, Denver (where ethno- especially sharp recent increase among San Diego graphic sources report college students increas- treatment clients. ingly using heroin and street youth switching from methamphetamine to heroin), Philadelphia (where Heroin/cocaine (“speedball”) combinations are focus groups report new teen users), St. Louis, San reported in Baltimore, Boston, Chicago (where Diego, San Francisco, and Seattle (where young reports of the combination, nicknamed “John injectors are increasing). The proportion of Belushi,” have increased), New York City, treatment clients who snort is increasing in Atlanta, Philadelphia, St. Louis, San Francisco, and Seattle. Baltimore, Chicago, Denver, New York City, and Heroin is also combined with pharmaceutical Philadelphia; conversely, injecting is increasing in depressants (in Chicago and Seattle) and with Minneapolis/St. Paul, Newark, St. Louis, and methylenedioxymethamphetamine (MDMA) in Seattle (among younger users). In Boston and Texas.
Marijuana ED mentions’ increased significantly in they exceeded adult marijuana-positive levels at all 3 cities (Dallas, Philadelphia, and San Diego) and four sites where juveniles were tested. In some nonsignificantly in 10 others; they remained level cities, such as Denver, increased potency resulting in 4 cities; and they declined significantly in only 1 from genetic plant manipulation may have contrib- city (New Orleans) and nonsignificantly in 2 cities. uted to increased consequences, especially among However, the proportion of 12–17 -year-olds older users who had smoked marijuana in their among marijuana ED mentions declined consider- teens and have recently resumed use. Marijuana is ably in several cities-perhaps reflecting pre- increasingly a delivery medium for other psycho- vention efforts in those areas. Marijuana is the top active drugs. For example, in Chicago, blunts are primary drug treatment problem3 in four cities often laced with either crack or PCP (“3750s”). (Denver, Minneapolis/St. Paul, New Orleans, and Marijuana/crack combinations are also reported in Seattle). Treatment percentages increased (4-9 Boston, Minneapolis/St. Paul (“fireweed”), and percentage points) in three cities (Atlanta, Denver, parts of Texas; and marijuana/PCP combinations and San Diego) and declined in two (Chicago and are also reported in Minneapolis/St. Paul (“happy New Orleans). Among adult male arrestees4, stick”), New York City, Philadelphia (“loveboat” marijuana has now surpassed cocaine as the most or “wet”), and St. Louis. In Philadelpha, blunts commonly detected drug in the majority of CEWG are also laced with cocaine HCl (“turbo”). cities; positive findings increased sharply in four Marijuana/embalming fluid combinations are cities (Atlanta, Los Angeles, Miami, and reported in Minneapolis/St. Paul (“wets” or Washington, DC) and remained relatively stable “amp”), New York City (“duck foot,” which also elsewhere. Levels also remained relatively stable includes the pesticide DDT), and parts of Texas among female arrestees, except for increases in (where this combination also includes PCP). In four cities (Chicago, Denver, Minneapolis, and Texas, joints are also dipped in codeine cough New Orleans) and a decline in Seattle. Juvenile syrup. arrestee levels also remained relatively stable, but
4 CEWG December 1999 Highlights
Methamphetamine (“crystal meth,” “ice”) remains Methylenedioxymethamphetamine (MDMA) concentrated in the West and, to a lesser extent, in (“ecstasy,” “XTC,” “E,” “Florida dove,” some rural areas elsewhere. In the West, some “Mitsubishi,” “red devils,” “white dove,” “green recent indicators suggest declines, possibly related Adidas,” and “purple Adidas”), used primarily as a to national and community prevention programs, club drug at raves, dance clubs, and college stricter precursor laws, increased clandestine lab scenes, seems to be increasing in Boston, Miami, seizures, and declining methamphetamine potency. New Orleans, New York City, and parts of Texas; In the East, indicators remain low, but ethno- it is also reportedly available in Atlanta, Chicago, graphic and law enforcement evidence indicates a Minneapolis/St. Paul, Phoenix, St. Louis, Seattle, slight increase in availability, especially in rural Washington, DC, and parts of New Jersey. In areas and among whites. Methamphetamine- Boston, it is reportedly spreading outside the club related deaths] declined in two cities (Minneap- scone. In Minneapolis/St. Paul, respirator masks olis/St. Paul and San Diego) and increased in four rubbed with menthol-based cold ointments are (Honolulu, Philadelpha, Phoenix, and Seattle). worn after taking MDMA, a practice believed to Methamphetamine ED mentions’ declined heighten the drug’s effect. MDMA is combined significantly in six cities, all in the West (Denver, with LSD in some areas, including Miami (“rolling Los Angeles, Phoenix, San Diego, San Francisco, and trolling”), Washington, DC (in a pill form and Seattle), and increased significantly in Dallas called “nexus”), and parts of Texas. It is also and Miami. Methamphetamine remains the top combined with cocaine in Miami (“rolls”) and with primary drug problem among treatment heroin in Texas. In Atlanta, the content of what is admissions in Honolulu and San Diego3; in San sold as MDMA may vary widely. In Chicago, Diego, however, many methamphetamine homemade MDMA is sold as “wigits.” indicators have declined. Methamphetamine- Methylphenidate is abused by young adults in positive percentages among adult arrestees4 Mmneapolis/St. Paul and in middle- and upper- remained relatively stable, except for increases class communities in Boston; African-Americans among males in two cities (San Diego and Seattle) in Chicago sometimes inject methylphenidate and a decline among females in Phoenix. Meth- (“west coast”) with heroin or with heroin plus amphetamine users are heterogeneous, consisting cocaine. White injecting drug users (IDUs) in of many small subgroups, as suggested by ethno- Chicago inject phenmetrazine (Preludin). Khat, a graphic data in Atlanta, where methamphetamine flowering shrub imported from east Africa and the indicators appeared for the first time among Middle East, is reportedly used by small enclaves arrestees. Increases in lab seizures were reported of immigrants in Boston and Minneapolis/St. Paul. in five areas: Atlanta, Minneapolis/St. Paul, Phoenix, Seattle, and parts of Texas.
Problems associated with rave and club drugs have increasingly involved in fatalities, poisonings, risen dramatically in 1999. Gamma-hydroxy- overdoses, drug rapes, and other criminal butyrate (GHB, a central nervous system depres- behaviors in nearly every CEWG city and their sant) and two of its precursors, gamma- surrounding suburban and rural areas. These butyrolactone (GBL) and 1,4-butanediol (1,4- products, obtainable over the Internet and some- BDL, also called tetramethylene), have been times still sold in health food stores, are also
CEWG December 1999 5 I
Highlights available at gyms, nightclubs, raves, gay male (Xanax, or “sticks”) mentions2 have increased party venues, college campuses, or on the street. significantly. Those two drugs are frequently Commonly mixed with alcohol, they have a short reported by crack users in Philadelphia. In New action duration, and are not easily detected on York, diazepam now follows alprazolam as the routine hospital toxicology screens. GBL is leading psychoactive prescription drug; in available in commercial products such as Blue Chicago, however, diazepam remains the most Nitro, RenewTrient, and Revivarent G, while 1,4- readily available and frequently used pharma- butanediol is sold in products such as Enliven, ceutical depressant. Clonazepam (Klonopin or Weight Belt Cleaner, and Revitalize Plus. New Rivotril) and alprazolam use, in various combina- esters and analogs continue to appear as Federal tions and with alcohol, has recently increased in and State laws prohibit the sale of these drugs. Boston, where diverted prescription drug seizures The anesthetic ketamine (“Special K” or “vitamin have increased sharply after a recent rash of K”), also common in the club, rave, and party pharmacy break-ins. Those two drugs have re- scene, is reported in numerous cities, including placed flunitrazepam (Rohypnol) among adoles- Baltimore (predominantly among suburban, white, cents in Miami; similarly, in parts of Texas, middle- and upper-class youth), Boston (injected clonazepam continues to replace flunitrazepam, by some white, middle-class youth; as a heroin especially in combination with beer. Flunitra- adulterant; and in some overdose deaths), zepam remains a treatment problem in Texas, Minneapolis/St. Paul (in crime lab submissions), particularly among young Hispanic males along the New York (on the street; either snorted or injected; border, and it has been involved in numerous and sometimes mistaken for cocaine HCl), poison control calls. Seizures of that drug have Newark, and Phoenix. increased during the past year in New Orleans, where it remains common among white, upper- Recent deaths in Seattle have involved concomitant class high school and college students. It is also injection of heroin and a depressant, typically widely available in Atlanta. Amitriptyline (Elavil) diazepam. Diazepam ED mentions’ have declined use has reportedly increased among heroin users in significantly in several cities, while alprazolam Chicago.
Despite relatively low numbers in traditional data slight decline in Philadelphia. The recent increases sources, qualitative data suggest that hallucinogens in Dallas PCP indicators may reflect the use of are common among adolescents and young adults. marijuana cigarettes dipped in embalming fluid Emergency department mentions’ declined containing PCP. PCP continues to be often significantly in several cities, for both phencycli- smoked with marijuana in Chicago (“wicky stick” dine (PCP) (in Baltimore, New Orleans, and San or “donk”), New York, and St. Louis. Some Francisco) and lysergic acid diethylamide (LSD) medical emergencies in south Florida have in- (in Denver, Detroit, Miami, Minneapolis/St. Paul, volved LSD abused with “rolls” (MDMA and New York, San Francisco, and Washington, DC); cocaine). In parts of Texas, LSD is sometimes however, LSD mentions increased significantly in mixed with other drugs such as MDMA and Dallas and New Orleans. Among adult male diazepam, and it is sometimes sold with arrestees4, PCP-positive findings remained methamphetamine. LSD in Dallas is becoming generally stable, except for a slight increase in more available in the young adult nightclub scene. Dallas, a marked upturn in Washington, DC In Seattle, LSD and mushrooms turn up frequently (following a decade of marked decline), and a at local concerts or raves. Psilocybin mushrooms
CEWG December 1999 I
Highlights
(“shrooms”) and mescaline are common among use locally grown mushrooms, which are some- adolescents and young adults in Boston. times dipped in or treated with PCP, LSD, or Mushroom availability is also reported in methamphetamine. Peyote is readily available in Minneapolis/St. Paul. In New York, the term Phoenix. “eaters” refers to teenagers and young adults who
Among opiate ED mentions2, oxycodone and Two anticholinergic plants, “devil’s trumpet” and hydrocodone increased significantly in several “angel’s trumpet,” have resulted in some medical CEWG cities, while codeine and propoxyphene emergencies among teenagers in south Florida. A showed several significant declines. Five opiates substance called “red rock opium,” “red run,” and are reported most frequently as diverted or abused: “red stuff,” is smoked in Baltimore in combination hydrocodone (in Boston, New Orleans, New York with marijuana. It contains dracorhodin, a City, San Francisco, and parts of Texas); compound in the plant daemonorops draco oxycodone (in Boston, New Orleans, New York (“dragon’s blood”). Jimson weed has been City, Phoenix, St. Louis, Washington, DC, and involved in a recent death and in poison center parts of Texas); codeine and its products (in calls in Phoenix. Cough medicines with dextro- Chicago, primarily by heroin addicts; Houston, methorphan (DXM) are commonly abused by sometimes with marijuana; New York City; teens in some cities, including Boston and Phoenix; and Washington, DC); propoxyphene (in Minneapolis/St. Paul (“robo tipping”). Inhalant- Chicago, New Orleans, and New York City); and related deaths continue to be reported in Phoenix hydromorphone (in Atlanta, Chicago, Dallas, and parts of Texas. “Huffing” of toluene and other Honolulu, Minneapolis/St. Paul, St. Louis, and solvents continues among Philadelphia youth. Washington, DC). Hydromorphone is sometimes Needle exchange personnel in areas surrounding used as a heroin substitute by IDUs. Propo- Boston report steroid injection among young male xyphene availability has recently declined in bodybuilders. Sildenafil citrate (Viagra) has been Chicago. Opium seizures continue in Minneap- involved in seizures of diverted prescription drugs olis/St. Paul and Seattle. in Boston.
1Mortality figures are for 1998 versus 1999 projections (based on first-half-year 1999 data) and were available in seven reporting areas. 2Emergency department mentions are for 20 CEWG cities in the Drug Abuse Warning Network (DAWN) of SAMHSA’s Office of Applied Studies; comparisons are for 1997 versus 1998 estimates, except for age group comparisons, which are for 1996 versus 1998; changes are noted only when statistically significant at p<0.05 3Treatment admission figures are primary drug of abuse as a percentage of total admissions; total admissions exclude alcohol-only but include alcohol-in-combination. Comparisons generally are for the first half of 1998 versus the first half of 1999. Arrestee urinalysis data are for the 18 CEWG cities in the National Institute of Justice’s Arrestee Drug Abuse Monitoring (ADAM)program; comparisons are for 1998 versus first-half-1999; first-half-1999 data are preliminary; changes are noted only when they are 5 percentage points. ’Heroin price and purity information are for 19 CEWG cities in the Drug Enforcement Administration (DEA) Domestic Monitor Program (DMP);comparisons are for 1998 versus the first half of 1999; shifts percentage points are noted.
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EXECUTIVE SUMMARY
Boston: "According to focus groups with teens and youth treatment providers, cocaine use remains relatively rare among school-aged adolescents... . However, inadvertent exposure to cocaine via marijuana joints or blunts laced with crack was mentioned by participants in several focus groups."
MORTALITY DATA Mortality trends appear stable or declining in the following cities: Partial- 1999 cocaine-related mortality data were available in seven cities. Compared Honolulu: After increasing 26 percent with 1998 data, projections suggest increases between 1997 and 1998 (from 23 to 29), in three cities and declines or stable trends in cocaine toxicology cases appear to be four. The increases were reported in the stable in 1999 (1 5 in the first half). following cities: Miami: Cocaine-induced deaths declined Philadelphia: After declining 14 percent slightly between 1997 and 1998 (from 42 between 1997 and 1998 (from 284 to to 39) and appear relatively stable in 1999 245), cocaine-positive toxicology reports (25 in the first 9 months, compared with appear to be rebounding slightly in 1999 24 for the same period a year earlier). (130 in the first half). Minneapolis/St. Paul: Cocaine-related Phoenix: Cocaine-related deaths deaths declined 24 percent between 1997 increased by more than 300 percent and 1998 (from 5 8 to 44) and appear to between 1997 and 1998 (from 21 to 87), be declining again in 1999 (17 in the first and the dramatic increase continues into half). 1999-the half-year figure (89) has already surpassed the previous year's San Diego: Cocaine-related accidental total. Cocaine has also increased as a overdose deaths declined 14 percent percent of total drug-related deaths between 1997 and 1998 (from 63 to 54) during those three periods (10, 2 1, and and appear to be declining again in 1999 28 percent, respectively). (40 projected, based on first-half-year data). Seattle: Except for a decline in 1997, cocaine-related deaths have been in- Earlier data show four increases between creasing for several consecutive years. 1997 and 1998: The increase was slight between 1997 and 1998 (from 66 to 69) but appears to Colorado: Continuing a steady 6-year be sharper in 1999 (63 through Septem- climb, cocaine deaths increased 18 ber 13). percent (from 92 to 109), reaching a record high.
15 Executive Summary: Cocaine
St. Louis: After declining from a 1996 374)-the third consecutive increase since peak (of 93), cocaine-related deaths a 1995 low (of 189). increased, but only slightly (from 43 to 47). EMERGENCY DEPARTMENT DATA San Francisco (fiscal year data): Medical examiner (ME) cocaine mentions Cocaine (including crack) remains the most increased 22 percent (from 83 to 101) but frequent illicit drug mention in 15 of the 20 remained below the 1996 peak (of 11 1). CEWG cities in the Drug Abuse Warning Network, according to 1998 estimates, and Texas: Cocaine mentions increased 11 is equal to heroin as a proportion in percent to a record high (from 338 to Baltimore (exhibit 1). It accounts for
Exhibit 1. Percentages of total ED mentions composed of cocaine, heroin, marijuana, methamphetamine,and "other" by metropolitan area, ranked by cocaine, 1998 New York (N=58,368) Miami (N=l0,756) Atlanta (N=9,593) Baltimore (N=23,550) Philadelphia (N=45,626) Chicago (N=48,375) Detroit (N=32,604) Newark (N=l5,185) New Orleans (N=9,662) Los Angeles (N=29,820) Washington, DC (N=l9,068) Dallas (N=13,419) St. Louis (N=10,712) Boston (N=24,893) Seattle (N=13,927) Denver (N=7,179) San Francisco (N=12,530) Phoenix (N=12,296) Minneapolis/St. Paul (N=8,150) San Diego (N=12,190)
0 10 20 30 40 50 60 70 80 90 100 Percentage of Total ED Mentions
Marijuana Other (includes alcohol-in-combination)
Heroin Methamphetamine
SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 1998 (July 1999 update)
16 CEWG December 1999 Executive Summary: Cocaine particularly high proportions (>20 percent) percent, p<0.05) in five cities (Dallas, Los of total emergency department (ED) drug Angeles, Philadelphia, Phoenix, and mentions (including alcohol-in-combination) Washington, DC), with the largest shift a 45- in nine cities (Atlanta, Baltimore, Chicago, percent increase in Dallas (exhibit 3). Detroit, Miami, New Orleans, New York, Additionally, nonsignificant increases were Newark, and Philadelphia). It is outranked reported in the majority of the other cities; by heroin, however, in three cities (Newark, no significant declines were noted. Corre- San Francisco, and Seattle); and in San spondingly, over that same time period, Diego it nearly equals marijuana and heroin cocaine increased slightly (3-5 percentage in frequency of mention. points) as a proportion of total ED mentions in six cities: Atlanta, Boston, Dallas, Los The Nation’s highest rate of cocaine ED Angeles, Philadelphia, and St. Louis. Thus, mentions per 100,000 population was re- cocaine increased both in number and ported in Baltimore (as it has been since proportion in three cities: Dallas, Los 1992), followed by Philadelphia; the lowest Angeles, and Philadelphia. rate, again, was in Minneapolis/St. Paul (ex- hibit 2). Long-term trends have varied somewhat among the Nation’s four top-ranking cities Between 1997 and 1998, cocaine ED (exhibit 4). Baltimore’s current rate- mentions increased significantly (> 10 despite its top-ranking national status, and despite the recent slight increase-is still Exhibit 2. Estimated rate of cocainelcrack ED well below that city’s 1994 peak. Philadel- mentions per 100,000 population phia’s latest increase, however, has brought by metropolitan area, 1998 that city’s cocaine ED rate to a record level, continuing a 4-year climb. The current leveling in Chicago follows a generally increasing trend since 1991. In New York, however, rates have been fairly stable throughout the 1990s, with minor fluctua- tions.
San Francisco TREATMENT DATA
BEYOND THE CITY LIMITS ...
St. Louis: “Cocaine... is the primary drug of choice identified in inner-city treatment programs; alcohol, however, remains the 0 50 100 150 200 250 300 primary drug in both the outlying rural areas and statewide. ” ED Mentions per 100,000 Population
SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 1998 (July 1999 update)
17 I
Executive Summary: Cocaine
Exhibit 3. Percentage of change in cocaine/crack ED mentions by metropolitan area, 1997 versus 1998
Seattle (N=2,399) San Francisco (N=1,843) Chicago (N=13,640) New York (N=19,549) New Orleans (N=2,396) Minneapolis (N=773) Newark (N=3,743) Detroit (N=8,617) Denver (N=1,154) Miami (N=3,553) Baltimore (N=6,871) Phoenix (N=1,486) Washington, DC (N=3,718) San Diego (N=971) Philadelphia (N=13,049) Los Angeles (N=5,783) 23” Boston (N=4,526) St. Louis (N=2,073) Atlanta (N=5,980) Dallas I I 45* -20 -1 0 0 10 20 30 40 50 Percent of Decrease Percent of Increase NOTE: (N) refers to 1998 mentions
*p<0.05
SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 1998 (July 1999 update)
Exhibit 4. Annual trends in cocain/crack ED mentions per 100,000 population in four top-ranking cities, 1991-98 ED Mentions per 100,000 Population 400 350 300 250 200 150 100 50 Chicago
I I I I I 0 I 1991 1992 1993 1994 1995 1996 1997 1998 Year SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 1998 (July 1999 update)
18 CEWG December 1999 Executive Summary: Cocaine
Cocaine (including crack) as a primary drug cisco, and Seattle. Heroin now dominates of abuse accounts for the largest percentage treatment proportions in six areas, marijuana of admissions (excluding alcohol-only but in four, and methamphetamine in two. including alcohol-in-combination) in 6 of 18 reporting areas: Atlanta, Chicago, Phila- Contrary to most ED indicators, treatment delphia, St. Louis, Texas, and Washington, percentages for cocaine remained generally DC (exhibit 5). It also accounts for major stable or declined in all areas where trend proportions of admissions (>20 percent) in data were available, in comparison with New Orleans, New York City, San Fran-
Exhibit 5. Primary drugs of abuse as percentages of treatment admissionsa in reporting CEWG areas, first half 1999b
Area
NOTE: The bolded areas indicate the top-ranking primary drug of abuse in each area.
aTotal admissions number excludes alcohol-only but includes alcohol-in-combination. bReporting periods are January-June 1999, except for the following: January-June 1998 in Baltimore; July 1998-March 1999 in Boston; July-September 1999 in Los Angeles; full calendar year 1998 in Chicago; and FY 1999 in San Francisco. cData are preliminary. dAlcohol-only is not excluded.
SOURCE: State drug abuse treatment agencies Executive Summary: Cocaine figures from the same reporting period 1 to 49) and have remained at about that year earlier. The largest declines were noted level through 1998. in Atlanta, Chicago, Philadelphia, and St. Louis. Longer term comparisons show some Chicago: Among infants who tested drug more notable declines. In Boston, for positive, the proportion of cocaine example, admissions for primary cocaine findings declined between 1996 and 1998 abuse declined from 27 percent in 1994 to 13 (from 64 to 57 percent). percent in the first half of 1999. Similarly, in Denver, the cocaine percentage (excluding Massachusetts: Cocaine was mentioned both alcohol-only and alcohol-in-combina- in 17 percent of helpline calls between tion) declined from 41 percent in 1993 to 22 May and September 1999, level with the percent in the first half of 1999. And, in prior 5-month period. Newark, cocaine admissions declined from 33 percent in 1992 to 9 percent in the first Massachusetts: In 1998, lifetime cocaine half of 1999. or crack use was reported by 21 percent of juvenile offenders (I 17 years), While treatment data were not available for compared with just 5 percent for heroin. Miami or Florida, a south Florida provider reports stable trends for primary cocaine hydrochloride (HCl) admissions but a WHY DO TREATMENT INDICATORS dramatic decline in primary crack admissions GENERALL Y SHOW DECLINES, WHILE between the first halves of 1998 and 1999. SOME 0 THER INDICA TORS SHOW Similarly, a Phoenix provider reports stable INCREASES? cocaine trends. POSSIBL E EXPLA NA TIONS... OTHER LOCAL DATA Texas: “This decrease could reflect shifts in funding among treatment programs with different target groups, Local data sources around the country especially heroin users, or it could underscore the severity of the cocaine indicate an upsurge in cocaine use problem, despite some indications of leveling among new users not yet in need of or declining trends: trea tmen t. ”
South Florida: Among the 2,962 Newark: “Some of the decline may be attributed to the effect of managed care toxicology screens performed at a on admissions to hospital-based
Broward County hospital during the first detoxification programs. ” half of 1999, 26 percent were positive for cocaine. NOTE: In comparing indicators, another factor should be considered: treatment data are generally available about 6 Denver area: Poison control calls months before the ED data. declined between 1994 and 1995 (from 71 Executive Summary: Cocaine DEMOGRAPHIC DATA Minneapolis/St. Paul, Philadelphia, and Phoenix) (exhibit 6). Between 1996 and BEYOND THE CITY LIMITS... 1998, that older group's representation increased by 5 or more percentage points in Atlanta: "The emergence of cocaine HCI 13 cities (Boston, Chicago, Denver, Detroit, as well as crack cocaine outside the Los Angeles, Miami, Minneapolis/St. Paul, inner city is also confirmed by ethno- graphic data. These new users are less New Orleans, Newark, Phoenix, St. Louis, likely to be adolescents, but encompass Seattle, and Washington, DC). young adults who use cocaine for re- creational purposes as well as profes- Correspondingly, as they moved into the sionals who use it to enhance their job older age group, the 26-34 group declined performance. Typically, the crack used as a percentage of cocaine ED mentions in is not in rock form; rather, these users nearly every city, accounting for only 27-39 smoke freebase cocaine. " percent of cocaine mentions among the 20 cities. The largest declines 5 percentage Age points) were recorded in 12 cities (Boston, Dallas, Denver, Detroit, Los Angeles, Available mortality demographics continue Miami, New Orleans, Newark, Philadelphia, to reflect an older cocaine-using population. St. Louis, San Francisco, and Washington, For example, the average age of cocaine DC) . decedents was 39 in Miami (although the range was 17-63), 3 8.9 in Minneapolis/St. The young adult (18-25) group, which Paul, and 36.9 in Texas (an increasing trend). accounts for 7-22 percent of cocaine ED More than half (55 percent) of San Diego's mentions in the various cities, remained cocaine decedents were age 35 or older. relatively stable in proportion, with a few And, in San Francisco, median age was 40, a exceptions: a 6-point increase in San Diego, record high for recent years. and 5-percentage-point declines in both Philadelphia and Seattle. Similarly, the Philadelphia: "The recent [focus] juvenile (1 2-1 7) group remained relatively groups also reported an aging crack- stable between 1996 and 1998, generally using population with fewer new accounting for 1-3 percent of cocaine users. " mentions in all the cities except Dallas (6 percent) and Phoenix (5 percent). Likewise, age distributions among cocaine ED mentions generally suggest an aging Despite the juvenile group's stable cohort of cocaine users; however, rate proportions, their rates (cocaine ED increases among youth in four cities bear mentions per 100,000 population) increased watching. The 35+ group now accounts for disturbingly between 1996 and 1998 in four the largest percentage of cocaine mentions in cities: Baltimore, Boston, Dallas, and every CEWG city in DAWN; moreover, it Denver (exhibit 7). In Baltimore, moreover, accounts for 50 percent or more in all but 6 the increase is even more dramatic because it of those 20 cities (Boston, Dallas, Denver, was accompanied by rate declines for the
CEWG December 1999 21 Executive Summary: Cocaine
Exhibit 6. Age distribution of Exhibit 7. Cocaine emergency department cocaine ED mentions, by percentage, mentions per 100,000 population for the 12-17 in reporting CEWG cities, 1998 age group in selected cities, 1996 versus 1998 ED Mentions per 100,000Population Area 12-17 18-25 26-34 35+ 70
Atlanta Baltimore 50 16 Boston 45 41 Chicago 1 11 35 53 40 35 Dallas 6 22 33 39 Denver 3 19 33 44 Detroit <1 7 27 65 Los Angeles 2 15 31 52 Miami 1 11 30 56 Dallas Minneapolis/ Denver Baltimore San Diego Boston St. Paul City Newark SOURCE: Office of Applied Studies, SAMIHSA, New Orleans Drug Abuse Warning Network, 1998 (July 1999 update)
York City < 1 8 39 52 Treatment data also continue to reflect a Philadelphia 1 15 35 48 generally aging group of cocaine users Phoenix 5 22 36 37 (exhibit 8). The oldest (35+) group accounts for the largest percentages of primary San Diego cocaine admissions (ranging from 45 percent in Texas to 63 percent in Washington, DC) Seattle 2 13 33 52 in all but one reporting area: Newark, where Washington, DC 9 35 55 that oldest group trails the middle (26-34) group by just 1 percentage point. In several NOTE: Bolded areas reflect percentages that have areas where trend data were available, the increased by points since 1996. middle group still seems to be transitioning SOURCE: Office of Applied Studies, SAMHSA, into the oldest group: compared with the Drug Abuse Warning Network, 1998 (July 1999 same period 1 year earlier, the middle group update) declined substantially percentage points) in four areas-Chicago, Minneapolis/St. three older age groups. In Boston and Paul, New York City, and Texas-while the Denver, the older age groups did increase in oldest group increased correspondingly. The rate; however, those increases were minor younger (1 8-25) group accounts for much compared with the increase among juveniles. smaller percentages than the two older Only in Dallas did all four age groups show groups (ranging from 5 percent in Washing- sharp rate increases. The sharpest rate ton, DC, to 16 percent in Texas). The decline in the 12-17 group took place in San youngest 17) group generally accounts for Diego, where the 18-25 group correspond- 1 percent or less of primary cocaine admis- ingly increased. sions, with a few exceptions: Baltimore Executive Summary: Cocaine Exhibit 8. Age distribution of primary percent); and San Diego (5 percent). cocaine treatment admissions, by a Similarly, in Washington, DC, Pretrial percentage, in reporting CEWG areas Services Agency urinalyses show relatively stable cocaine-positive levels among juvenile arrestees (8 percent in 1998 and 7 percent in the first 10 months of 1999).
Gender
Males continue to account for the large majority of cocaine deaths in all areas where mortality demographics were available: 90 percent in San Diego, 88 percent in Minnea- polis/St. Paul, 74 percent in Seattle, 70 per- cent in San Francisco, and 60 percent in Miami. I I
I I Males also continue to outnumber females as Texas a percentage of cocaine ED mentions in 5 every CEWG city in DAWN. The gender Washington, < 1 gap remains widest in New Orleans and New NOTE: Bolded areas reflect percentages that have York (72 versus 28 percent); it is narrowest increased by points since the reporting period 1 in Boston and Washington, DC (57 versus year earlier. 43 percent). Between 1997 and 1998, gender distributions remained generally aReporting periods are January-June 1999, except for the following: January-June 1998 in Baltimore; stable. The largest shifts were some slight July 1998-March 1999 in Boston; July-September increases (3-4 percentage points) for females 1999 in Los Angeles; full calendar year 1998 in in Los Angeles, Newark, and San Diego, and Chicago; and FY 1999 in San Francisco. a slight decline (3 points) for females in bAge groups reported are < 17, 17-25, 26-35, and 36 + . Seattle.
SOURCE: State drug abuse treatment agencies Similarly, among cocaine admissions, males outnumber females in all reporting areas (4 percent), Texas (3 percent), and except Newark (where females account for Minneapolis/St. Paul (2 percent). 55 percent) and Chicago (where males and females are evenly divided). Following Available juvenile arrestee urinalysis data Newark and Chicago, the narrowest gender show level or declining trends. In Denver, gap occurred in Philadelphia (52 percent cocaine-positive findings in that population versus 49 percent); the widest gap was declined considerably between 1998 and the reported in Minneapolis/St. Paul (68 percent first half of 1999 (from 13 to 7 percent). versus 32 percent). Since the same period 1 Levels remained relatively stable in the other year earlier, female representation increased three cities where ADAM tested juveniles: markedly (5-7 percentage points) in three Phoenix (16 percent); San Antonio (10 cities where trend data were available I
(Newark, Philadelphia, and San Francisco) cities in DAWN, whites predominate in 5, and declined in one (Denver). and 3 cities have too many mentions in the “race unknown” category to be included in In nearly every reporting area, women in the count. The largest Hispanic represen- treatment had a higher representation for tation occurs in Los Angeles, New York, cocaine than for other drugs. Men, by and Phoenix (24-27 percent). contrast, were more highly represented for marijuana than for other drugs. Between 1997 and 1998, San Diego’s racial/ethnic distribution of cocaine ED Only in one indicator do women predomi- mentions shifted dramatically, with a 13- nate: according to preliminary first-half- percentage-point increase for whites and an 1999 ADAM data, female arrestees tested 8-point decline for African-Americans. A cocaine-positive at higher levels than males in nearly every CEWG city (exhibit 9). The Exhibit 9. Percentage positive for cocaine only exceptions occurred in New Orleans among adult male and female booked arrestees, and in two Texas cities (Houston and San first half 1999 (ranked by males) Antonio), where percentages were higher for males than for females. Miami had the Atlanta highest cocaine-positive level among males, while Philadelphia had the highest level Washington, DC* among females. New 45 New Orleans 45 Atlanta: “An ethnographic study to Denver further explore this gender gap Chicago revealed a complex series of issues that might provide explanations, such Philadelphia as the following: women are easier to Los Angeles arrest; female prostitution is a highly Houston visible crime; and women are less likely to report to emergency Seattle departments and drug treatment Phoenix centers. ” Minneapolis Dallas Race/Ethnicity Detroit 54 Whites generally predominate in available San Antonio 26 F l cocaine mortality data. They account for 70 23 ema e percent of the cocaine decedents in San Diego, 60 percent in Miami, and 48 percent 0 in Texas. In Minneapolis/St. Paul, however, Percentage Positive 53 percent of cocaine decedents are African- *Females not tested at these sites, American. SOURCE: National Institute of Justice, Arrestee Drug Abuse Monitoring program, African-Americans predominate among November 1999 files, preliminary data cocaine ED mentions in 12 of the 20 CEWG
CEWG December 1999 Executive Summary: Cocaine similar but less dramatic trend (±2-4 African-Americans are overrepresented at a percentage points) was reported in five other south Florida treatment facility; but there, cities: Baltimore, Chicago, Miami, New too, crack abusers who are African-American Orleans, and St. Louis. The reverse trend have been declining while whites and (±3-6 points) was reported in Los Angeles Hispanics have been increasing. and Philadelphia, where white representation declined while African-American represen- USE PATTERNS tation increased. Hispanic representation declined slightly (3-4 percentage points) in Route of Administration Los Angeles and Phoenix, increased (4 points) in New York, and remained relatively Atlanta: "At some crack houses, users stable elsewhere. can 'borrow' a pipe that is already loaded with a rock for $6. They have Among primary cocaine treatment admis- to leave the crack pipe at the house, sions, African-Americans account for the and typically the pipes are stored in majority in nearly every reporting area, and one big box, which, in turn, leads to sharing crack pipes. " they are the modal group in Texas (40 per- cent). The only exception is Denver, where Philadelphia: "Focus group participants whites predominate (45 percent). In the estimated that 60 percent of cocaine majority of reporting areas, however, HCI buys are for inhaling, 25 percent African-American representation has are for injecting in a 'speedball,' and 75 percent are for injecting straight. ” declined slightly (1-3 percentage points) since the same period 1 year earlier; and it Smoking, typically crack, remains the pre- has declined more markedly (4-7 points) in dominant route of administration, by far, Atlanta, Baltimore, and Denver. Corre- among primary cocaine treatment admissions spondingly, whites have increased markedly in every reporting area. However, since the as a percentage of primary cocaine treatment same period 1 year earlier, smoking declined admissions in Atlanta and Baltimore, while markedly (4-6 percentage points) in four Hispanic representation has increased cities (Denver, Newark, Philadelphia, and San considerably in Denver and San Diego. The largest Hispanic representation is reported in Diego) and to a lesser extent (2 points each) in three others (Minneapolis/St. Paul, New Denver (27 percent), Texas (19 percent), York City, and St. Louis); intranasal use New York City (1 8 percent), and Los showed corresponding increases, possibly due Angeles (1 8 percent). to increased availability of cocaine HCl in some areas. The highest levels for intranasal In some areas, these recent shifts are part of use were reported in Newark (35 percent), a long-term trend: in Texas, for example, New York City (28 percent), and Denver (24 the percentages of Hispanics and whites percent). Injecting accounted for 4 percent among treatment admissions, both for or less of cocaine admissions in all areas cocaine HCl and crack, have been increasing except Denver (1 4 percent), Texas (12 since 1987, while the percentage of African- percent), and Baltimore (8 percent). The Americans has been declining. Denver percentage for injecting represents a I
Executive Summary: Cocaine 3-point increase over the figure reported 1 Multisubstance Use year earlier. Heroin was present in 39 percent of Phila- Boston: “Needle exchange delphia’s first-half- 1999 cocaine-positive workers... continue to see some mortality cases. It was involved in 71 percent injecting drug users (IDUS) dissolving crack cocaine in vinegar or lemon of Seattle’s cocaine deaths, and 70 percent of juice, to be used most often in those deaths involved injecting of both the combination with heroin (speed- cocaine and heroin, suggesting the possibility balling). Primary cocaine injectors, of speedball injection. who constitute a small minority of
IDUS, tend to use cocaine HCI. ” EXPLANA TION FOR A SIMILARITY? Crack injection continues to be reported in some cities, including Boston, New York, Baltimore: “The similarity in the cocaine and heroin ED rates and patterns are and Washington, DC. In New York, like in probably attributable to the concurrent
Boston, injectors use lemon juice or vinegar use of the two drugs. ” to dissolve the crack. Since this mixture has been causing serious skin infections, some needle exchange programs in that city have been distributing kits of boric acid and Speedballing was reported in several other vitamin C to treat the problem. In Wash- cities besides Baltimore and Seattle: Boston; ington, DC, where injection is becoming a Chicago; New York City, where dealers in common method of crack administration, some areas sell a “piggyback” combination injectors similarly use vinegar as a diluent, that includes a $10 bag of crack attached to a and they often shoot the drug in tandem with $10 bag of heroin; Philadelphia; St. Louis, heroin (as a speedball). where old-time IDUs continue to mix HCl and heroin together; and San Francisco, Route of administration varies by social and where speedballs (heroin and cocaine sold demographic characteristics of the treatment together for combination use) have become population. For example, in Newark, cheaper and more widely available. smoking was reported by 76 percent of African-American cocaine admissions, 42 Treatment data further suggest the overlap of percent of whites, and 42 percent of cocaine and heroin use: among primary Hispanics. In Philadelphia, smoking was heroin users, cocaine was the most common reported by 76 percent of male cocaine secondary drug in every area where such admissions and 87 percent of females. And, treatment data were available, except Texas in New York, crack smokers, compared with (where alcohol was the most common cocaine inhalers or snorters, were more likely secondary drug and cocaine was the most to be female (44 percent versus 28 percent) common tertiary drug). The severity of and African-American (72 percent versus 44 cocaine as a secondary drug problem among percent). In Texas, cocaine HCl abusers heroin admissions is underscored by the were younger than crack abusers (3 1 years relatively high percentages reported: Wash- compared with 35), and more likely to be ington, DC (57 percent), Baltimore (52 male and white. Executive Summary: Cocaine percent), Newark (40 percent), New York Compared with full-year 1998 levels, cocaine- City (37 percent), San Diego (37 percent), positive levels among male adult arrestees Atlanta (32 percent), Los Angeles (3 1 per- remained generally stable (<4 percentage cent), Denver (23 percent), and St. Louis points ±) in the first half of 1999, with some (1 9 percent). exceptions: levels increased in Miami (7 percentage points) and Washington, DC (1 3 Among primary cocaine treatment admis- points); and they declined in Chicago (7 per- sions, however, alcohol and marijuana centage points), Los Angeles (6 points), generally remained the most frequently Philadelphia (8 points), and San Diego (5 reported secondary or tertiary drugs of points). Among females, however, levels abuse. Some exceptions include Denver, were more volatile: percentages increased Newark, and San Diego, where alcohol was markedly 5 percentage points) in six cities most common, both as a secondary and (Dallas, Detroit, Minneapolis, Philadelphia, tertiary drug; and Texas, where opiates and Phoenix, and San Diego) and declined in two alcohol, respectively, were the most common (Houston and Los Angeles). The largest secondary and tertiary drugs. increases were recorded in Dallas (1 3 percentage points) and Philadelphia (10 In Philadelphia, cocaine HCl continues to be points); Houston had the largest decline (10 used with marijuana in a blunt known as a points). “turbo.” Crack in that city continues to be used frequently with malt liquor, alprazolam Boston: “Police contacts report that (Xanax), diazepam, or marijuana, and less cocaine is still the number-one street frequently with heroin or phencyclidine drug, despite the long-term drop in arrests. ” (PCP). Other arrest data generally show level or LAW ENFORCEMENT DATA declining trends:
Arrestee Data Boston: Cocaine arrests stayed level between 1997 and 1998 (at 48 percent of Cocaine is the most frequently detected drug all drug arrests) but well below the 1992 among adult male arrestees in only 5 of the peak (of 66 percent). 17 CEWG cities in the ADAM program: Atlanta, Los Angeles, Miami, New Orleans, Newark: Cocaine arrests had averaged and New York. It is exceeded by marijuana 4,500 per year between 1991 and 1996, in the other 12 cities (Chicago, Dallas, but then declined to 3,608 in 1998 and Denver, Detroit, Houston, Minneapolis, 3,120 in 1999 through October-still Philadelphia, Phoenix, San Antonio, San outnumbering heroin arrests. Diego, Seattle, and Washington, DC). Among adult female arrestees, however, New York City: Cocaine arrests in cocaine still ranks first in all cities, except for declined 13 percent between 1995 and San Diego (where it is exceeded by both 1998 (to 35,577). marijuana and methamphetamine). Executive Summary: Cocaine Honolulu: Cocaine cases declined between 1997 and 1998 (from 1,045 to INCREASING HCI: POSSIBLE EXPLANA TIONS.. . 874) and again appeared to be declining slightly in 1999 (408 in the first half). Boston: "The increase in cocaine HCI availability reported by the DEA and the In Phoenix, however, after declining between Department of Public Health drug lab, 1996 and 1997, opiate/cocaine arrests for and the continuing decline of crack in lab manufacturing/sales rebounded in 1998 (to submissions may reflect the relatively harsh Federal penalties associated with 1,776, or 33 percent of all manufacturing/ crack possession and distribution. They sales arrests)-but still well below their 1989 may also reflect the stigma of crack use peak. as the drug has taken its toll on long- term users. "
Market Data INCREASING HCI: POSSIBLE EFFECTS... Boston: "Most anecdotal reports indicate that cocaine is still heavily Denver: ". . .the increased availability of trafficked on Boston streets, with cocaine HCI may be bringing about increases in the availability of cocaine changes in the cocaine user groups, and HCI. " thus, in the population entering
treatment. " Washington, DC: "Ethnographic reports indicate that this form of cocaine [HCI] can be found only in particular neigh- borhoods of Northwest and Southeast DC. ... crack is much more widely BEYOND THE CITY LIMITS... available, being found in every neigh- Boston: "Crack remains the predominant borhood in the District. " form of cocaine in the inner city, with cocaine HCI more popular in nearby
Increased availability of cocaine HCl is suburbs. " reported in some cities, including Boston, Dallas, Denver, Philadelphia, and Phoenix. St. Louis: "Crack prices in outlying [rural] In Boston, crack remains the predominant areas are stable at $100 per gram. " form of cocaine, despite the increased availability of HCl. Crack also remains available in New York City, but at lower levels than in the late 1980s and early 1990s. Cocaine HCl and crack prices vary widely Cocaine, predominantly crack, is the most across the country (exhibits 10 and 11). In frequently encountered drug in Atlanta, several cities, HCl prices declined recently at where it is usually transported in HCl form some purchase quantities, but crack prices and converted for sale as crack by the sellers. were stable. In Boston, for example, Similarly, in St. Louis, most cocaine arrives kilogram prices declined, while crack prices as HCl and is processed locally into crack. remained unchanged. Similarly, in San Diego, Ready availability of cocaine is also reported the pound price range declined at the low in south Florida and Texas. Executive Summary: Cocaine
Exhibit 10. Cocaine hydrochloride prices in reporting CEWG areas
aGram purity 50 percent, ounce purity 80 percent, ePurity 50 percent kilogram purity percent fPurity 50-60 percent bPurity 61 percent (samples of 2-25 grams) gpurity 2 1 -90 percent cGram purity 20-50 percent, >90 percent pound hGrarn purity 65-90 percent purity iPurity 19-95 percent dGram purity 80 percent
SOURCE: CEWG city reports, December 1999 end (to $4,000-$12,000, with street purity fluctuates, and crack is still available stable at 20-40 percent), but crack prices for as little as $5, or sometimes remained stable. Ounce and kilogram prices even $3." dropped in Minneapolis/St. Paul, but gram Philadelphia: "During focus group prices remained stable. Prices in Texas were sessions, former drug users new to dropping since 1987 but have remained fairly formal treatment said they perceived stable more recently. Stable prices are crack to be less potent in autumn reported in several other cities: New York 1999 than it had been since 7996." City (kilogram level), Newark, New Orleans Seattle: "Reports from users indicate (both HCl and crack, for the past 3 years), that purity has declined compared Phoenix, and Seattle. with a year ago. "
Atlanta: "Ethnographic information Washington, DC: "Users say the indicates that the price for a rock quality is 'up and down. "'
29 Executive Summary: Cocaine
Exhibit 11. Crack prices and purity in increased by $2,000 for several days, reporting CEWG areas possibly because of a purposely induced shortage. And, in Washington, DC, since
Area Price/Unit the previous half-year period, gram prices for both cocaine HCl and crack increased Atlanta $10-$20/rock somewhat, as did crack kilogram prices. $85-$100/g $750-$1,100/oz $22,000-$26,000/kg Seizures, Trafficking, and Bostona $10 -$2O/vial Distribution Chicago $5-$20/rock Denver $10 - $20/roc k Seizure and submission data still indicate a Honolulu $5-$15/dose high level of cocaine activity around the $20-$100/rock country. In Boston, cocaine HCl submis- $100 -$150/g sions have been increasing; crack submis- $1,000-$1,500/oz sions, however, have been declining. Miami $5-$20/bag or vial Cocaine is still the most common substance Minneapolis/ $20/rock analyzed by crime labs in south Florida. In St. Paul Minneapolis, the amount seized increased Newark $3-$20/vial sharply between 1998 and the first three New Orleans $5-$25/rock quarters of 1999, as did the number of New York City $2-$1O/via1 submissions to the State crime lab. Crack Philadelphia $3-$5/rock seizures have also increased in New Orleans Phoenix $20/rock and its surrounding parishes. Cocaine $500-$700/oz continues to account for approximately 43 St. Louis $25/roc k percent of all drug seizures in Washington, $40-$100/g DC (1 5.4 kilograms in the first 9 months of San Diego $10/0.1 g 1999). While seizures of cocaine coming San Francisco $50/g into Washington State decreased slightly Seattle $20-$40/rock between 1998 and 1999, amounts were still Texas $10-$20/rock higher than in previous years. $500-$1 ,1 00/oz b Washington, DC $3-$4/rock BEYOND THE CITY LIMITS... $100/g $24,000-$27,000/kg Chicago: “...the amount of cocaine seized in other areas of the State, aPurity 60-80 percent bGram purity 30-81 percent especially in rural counties, has increased greatly. “ SOURCE: CEWG city reports, December 1999 I A few price increases are reported. In Control of New York City’s major crack Denver, for example, the gram price increased markets is divided among small trafficking since the last report; but there, too, crack groups, with independent operators able to prices remained stable. In Miami, according distribute only in certain areas. to the DEA, the kilogram price temporarily I
Executive Summary: Cocaine
New York: "The Street Studies Unit New York City remains a primary source (SSU) continues to report less visible area for Atlanta, as do Florida and Texas. drug activity in public places. The big Cocaine in the Boston area is also trafficked 'drug supermarkets, ' where sellers operated openly and with impunity, are from New York, as well as from Houston, a thing of the past. '' the Southwest border, Puerto Rico, and Miami. Boston's trafficking continues to The open-air crack markets that still exist in be dominated by Colombian, Dominican, New York City are smaller and less volatile and Puerto Rican groups. than in the past. The crack dealers who continue to deal outdoors do so in areas with Gang involvement remains a key feature of as much cover as possible, such as passage- cocaine distribution and sales in several ways in housing projects, the sides of cities, including Minneapolis/St. Paul and buildings, parks, and playgrounds. Cocaine Seattle. HCl is generally available through house connections and in nightclubs and bars. Boston: "Heroin has established itself as a cheap, pure, easily found alternative to
cocaine. "
Chicago: "New sociodemographic groups (namely white suburbanites) are visible in heroin-related ED mentions and in prospective surveys of younger IDUs; and prices per milligram of heroin are at their lowest in a decade."
Miami: "The new South American heroin source, increased purity, and decreased price have allowed for new routes of abuse (snorting, smoking) and for new users
(those who 'would never inject'). "
San Francisco: "Ethnographic observers report that heroin is abundant, cheap, and high quality. Young people (ages 18-25) appear to be using it more. Comments along the lines of 'I first shot up in San Francisco-never before' are often heard."
MORTALITY DATA Minneapolis/St. Paul: After increasing between 1997 and 1998 (from 33 to 38), Phoenix: "An ME staff member opiate-related deaths appeared to be reported several morphine-related declining slightly in the first half of 1999, deaths among users from the when 17 cases were reported. This time 'traditional/professional' community. period was the first during which the They died with the needle still in their number of opiate- and cocaine-related arms. " deaths were equal. Denver: "An ethnographic report finds that some street youth who Philadelphia: Heroin/morphine toxicology initially injected methamphetamine reports declined 23 percent between 1997 have shifted to heroin injection." and 1998 (from 353 to 271) and appeared to decline again in 1999 (1 19 cases in the St. Louis: "Most heroin deaths involved older, experienced users and first half). may have resulted from the reported
increased purity levels. " San Diego: Accidental overdose deaths involving heroin seemed to continue the Partial- 1999 heroin-related mortality data 1997-98 decline (from 16 1 to 138) in were available in six cities. Compared with 1999 (1 19 projected, based on first-half- 1998 data, projections suggest declines in year data). five cities and an increase in one. Seattle: After reaching an all-time high in Declines were reported in the following 1998 (143 deaths), heroin/morphine- cities: caused deaths appeared to decrease in 1999 (61 in the first half). Honolulu: First-half- 1999 heroin toxicology cases (8) seemed to continue An increase was reported in Phoenix, where the 1995-98 decline (from 40 to 20). morphine-related deaths (which had been increasing since 1991) continued the upward
32 CEWG December 1999 I
ecutive Summary: Heroin trend. A 33-percent increase in deaths In 1998, heroin remained the number-one between 1998 and 1999 is projected (based ED drug mentioned in Newark, San Fran- on 60 deaths in the first half). cisco, and Seattle (exhibit 1). In Baltimore, the proportion of heroin ED mentions Earlier 1997-98 data show four increases: equaled that of cocaine. Four other CEWG cities (mostly eastern) also had relatively Colorado: Narcotic-related deaths large proportions (1 1-19 percent) of heroin increased (from 98 to 135), continuing a ED total mentions: Boston Chicago, New 2-year trend. The 1998 opiate death total York, and Washington, DC. was the highest ever recorded in the State. During that time period, Baltimore continued Miami-Dade County: The number of to have the Nation’s highest rate of heroin heroin-induced deaths increased 3 0 ED mentions per 100,000 population percent (from 47 to 61). (290.0); Newark followed closely with 282.4 (exhibit 12). Minneapolis/St. Paul once San Francisco (FY data): Heroin-caused again had the lowest heroin rate. deaths increased 2 1 percent (from 107 to 130). Rates are higher than they were 7 years earlier in four out of five top-ranking cities Texas: Heroin/narcotic overdose deaths (exhibit 13). In Chicago, Newark, and increased 12 percent (from 333 to 374). Seattle, the rates have more than doubled since 1991; only in San Francisco, where In the first 9 months of 1998, 270 narcotics- rates have declined since 1993, is the rate caused deaths were reported in the Baltimore lower. metropolitan area. No comparison data were available. Between 1997 and 1998, heroin ED trends were mixed: mentions increased in 14 cities EMERGENCY DEPARTMENT and decreased in 6 (exhibit 14). Increases AND POISON CENTER DATA (ranging from 16 to 29 percent) were signi- ficant (p<0.05) in Miami, Newark, New Boston: “Heroin users remain at high Orleans, and Washington, DC. They were risk for overdoses. From March nonsignificant but substantial in St. Louis through May 1999, an emergency (where they have increased steadily since department reported 179 heroin- 1993) and Atlanta. Only in San Francisco related overdoses. did rates decrease significantly (1 3 percent); in Seattle, after the 1997 peak, they de- St. Louis: “While heroin users have a variety of medical consequences and creased notably but not significantly (1 7 need detoxification services, these percent). individuals do not seek services from the traditional medical model unless Heroin as a percentage of total ED mentions faced with life-threatening situations. ” remained relatively stable, except in Newark, where it continued to increase (4 percentage
CEWG December 1999 33 Executive Summary: Heroin
Exhibit 12. Estimated rate of heroin/morphineED mentions per 100,000 population by metropolitan area, 1998 Baltimore Newark Chicago San Francisco Seattle New York Philadelphia Boston Detroit New Orleans Phoenix San Diego Miami Denver Los Angeles St. Louis Washington, DC Dallas Atlanta Minneapolis/St. Paul All of United States 0 50 100 150 200 250 300 ED Mentions per 100,000 Population SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 1998 (July 1999 update)
Exhibit 13. 7-Year trends in heroin ED mentions per 100,000 population in the five cities with the highest mentions, 1991-98
ED Mentions per 100,000 Population
Baltimore Newark Chicago U San Francisco Seattle
200
150
100
50
0' I 1991 1992 1993 1994 1995 1996 1997 1998 Year SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 1998 (July 1999 update)
34 CEWG December 1999 Executive Summary: Heroin
Exhibit 14. Percentage of change in heroin ED mentions by metropolitan area, 1997 versus 1998
Seattle (N=2,922) -17 San Francisco (N=2,751) -13* Philadephia (N=3,817) -6 Detroit (N=3,046) -5 New York (N=9,491) I-3 Dallas (N=516) -1 Minneapolis (N=170) Los Angeles (N=2,532) Phoenix (N=832) Denver (N=476) Boston (N=2,517) San Diego (N=927) Chicago (N=8,633) Baltimore (N=5,873) 15 Newark (N=4,367) 16* Atlanta (N=400) 21 New Orleans (N=431) 24* Washington, DC (N=1691) 25* Miami (N=599) 29* St. Louis (N=472) I I I I 36 -40 -30 -20 -10 0 10 20 30 40 Percent of Decrease Percent of Increase NOTE: (N) refers to 1998 heroin mentions. *p<0.05
SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 1998 (July 1999 update) points between 1997 and 1998). Thus, both Massachusetts: The proportion of heroin- heroin proportions and numbers increased in related substance abuse calls was 21 Newark. percent in January-April 1999, compared with 23 percent in May-September 1999. The proportion of poison center calls regarding heroin in various parts of the TREATMENT DATA country remained relatively stable: Boston: "Heroin users leaving Colorado: The proportion of heroin- treatment are particularly at risk due related calls was 21 percent in 1994 and to their lowered tolerance for the 22 percent in 1998. drug. "
St. Louis: "Rapid detoxification, using Georgia: Opioid-related calls (1,7 19) naltrexone, is a new treatment option accounted for only 2 percent of toxic at private hospitals. Sources from exposure calls in 1998. this program state that calls regarding the treatment have increased in the
last year. "
35 Executive Summary: Heroin
particularly among younger injectors. The BEYOND THE CITY LIMITS... proportion of new study recruits reporting Baltimore: "While heroin has historically heroin as their primary injection drug dominated the Baltimore City treatment increased from 61 percent in 1994 to 86 system, in 3 of the 4 years from 1995 percent in 1999. Among injectors younger through 1998, it was the dominant than 20, the proportion reporting heroin primary drug in the suburban counties as increased from 78 to 100 percent in 1998. well. "
Newark: "Treatment data show Among Chicago infants tested for controlled continuing [and parallel] increases in the substances, opioid toxicity remained stable use of heroin in both the city and areas between 1997 and 1998 (9 percent positive). outside the city.
In the first half of 1999, heroin remained the Exhibit 15. Heroin as a proportion of primary drugs a number-one primary treatment drug in six of abuse among treatment admissions , first half 1999b CEWG cities: Baltimore, Boston, Los Angeles, Newark, New York City, and San 66 Francisco (exhibits 5 and 15). As a pro- portion of treatment admissions, it also accounted for a high percentage in San Francisco Bay Philadelphia, Seattle, and Washington, DC.
Between the first halves of 1998 and 1999, heroin as a proportion of treatment admis- sions decreased notably in three cities: Boston, Newark, and San Francisco (by 9, 12, and 13 percentage points, respectively). By contrast, in St. Louis, heroin increased 6 points to 18 percent of treatment admissions.
Though heroin remained stable as a primary Minneapolis/St. Paul drug among Denver admissions, the I I I proportion of new heroin users entering 0 20 40 60 80 treatment increased between 1995 and 1998 Percentage (from 15 to 20 percent). However, a slight aTotal admissions number excludes alcohol-only decline occurred during the first half of 1999 but includes alcohol-in-combination. b (to 17 percent). Reporting periods are January-June 1999, except for the following: January-June 1998 in Baltimore; July 1998-March 1999 in Boston; OTHER LOCAL DATA July-September 1999 in Los Angeles; full calendar year 1998 in Chicago; and FY 1999 in San Francisco. cAlcohol-only is not excluded. A study of Seattle area drug injectors suggests that heroin use increased in 1998, SOURCE: State drug abuse treatment agencies
36 CEWG December 1999 Executive Summary: Heroin
School survey data in various parts of the St. Louis: "Younger users report a United States show relatively low levels of fear of needles as the reason for alter- heroin use by youth: native methods of administration; the increased availability of consistent, higher purity heroin has led to a wider Chicago: Surveys conducted every 2 acceptance of the drug because nee- years indicate that heroin use is relatively dle administration is not necessary." rare among students: about 1.5 percent reported past-year use in 1997. Injecting remains the most common mode of administration among treatment admissions Massachusetts: 1996-97 data show that in the majority of reporting CEWG cities, heroin and other opiate use remains low with the highest percentages reported in the among adolescents and that students West, where lower purity black tar heroin perceive it as involving substantial risks. still predominates (exhibit 16).
USE PATTERNS Atlanta: "Heroin use remains compar- atively low, although intranasal admin- istration is becoming more prevalent,
Route of Administration especially among younger users. "
Miami: "New users, intranasal heroin BEYOND THE CITY LIMITS... snorters, are now those who most frequently appear to be in trouble with Chicago: "The high enrollment of that drug. " suburban youth in ...[a recently initiated prospective study of younger injectors in Texas: "While the number of indi- Chicago and its surrounding suburbs], viduals who inhale heroin is small, it is coupled with increasing heroin ED significant to note that their lag period admissions outside central city borders, in seeking treatment is 8 years rather indicate that heroin use, specifically by than 14 for injectors. This shorter lag injection, is no longer primarily an urban period suggests that contrary to street or inner-city phenomenon. " rumors that 'sniffing or inhaling is not addictive,' inhalers will need treatment much more quickly than needle Chicago: "Brown and black tar heroin users. " are typically sought only by those who inject, although reports indicate Snorting remains the most common route of that some users dissolve black tar administration for heroin in three cities: heroin and drip the solution into their Chicago, where heroin snorting admissions nostrils. " rose 90 percent between FYs 1993 and 1997; Newark, where, conversely, heroin Newark: "The substitution of snorting injection continues to show an upward trend for injection among heroin users is in recent years, especially among Hispanics believed to have resulted from and African-Americans; and New York City, improved heroin purity and the heavy where the upward trend in snorting contin- toll of AIDS among IDUs." ues. Notable increases in the proportion of treatment clients who snort heroin between Executive Summary: Heroin the first halves of 1998 and 1999 were remains low-0-3 percent in eastern and recorded in Atlanta (from 15 to 29 percent). midwestern cities and 4-10 percent in The percentage of treatment clients who western cities. In San Diego, the proportion snort also continues to rise in Philadelphia of heroin treatment clients who smoke (from 29 to 39 percent between the first doubled between the first halves of 1998 and halves of 1996 and 1999) and in Denver, 1999 (from 5 to 10 percent). where a small but steady upward trend of both snorters and smokers continues. In Route of administration often varies demo- Baltimore, the increase in heroin treatment graphically. In CEWG areas reporting on admissions between the two halves of 1998 age and route of administration among was driven primarily by an increase in clients treatment admissions, injectors tend to be snorting in both the city and suburban older than snorters. In Texas, for example, counties. where 93 percent of heroin clients inject, the average age of heroin injectors was 5 years older than those who snort (36 and 3 1 years, FROM SNORTING TO INJECTING? respectively). In Baltimore, the average age Boston: “Due to high heroin purity, of admission was 34 for injectors and 3 1 for snorting is the common starting route of snorters. In New York City, those who administration for new and younger inject are more likely to be older than those users. However, progression to injection who snort. is widely reported due to the increased effect from a given amount of heroin and the need to buy fewer bags to support Based on geographic location, route of
one’s habit. “ administration also tends to follow certain patterns along racial/ethnic lines. For ex- ample, in Baltimore, Texas, and Newark, African-Americans are more likely than other In St. Louis, the proportion of snorting groups to snort, while in New York City, declined while injecting increased (from 62 those who snort are more likely to be His- to 69 percent). Likewise, in Minneapolis/St. panic. A higher percentage of whites and Paul, injecting increased slightly (from 53 to Hispanics inject rather than snort in Texas; in 59 percent between 1997 and the first half of New York City, heroin injectors are more 1999), while snorting decreased. likely than snorters to be white.
Denver: “Reports suggest that smoking In both Baltimore and Texas, females are heroin enables users [especially younger more likely to snort than inject, and the users] to avoid the stigma and health risks proportions of males and females who snort associated with injecting. " are almost equal. In all reporting CEWG cities, the proportion of treatment clients who smoke heroin
38 CEWG December 1999 I
Executive Summary: Heroin
Exhibit 16. Snorting versus injectinga among heroin admissions, by percentage, in reporting CEWG areasb Snorting Injecting 75 Los Angeles 73 Texas Denver San Diego San Francisco Minneapolis/St.Paul St. Louis Atlanta Boston Minneapolis/St. Paul Philadelphia Baltimore New York City San Diego 2 Chicago San Francisco NR I I I Newark I 0 20 40 60 80 100 0 20 40 60 80 100 Percentage Percentage aSmoking and "other" routes of administration also account for small percentages in some areas. bReporting periods are January-June 1999, except for the following: January-June 1998 in Baltimore; July 1998-March 1999 in Boston; full calendar year 1998 in Chicago; July-September 1999 in Los Angeles; and FY 1999 in San Francisco.
SOURCE: State drug abuse treatment agencies
Multisubstance Use In Seattle, through mid-September 1999, multiple drugs were present in more than 80 Boston: "Focus group participants percent of the heroin-related deaths, with and treatment providers suggest that cocaine as the most common other drug, toxic additives to heroin (including suggesting speedball use. High proportions scopolamine and ketamine) and the of cocaine detected in heroin-related deaths co-occurring use of benzodiazepines, synthetic opiates, cocaine, and alcohol were also reported in Philadelphia during the may increase the risk of heroin first half of 1999, when it was detected in 43
overdose. " percent of heroin-positive decedents. In Minneapolis/St. Paul during the same time Chicago: "Recent field reports, espe- period, 3 of 17 heroin-related deaths in the cially from the South Side, indicated an increased use of heroin/cocaine first half of 1999 also involved methadone. combinations (speedball), now In Seattle, deaths caused by the combination
nicknamed ‘John Belushi, ‘and of of depressants (usually diazepam) and clonidine (Catapres) or amitriptyline heroin, first noted in 1998, continued in (Elavil) immediately after injecting 1999.
heroin (or methadone). " I
Executive Summary: Heroin
New York City: "Treatment programs ing an increased number of college
testing new admissions for heroin are students are using heroin. " sometimes finding drugs other than heroin. One program reports that Philadelphia: "For the seventh several recent admissions tested consecutive half- year, focus group positive for methadone and zidovudine participants reported that new users (AZT) (Retrovere). The newly admit- entering the prevalence pool are likely ted patients were surprised by the to be in their teens and male or female findings because they were certain in even proportions, and 1998-99 they were using heroin." groups reported they are likely to be white, African-American, or Hispanic In all CEWG areas reporting on polydrug in even proportions. " mentions among heroin treatment admissions in the first half of 1999, cocaine is the Age secondary drug most mentioned, except in Boston and Texas, where alcohol is the most Boston: "Most focus groups among mentioned secondary drug. Alcohol is the adolescents revealed relatively low awareness and use of heroin com- most common tertiary drug among heroin pared with marijuana, diverted admissions in all reporting CEWG areas prescription medications, LSD, or except Atlanta and Minneapolis/St. Paul, MDMA. However, anecdotal reports where marijuana is the most common tertiary suggest that heroin snorting has drug. The rate of polysubstance use among increased among high school youth. " primary heroin users in Boston was the highest for any primary drug, with 88 In CEWG areas reporting mortality demo- percent reporting the use of at least one graphics, heroin decedents were most often other illicit drug in the month prior to in their late thirties or forties. In Phila- admission. In Texas, 35 percent of primary delphia, the 25-and-younger age group was cocaine admissions in the first half of 1999 involved in 1 1 percent of heroin/morphine reported opiates as their secondary drug. detections in the first half of 1999, a decline from 23 percent during the previous half- In Baltimore, Boston, Chicago, New York year. In Texas, where heroin overdose City, Philadelphia, St. Louis, San Francisco, deaths have increased annually, the average and Seattle, IDUs reportedly continue to age of decedents dropped from nearly 40 in inject heroin and cocaine (speedballs). In 1997 to 37 in 1998. Chicago, pharmaceutical depressants are frequently combined with heroin. In Texas, The 35+ age group still accounts for the methylenedioxymethamphetamine (MDMA) highest percentage of heroin ED mentions in combined with heroin was reported. all cities, except in Phoenix where the 26-34 group (at 43 percent) is slightly larger than DEMOGRAPHIC DATA the 35+ age group (exhibit 17). High per- centages (>30 percent) are also recorded for the 26-34 group in six other cities (Balti- Denver: "Anecdotal information from local researchers corroborates treat- more, Boston, Chicago, Miami, Newark, and ment analyses, with reports suggest- Philadelphia). In three cities, the 18-25 group accounts for >20 percent (Dallas, Executive Summary: Heroin
New Orleans, and Philadelphia). The 12-17 period, heroin mentions among the 35+ age age group still accounts for 1 percent in all group declined significantly in only one city cities, except in Dallas, New Orleans, (San Francisco) and increased significantly in Philadelphia, and St. Louis, where that age seven (Dallas, Denver, Miami, Minneapolis/ group accounts for at least 2 percent of St. Paul, New Orleans, Phoenix, and heroin mentions. Heroin ED mentions in Washington, DC). that youngest group are a relatively new phenomenon, but they were recorded in Atlanta: "Treatment admission data more than half the CEWG cities in 1998. confirm ethnographic evidence of an emerging younger cohort of heroin users, many of whom are snorting the Heroin ED age distributions from 199 1 drug. In addition, a number of 'old through 1998 show generally steady declines dope fiends ' resumed their habit when in the 26-34 age group-possibly as that they got their hands on high-quality group has been transitioning into the next heroin. " age bracket. Also apparent is the emergence Boston: "Treatment providers report- of a younger cohort (1 8-25) in many cities. ed increases among heroin injectors in their late teens, and statewide data Increases in both number and proportion of show that from FY 7992 to the first heroin ED mentions involving those younger three quarters of 1999, primary heroin than 26 suggest that heroin consequences users rose from 4 percent of all among this group are growing. Between adolescent admissions to 13 percent. " 1996 and 1998, heroin ED mentions among the youngest age group (12-17 years) Similar to heroin ED mentions, in most increased significantly (p<0.05) in three cities reporting areas, the largest percentage of (Baltimore, Chicago, and Seattle); they did heroin primary treatment clients in the first not decline significantly in any city. During half of 1999 was 3 5 years or older, except in that same time period, heroin mentions Boston, where the 26-34 age group was among the 18-25 group increased signif- largest (exhibit 18). Large proportions (33- icantly (p<0.05) in 10 cities (Atlanta, 42 percent) of the 26-34 group were noted Baltimore, Dallas, Denver, Miami, Minne- in seven cities. The 18-25 group remains the apolis/St. Paul, New Orleans, Philadelphia, smallest group (next to the 17-and-younger Phoenix, and San Diego), and the proportion group, which ranges from 0 to 3 percent) in of that group among ED mentions increased most CEWG areas, with proportions among heroin admissions ranging from 2 percent in by 5 points in 4 cities. Conversely, signif- icant declines in heroin mentions among that Washington, DC, to 28 percent in Boston. age group were noted in two cities (Los Angeles and San Francisco). Between the first halves of 1998 and 1999, the 18-25 group among heroin treatment Heroin ED trends among the 26-34 age admissions increased notably 5 percentage group were mixed: mentions increased points) in Minneapolis/St. Paul and San significantly in Dallas, Miami, and New Diego. Proportions for this age group did Orleans; they declined significantly in New not decline in any cities, suggesting that this young cohort may be increasing. The 26-34 York and San Francisco. During that same group increased notably in Atlanta (by 18 Executive Summary: Heroin
percentage points). The 35+ age group stable in proportion, with an increase noted seeking heroin treatment remained relatively in Boston and a decline in Atlanta.
Exhibit 17. Age distribution of total Exhibit 18. Age distribution of primary heroin heroin ED mentions, by percentage, treatment admissions, by percentage, in in reporting CEWG areas, 1998 reporting CEWG areasa
Area 18-25 26-34 35+ Atlanta 14 b49 Baltimore Boston'
6 20 74
St. Paul I 19 33 47 ... 10 33 56 7 39 54 ... 34 59 St. Paul 16 "25 58 St. Louis
NOTE: Bolded areas reflect percentages that have St. Louis increased by percentage points since the previous reporting period. San Diego a San Francisco Reporting periods are January-June 1999, except for the following: January-June 1998 in Baltimore; Seattle July 1998-March 1999 in Boston; full calendar year Washington, DC < 1 74 1998 in Chicago; July-September 1999 in Los Angeles; and FY 1999 in San Francisco. b NOTES: " ...” denotes estimate does not meet Percentage has declined by points since the standard of precision or is less than 10 percent. previous reporting period. Bolded areas reflect percentages that have cAge categories are 19-29, 30-39, and 40+, increased by percentage points since 1996. dAge categories are <26, 26-35, and 36+. * eAge categories are 36 +. Percentage has declined by percentage points since 1996. SOURCE: State drug abuse treatment agencies
SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 1998 (July 1999 update) Executive Summary: Heroin
Paul (94 percent of opiate-related deaths in BEYOND THE CITY LIMITS ... the first,half of 1999); San Diego (92 percent Baltimore: "Both indicators and anec- of accidental heroin overdose deaths in the dotal evidence point to a substantial and first half of 1999); San Francisco (76 percent growing heroin problem among youth, of heroin-caused deaths in FY 1998); and particularly in the suburban counties Texas (80 percent of heroin overdose surrounding Baltimore City. " mentions in 1998). Boston: "Needle exchange contacts in Boston proper report mostly traditional, Males also outnumber females as a percent- older clients who have injected heroin for age of heroin ED mentions in all the CEWG many years, while exchanges in Cam- cities in DAWN, although the gender gap bridge and Northampton (in western seems to be narrowing. The male-female Massachusetts) have seen an increase in younger heroin injectors. Interviews with gender gap remains widest in New Orleans some of these injectors suggest that (83 versus 17 percent, although it seems to early onset of heroin use, sometimes in be narrowing) and remains narrowest in the midteens, is not uncommon. ” Chicago (58 versus 42 percent, where it continues to narrow). Chicago: "A recently initiated pros- pective study of younger injectors in Chicago and its surrounding suburbs Between 1997 and 1998, heroin mentions identified 715 drug injectors age 18-30. among females increased significantly Among these, heroin use is nearly (p<0.05) in seven cities; furthermore, the universal (99percent). ...nearly 40 proportion of females among heroin percent of the sample report a suburban mentions increased notably (>2 percentage residence, and suburban injectors are significantly more likely than urban points) in five cities. The greatest increases
respondents to be younger than 25. " in the proportion of females among heroin admissions occurred in Dallas and San Diego (by 6 and 12 percentage points, respec- In San Diego, anecdotal reports of adoles- tively). By contrast, the percentage of cent heroin use continue to surface, particu- females among heroin mentions declined larly in the north county area, but use was notably in only two cities, and heroin men- not reflected in the data sets reported. In tions among females declined significantly Boston, only 5 percent of the juveniles only in San Francisco. committed to the Department of Youth Services programs in 1998 reported lifetime Similarly, among treatment admissions, heroin use, compared with 21 percent for males outnumber females in every CEWG re- cocaine. porting area. Women had the largest repre- sentation in Phoenix, Chicago, Baltimore, Gender and Newark (46, 45,44, and 44 percent of heroin admissions, respectively) and the Males predominate in heroin mortality smallest representation in New Orleans (1 8 figures in all areas where such data are percent). Unlike gender distribution for ED available: Miami (91 percent of heroin- mentions between 1997 and 1998 (when the induced deaths in 1998); Minneapolis/St. proportion of females generally increased or Executive Summary: Heroin remained stable), females declined among induced deaths in 1998; African-Americans heroin treatment admissions in almost every and Hispanics accounted for 15 percent reporting area. The largest declines were in each. In Minneapolis/St. Paul, whites and New Orleans, St. Louis, and Philadelphia (by African-Americans constituted almost equal 13, 10, and 8 percentage points, respec- proportions of opiate-related deaths in the tively). first half of 1999 (53 and 47 percent, respectively). FEMALE ARRESTEES TEST OPIATE- POSITIVE AT HIGHER RATES THAN African-Americans, as a proportion of heroin MALES: A POSSIBLE EXPLA NA TION... ED mentions, were overrepresented in many CEWG areas in 1998. African-Americans Females might have higher opiate- were the largest ethnic/racial group in nine positive levels than males because they are more likely to be arrested on drug cities (Atlanta, Baltimore, Chicago, Detroit, and prostitution charges, categories that Newark, New Orleans, New York, St. Louis, historically are likely to be drug-positive. and Washington, DC); whites predominated in eight cities (Boston, Dallas, Denver, Miami, Minneapolis/St. Paul, Philadelphia, Women continue to appear more promi- Phoenix, and San Diego); and Hispanics nently in the ADAM data than in other were the largest group in Los Angeles. indicators: female arrestees tested higher for opiates than males in 10 of the 16 cities Heroin ED mentions involving Hispanics where female arrestees are tested (exhibit seems to be increasing in several cities: 19). Chicago had the highest proportion of significant increases (p<0.05) were noted in female arrestees testing opiate-positive (22 four cities (Boston, Denver, New York, and percent), followed by San Diego and Seattle Washington, DC); however, mentions (21 percent each). The gender gap was declined significantly in Seattle. Heroin ED largest in Minneapolis. mentions involving whites also increased significantly between 1997 and 1998 in six Race/Ethnicity cities (Boston, Chicago, Dallas, Denver, Miami, and San Diego) and declined Whites predominate in heroin mortality significantly in none. Heroin ED mentions figures in all areas where such data are involving African-Americans increased available, although African-Americans and significantly in five cities (Atlanta, Denver, Hispanics are overrepresented. In Texas in Miami, New Orleans, and Washington, DC) 1998, 55 percent of persons dying from and declined significantly in Phoenix. heroin use were white (a proportion that has been increasing over the years); 32 percent Among treatment admissions, whites were Hispanic; and 12 percent were African- predominate, but African-Americans and American. Whites were also the majority in Hispanics are often overrepresented. In the San Diego (72 percent of accidental heroin last reporting period, whites constituted the overdose deaths in the first half of 1999); highest proportion of heroin treatment Hispanics totaled 24 percent. In Miami, admissions in seven areas reporting whites constituted 7 1 percent of heroin- treatment demographics (Atlanta, Boston,
CEWG December 1999 Executive Summary: Heroin
Denver, Minneapolis/St. Paul, Phoenix, San Washington, DC (exhibit 19). Opiate- Diego, and San Francisco); African-her- positive levels in this population remained icans predominated in five areas (Baltimore, relatively stable between 1998 and the first Chicago, Newark, St. Louis, and Washing- half of 1999. Washington, DC, was an ton, DC); and Hispanics were the predom- exception: levels there increased during that inate group in three (Los Angeles, New period from less than 10 percent to 27 York City, and Texas). percent, although first-half- 1999 sample size was relatively small (N=37). According to Between the first halves of 1998 and 1999, the District of Columbia Pretrial Services African-Americans as a proportion of heroin Agency, opiate-positive levels for adult treatment admissions declined in eight arrestees remained stable between 1998 and reporting areas (Atlanta, Baltimore, Chicago, the first 10 months of 1999 (1 1 and 13 Los Angeles, Minneapolis/St. Paul, Newark, percent, respectively). San Diego, and Washington, DC); con- versely, they increased in three (Denver, St, Among female arrestees, opiate-positive Louis, and San Francisco). Whites as a screens remain low relative to those for proportion of heroin treatment admissions cocaine; however, in many CEWG sites in increased in five areas (Atlanta, Baltimore, Chicago, Denver, and Minneapolis/St. Paul) Exhibit 19. Percentage positive for opiates and declined in three (St. Louis, San Fran- among male and female booked arrestees, cisco, and Texas). Hispanics increased in first half 1999 (ranked by males) five areas (Denver, Los Angeles, New York Washington, DC 27 City, San Diego, and San Francisco) and NR Chicago declined in Minneapolis/St. Paul. Philadelphia Seattle LAW ENFORCEMENT DATA New Orleans New York Arrestee Data San Diego
Los Angeles: "Heroin use by juvenile San Antonio male arrestees, while still less than 1 Phoenix percent, is persistent; increased purity Houston may account for this persistence, Los Angeles allowing the drug to be snorted Atlanta 5 instead of injected. " Males Dallas 6 Females Opiate-positive screens among male arrestees remain low relative to those for
cocaine and marijuana. Among adult males, I I I I I I seven CEWG cities in the program, 0 5 10 15 20 25 30 ADAM Percentage Positive spanning all regions of the country, had levels of 10 percent or higher in the first half 'Females are not tested at this site. of 1999: Chicago, New Orleans, New York SOURCE: National Institute of Justice, November 1999 files, preliminary data City, Philadelphia, San Diego, Seattle, and
45 Executive Summary: Heroin the ADAM program, they almost equal Availability marijuana-positive levels. In the first half of 1999 among adult females, eight cities had BEYOND THE CITY LIMITS. .. opiate-positive levels higher than 10 percent: Chicago, Minneapolis, New York, Phoenix, Baltimore: "The city's open-air drug mar- Philadelphia, San Antonio, San Diego, and kets seem to be the source of much of Seattle. Between 1998 and the first half of the heroin used in suburban counties. " 1999, levels among females increased notably in four CEWG sites (Minneapolis, Chicago: "Younger IDUs use white New Orleans, Phoenix, and Seattle) and heroin most often, as it tends to be declined notably in two (Chicago and what they started out using. Brown is Detroit). more popular among some older addicts, who perceive it to have
higher purity. " Different types of law enforcement indicators show increases in various cities: St. Louis: "The DEA's Domestic Monitor Program (DMP) purchased Boston: Heroin arrests accounted for 23 equal quantities of heroin on both the north and south sides of the city, percent of all drug arrests in 1998-level indicating wider market availability." with the previous year, but substantially higher than the all-time low of 13 percent Washington, DC: "Ethnographic data in 1992. continue to show that, although police activity intermittently makes heroin New York: Numbers and trends in heroin procurement difficult, a steady supply is available in many sections of the arrests are similar to those involving District of Columbia. " cocaine: They peaked in 1995, declined slightly (7 percent) in 1997, but increased Washington, DC: "Users have 6 percent in 1998, surpassing the number recently reported using a variant called of cocaine arrests that year. 'bag delight' from New York City, which purportedly does not need to be heated in order to dissolve." San Francisco: Heroin-related arrests increased 10 percent between 1997 and Different types of heroin are available in the 1998 (to 7,214-the highest number in United States (exhibit 20). High-quality the past 6 years). white or yellow heroin from Colombia, South America (SA) dominates the east Seattle: Heroin-related convictions have coast market and has spread to cities in the continued to increase since 1996; the central U.S. region. Lower quality Mexican highest number of heroin convictions ever black tar and brown heroin predominate in is projected for 1999. the U.S. West and Southwest but are also available in the Midwest and have recently Heroin cases reported by Honolulu police increased in purity. Southeast Asian (SEA) remained stable between the first halves of and Southwest Asian (SWA) heroin 1998 and 1999. availability declined in recent years, but these varieties are still reported in some cities.
CEWG December 1999 Executive Summary: Heroin
For example, in Boston, small amounts of of 1999 (714 seizures). Heroin seizures in SWA and SEA are available, although most the first quarter of 1999 represented 12 heroin is SA; in Atlanta, most comes from percent of total drug seizures. SA followed by SEA; and in New Orleans, SA (yellow and white), SEA (white), and Price Mexican (brown and black tar) heroin are available. Various types of heroin, including Washington, DC: “In a neighborhood brown and black tar, are also available in in lower Northwest DC, ‘bone,‘ a Chicago, but white heroin is the most avail- putatively uncut heroin used primarily able and common for injectors and snorters for snorting, is sold in $20, $50, and $70 bags. ” alike. Exhibit 20 lists price information reported at Most heroin available in St. Louis is Mexican the local level. The prices reflect stable or dark brown or black tar and is of consistent declining trends in most reporting cities, quality. Likewise in Hawaii, where high except in Atlanta, where gram prices doubled purity black tar (67 percent pure) is readily since the last reporting period. Heroin prices available in all areas of the State. China appear to be declining in seven CEWG white is uncommon there, but present. reporting areas: Denver (gram prices declined at the lower level by one-half), Seizures and Submissions Honolulu (gram prices declined at the upper level), Los Angeles (gram prices declined), Information on heroin seizures and Minneapolis/St. Paul (gram and ounce prices submissions in reporting CEWG areas is were high but declined by one-half), south mixed: Florida (kilogram prices declined at the upper level), Texas (the highest ounce and Boston: Heroin submissions declined lowest kilogram prices for black tar from a relatively high 17 percent of all declined), and Washington, DC (upper-level drug samples analyzed in 1998 to 15 gram prices declined). percent during the first half of 1999. Heroin street prices range from $6 to $20 Miami: More than 80 heroin seizures per bag (in Boston, Chicago, New York were reported in the first half of 1999. City, Philadelphia, south Florida, and Washington, DC), per capsule (in St. Louis Newark: Heroin seizures appear to be and Texas), and per “bundle,” foil-packaged decreasing, based on comparisons be- 1/10 gram one-hits, (in St. Louis). A much tween the first 10 months of 1998 and higher price per dosage unit ($50) was 1999 (3,372 and 2,362 seizures, reported in Minneapolis/St. Paul, perhaps respectively). because high-purity heroin is only sporadically available. In New York City Washington, DC: Seizures appear to be and Washington, DC, dealers sometimes increasing from the 1997 and 1998 levels, offer promotions, such as three bags for the based on numbers from the first 9 months price of two or even one.
CEWG December 1999 47 r Executive Summary: Heroin
Purity creased notably (4-6 percentage points) in four other cities (Atlanta, Los Angeles, BEYOND THE CITY LIMITS... Newark, and New Orleans), and declined by at least 3 percentage points in eight cities Atlanta: "According to ethnographic (Baltimore, Denver, Houston, Miami, San information, heroin purity varies drasti- cally depending on geographic location. Francisco, Seattle, St. Louis, and Washing- Purity levels are dropping in a number of ton, DC), with particularly steep declines in inner-city neighborhoods with a long Denver and Houston (21 and 18 percentage history of heroin use, and purity in newer points, respectively). Purity levels remained areas is higher. The highest levels were relatively steady in all other cities. mentioned by young, new, female heroin
users residing in suburban areas. " Trafficking and Distribution
According to the DMP, street-level purity Increases in trafficking have been reported in remained highest in the Northeast (exhibit several CEWG reporting areas, including an 21). The highest average purity of all con- increase in Colombian heroin transshipped trolled heroin buys recorded in the first half thorough Texas to the northeastern United of 1999 was in Philadelphia, where purity States. Law enforcement officials in New increased 4.5 percentage points since 1998. Orleans have also noted an increase in heroin During the same time period, purity in- trafficking.
Exhibit 21. Average heroin price and purity per milligram In CEWG cities, first half 1999
Price Purity Philadelphia Newark New York Boston Atlanta San Diego Detroit New Orleans Los Angeles Phoenix Chicago San Francisco St. Louis Baltimore Washington, DC Denver Houston Seattle Dallas 4.1 9 Miami I 0 1 2 3 4 5 0 10 20 30 40 50 60 70 80 Dollars Percent
*Second-quarter-1999 data only
SOURCE: DEA Domestic Monitor Program, Intelligence Division, Domestic Unit, unpublished data for first half 1999
CEWGDecember 1999 49 Executive Summary: Heroin
South Florida's heroin epidemic is linked to In many cities, including St. Louis and the active marketing of Colombian heroin Boston, current heroin business is handled by that has been moving into south Florida since cellular phone. Some Boston police workers the beginning of this decade. credit the cellular phone and beeper industry with helping to reduce drug-related crime- In New York City, heroin continues to be buys arranged by beeper are usually consum- supplied by multiethnic organizations mated off the street, in stores, malls, homes, including Algerians, Chinese, Colombians, and cars, making turf wars and drug-related Dominicans, Lebanese, Nigerians, Pakistanis, street violence infrequent. Russians, and Sicilians. Heroin is readily available throughout New England, due to In St. Louis, most heroin distribution is its transportation from New York. handled by large networks, although some Dominican nationals dominate heroin independent entrepreneurs are also involved. trafficking in Boston, although smaller operations run by South and Central Philadelphia: "Autumn 1999 focus Americans, Nigerians, Asians, and local groups identified as still available 28 groups do exist. of the 34 brand names on retail-level heroin packaging that were noted by spring 1999groups, and 23 new Colombian traffickers have reportedly brands were mentioned by the fall established heroin labs in Mexico where they 1999groups. " are producing refined white heroin. Washington, DC: "A large array of Boston: "The increase in purity brand names along with the fairly high variability in the city may result in part grade of heroin suggests a consider- able amount competition among from poor batch mixing done in New of dealers in the open-air markets and no England by marginally trained workers shortage of supplies The variety of who receive bulk heroin from New .... brand names for sale includes 'keep it York. In earlier years, heroin was cool,' 'let's do it again, 'blue steel,' ba tched in small quantities by New 'me man, 13, ' 'silk,' and 'lynch York professionals prior to shipment. 'G- mob. ' Many of these heroin brands A local police contact speculated that are considered reasonably high local dealers would probably tighten quality. " the monitoring of batching, because they do not want to lose customers to
overdoses. " In Philadelphia, as in Washington, DC, dealers use brand names to maintain buyer New York City: "Street dealers tend affiliation and to indicate consistent potency to be young, in their late teens and of a specific brand of heroin. In Phoenix, early twenties, while buyers appear to be veteran users in their thirties or heroin dealers are also dealing in kilogram
older. " quantities of cocaine, and referring to the joint sale of "crack and black." Phoenix: 'A 300-percent increase in arrests for the possession of synthetic narcotics was reported between 1989 and 7998."
MORTALITY AND EMERGENCY significantly (p<0.05) in five cities (Denver, DEPARTMENT DATA Minneapolis/St. Paul, Phoenix, San Diego, and San Francisco); hydrocodone mentions Methadone continued to be the opiate other increased significantly in three (Chicago, than heroin most frequently reported by the Phoenix, and San Diego). No significant ME in Seattle, with methadone-related declines for these two drugs were recorded. deaths increasing from 17 in 1998 to 15 in the first three quarters of 1999. Five TREATMENT DATA fentanyl-related deaths were reported in Seattle in 1998 and two in the three quarters Other opiates as primary drugs of abuse of 1999. Propoxyphene (Darvon and account for relatively small proportions of Darvocet)-related deaths continued to treatment admissions. These proportions increase in Phoenix and San Diego; they have remained stable for most reporting peaked in 1997 in Philadelphia. Hydro- CEWG areas at percent of total drug codone (Vicodin, Hycodan, Lortab, and treatment admissions. NORC0)-related deaths also seem to be increasing in Phoenix, San Diego, and DEMOGRAPHIC DATA Philadelphia, where deaths rose from 6 in 1994 to 15 in 1998. Also in Philadelphia, During the first three quarters of 1999, oxycodone (Percodan and Percocet)-related nearly half of Seattle's other-opiate deaths increased between 1994 and 1998 decedents were female (48 percent), most (from 4 to 29). were white (91 percent), and the mean age was 42 years. First-half-year-1999 treatment Exhibit 22 lists the CEWG cities with the admissions for other opiates in New Orleans highest ED rates per 100,000 population in were most likely to involve white males (82 1998 for selected opiates: codeine, propoxy- percent); African-American males as a phene, oxycodone, and hydrocodone. Be- proportion increased since the last reporting tween 1997 and 1998, codeine ED mentions period, while white females declined. declined significantly (p<0.05) in seven Primary other-opiate admissions in Texas CEWG areas (Atlanta, Boston, Chicago, were more likely to be older than 40, white, Phoenix, St. Louis, San Francisco, and and female. Seattle) and increased only in New Orleans. During that same period, propoxyphene MARKET DATA AND mentions declined significantly in four cities USE PATTERNS (Dallas, New York, Philadelphia, and St. Louis) and increased significantly only in San Codeine Diego.
Between 1997 and 1998, oxycodone and Although ED data have recently declined in hydrocodone mentions rose in many CEWG many CEWG cities, codeine and codeine areas: oxycodone mentions increased products are still reported as commonly
CEWG December 1999 51 Executive Summary: Other Opiates
Exhibit 22. Cities with the highest rates of ED mentions per 100,000 population for four selected opiates, 1998 Codeine Propoxyphene Detroit 7.0
Minneapolis/St.Paul New Orleans 4.7
San Diego St. Louis
Oxycodone Hydrocodone Boston
Philadelphia New Orleans
Phoenix 5.0 San Diego 0 2 4 6 8 SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 1998 (July 1999 update) diverted pharmaceutical opiates in many Minneapolis/St. Paul and Washington, DC, areas, including New York City, Phoenix, heroin users continue to use it as a heroin and Texas. In Chicago, where codeine is substitute. In St. Louis, the drug is common used primarily among heroin addicts to among a small, chronic population of white moderate withdrawal symptoms, the abuse of addicts. The drug is preferred by many codeine in pill and syrup form has been Chicago IDUs, but its use has diminished relatively stable over the decade. On the considerably there since 1987 due to South Side, some dealers specialize in their decreased street availability. sale and pills cost $1-$3. Codeine cough syrup abuse is increasing in the Houston area Street prices are reported in several cities: among youth who use it as a primary drug $25-$35 for 4 milligrams and $7 for 1 and among adult polydrug users. Also in milligram on Chicago's North Side; $40-$80 Houston, the practice of dipping marijuana per capsule in Honolulu; $25-$35 per tablet joints in codeine cough syrup continues. In in Phoenix; $40-$70 per 4-milligram pill in Washington, DC, codeine combinations in St. Louis; and $20 per pill in lower north- pill form (Tylenol 3s and 4s) can be west Washington, DC. purchased near methadone clinics for $2 each. Opium
Hydromorphone (Dilaudid) U.S. Customs seized nearly 53,500 grams of raw opium in 1998 at the Seattle-Tacoma Hydromorphone is reportedly available in International Airport in mail parcels destined Atlanta, Chicago, Honolulu, Minneapolis/St. for Alaska. Another 13,273 grams were Paul, St. Louis, Texas (especially in the seized in the first three quarters of 1999 from Dallas area), and Washington, DC. In other ports-of-entry in mail parcels destined Executive Summary: Other Opiates for Washington State. Although in the early Methadone (Dolophine)—Methadone 1990s U.S. Customs routinely seized raw pills are sold near methadone clinics in opium destined for the Pacific Northwest, Washington, DC, for $10 per pill. They only one or two such cases per year were are also available in Chicago for $1 per reported from 1994 through 1997 (53 1 milligram and in New York City for $5 grams over the period). Continuing a pattern per pill. that began in the 1980s, packages containing opium were shipped from Southeast Asia to Nalbuphine (Nubain)—Nalbuphine is destinations within Southeast Asian com- reported to be widely abused in the New munities in the Minneapolis/St. Paul area. In Orleans nightclub scene by white male and one recent St. Paul case, law enforcement female, middle- to upper-class college recovered more than 1,000 grams of opium. students and by strippers. It is available in liquid form and is often injected. Other Abused Opiates Oxycodone (Percodan and Percocet)— Butorphanol tartrate (Stadol)—This Oxycodone is one of the most commonly opioid analgesic in nasal spray form is one diverted pharmaceutical opiates in several of the most commonly abused prescrip- cities, including Boston, New Orleans, tion drugs in Texas. Phoenix, and St. Louis. It is also available in Texas, in New York City for $5–$8 per Hydrocodone (Vicodin, Hycodan, pill, and near methadone clinics in Lortab, and NORCO)-Hydrocodone is Northwest Washington, DC, for $5 per reported to be one of the most commonly pill. diverted pharmaceutical opiates in several areas, including Boston, New York, New Propoxyphene (Darvon and Darvocet)— Orleans, and parts of Texas. Despite low Propoxyphene and its combinations are indicators in New Orleans, hydrocodone some of the most frequently abused and abuse and fraudulent prescriptions are up, diverted pharmaceutical opiates in according to law enforcement sources. Chicago, New Orleans, and New York An ethnographer reported that it is also a City, although according to ethnographic common prescriptive drug of abuse in San reports, availability has decreased recently Francisco, in Chicago. In New York City, it sells for $1–$2 per pill. Boston: "Surveys and focus groups indicate that its use among adolescents is common, approaching that of cigarettes among older students. Cannabis is perceived by youth and those in treatment as less harmful and more 'natural' than drugs such as cocaine, heroin, or LSD. ''
Chicago: "Field observations on the behaviors of blunt smokers have noted that some youth exhibit a lack of control over their marijuana use and express sentiments about 'kicking the habit' that are more typically associated with heroin and cocaine
dependence. "
Miami: "Both marijuana prices and potencies have increased over the decade, with both factors directed at an older market as prevention efforts focus on youth."
San Diego: "These statistics showcase the integrated efforts of public health and criminal justice agencies and underscore the Board of Supervisors' commitment to
treatment on demand for adolescents. "
EMERGENCY DEPARTMENT ficantly (>10 percent, p<0.05) in three cities DATA (Dallas, Philadelphia, and San Diego) and nonsignificantly in the majority of the other In 1998, marijuana accounted for substantial CEWG cities in DAWN (exhibit 25). The 10 percent) proportions of total ED men- increase in Dallas was particularly sharp. tions in 11 cities (Atlanta, Boston, Chicago, Declines (>10 percent) were reported in Dallas, Detroit, Los Angeles, Miami, New three cities, but only in New Orleans did Orleans, Philadelphia, St. Louis, and Wash- mentions decline significantly. ington, DC) (exhibit 1). At 9 percent of San Diego's ED mentions, marijuana slightly In many cities, reason-for-ED-contact data outranked cocaine and heroin (at 8 percent differ for marijuana versus other drugs. In each) as the leading illicit drug mention. New York, for example, patients involved in marijuana episodes cited chronic effects and Philadelphia has the Nation's highest estima- unexpected reaction almost equally as the ted rate of marijuana ED mentions per foremost reasons for contact; by contrast, for 100,000 population, followed by Detroit, other ED episodes, patients mainly reported New Orleans, and Atlanta (exhibit 23). seeking detoxification, followed by chronic Rates in those four cities, as elsewhere, have effects-unexpected reaction ranked a been escalating throughout the 1990s (ex- distant fourth. In San Diego, unexpected hibit 24). In Philadelphia, for example, the reaction has been declining over time, while 1998 rate is about seven times the 1991 rate. chronic effects as a reason for contact has been increasing for marijuana mentions. More recently, between 1997 and 1998, marijuana ED mentions increased signi- Executive Summary: Marijuana
Exhibit 23. Estimated rate of marijuana/hashish ED mentions per 100,000 population by metropolitan area, 1998
Philadelphia 112.1 Detroit New Orleans Atlanta Chicago Boston Baltimore Dallas Washington, DC Miami St. Louis Seattle San Diego New York Los Angeles Denver Phoenix Newark San Francisco Minneapolis/St. Paul All of United States
0 20 40 60 80 100 120 ED Mentions per 100,000 Population SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 1998 (July 1999 update)
TREATMENT DATA Among areas where comparison data were available between the first halves of 1998 and 1999, marijuana increased considerably BEYOND THE CITY LIMITS... as a percentage of treatment admissions in at Baltimore: "The proportion of marijuana least three cities: Atlanta (from 16 to 20 treatment admissions was higher in the percent), Denver (from 22 to 3 1 percent), suburban counties than in Baltimore and San Diego (from 13 to 18 percent). City. . . . " Percentages declined considerably, however, I in Chicago (from 18 to 14 percent) and New Primary marijuana abuse accounts for the top Orleans (from 30 to 26 percent), but the percentage of total admissions in Seattle and 1999 New Orleans level represented a return Denver (excluding alcohol-only) and in New to the 1997 level. In a local Miami treatment Orleans and Minneapolis/St. Paul (including facility, primary marijuana abusers increased alcohol-only) (exhibits 5 and 26). It also from 37 to 43 percent of admissions between accounts for substantial proportions of the first halves of 1998 and 1999. admissions percent) in Atlanta, Hawaii, Philadelphia, St. Louis, and Texas.
CEWGDecember 1999 55 I
Executive Summary: Marijuana
Exhibit 24. Annual trends in marijuana/hashish ED mentions per 100,000 population in four top-ranking cities, 1991-98
ED Mentions per 100,000 Population 120 100 80 60 40 20 I I 0 1991 1992 1993 1994 1995 1996 1997 1998 Year
SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 1998 (July 1999 update)
Exhibit 25. Percentage of change in marijuana/hashish ED mentions by metropolitan area, 1997 versus 1998
Seattle (N=936) Minneapolis (N=491) New Orleans (N=1,196) New York (N=3,684) Phoenix (N=726) I Washington, DC (N=2,362) San Francisco (N=394) Newark (N=532) 6 Baltimore (N=1 ,495) Miami (N=1,118) Chicago (N=5,002) 13 Denver (N=579) 15 San Diego (N=l , 127) 16* Detroit (N=4,335) Philadelphia (N=5,310) St. Louis (N=1,338) Boston (N=2,907) 64 Los Angeles (N=3,423) 64 Dallas (N=1,513) 65' Atlanta (N=2,633) 67 0 10 20 30 40 50 60 70 80 Percent of Decrease Percent of Increase NOTE: (N) refers to 1998 mentions.
*p<0.05
SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 1998 (July 1999 update) Executive Summary: Marijuana
increased from 5 percent of all admissions in EXPLANATION FOR AN INCREASE? 1991 to 19 percent in the first half of 1999. San Diego: "Increases are largely attributable to expansion of county- OTHER LOCAL DATA funded treatment slots for adolescents. " Local data sources around the country are mixed, some showing declines, others Despite the recent increase in Denver, a stabilization, and still others increases. Some leveling may be on the horizon: the pro- sources show small numbers, while large portion of new users entering treatment for numbers in other areas underscore the marijuana use increased from 199 1 through magnitude of the marijuana problem: 1994, when it peaked at 37 percent; how- ever, this proportion has steadily declined Boston: Between May and September since then to only 22 percent in the first half 1999, marijuana was mentioned in 5 of 1999. percent of all calls to the substance abuse hotline-level with the prior 5-month Longer term data reveal escalating or period. leveling trends throughout the 1990s. In Baltimore, for example, the marijuana Denver: Interestingly, marijuana calls to admission percentage increased steadily from the Rocky Mountain Poison and Drug 1992 through 1996, then remained relatively Center are nearly nonexistent (only one or stable through the first half of 1998. In New two per year from 1994 to 1998). York City, primary marijuana admissions
Exhibit 26. Marijuana as a proportion of primary drugs of abuse among treatment admissions (excluding alcohol-only) in five CEWG areas, January–June 1999
Minneapolis/St. Paul" Hawaii
Marijuana Cocaine Heroin Stimulants Other
*Alcohol-only is not excluded.
SOURCE: State drug abuse treatment agencies I
Executive Summary: Marijuana
New Jersey: In spring 1999, 7 percent of BEYOND THE CITY LIMITS... middle school students reported using marijuana in the past 30 days-down Baltimore: "Some 10 percent of county from 8 percent in 1995. The Newark admissions used other substances, pri- middle school survey of 1999 showed a marily hallucinogens and inhalants, com- similar drug use pattern as the State data. pared with 7 percent of city admissions. "
Chicago: Among infants (N=1,650) testing drug-positive, the percentage Marijuana itself is also commonly reported testing marijuana-positive has been as a secondary drug, particularly among pri- gradually increasing: 4 percent in 1995, mary stimulant abusers (as reported in 5 percent in 1996, 7 percent in 1997, and Atlanta, Baltimore, Denver, Los Angeles, 8 percent (n=13 1) in 1998. Minneapolis/St. Paul, St. Louis, and San Diego). It is also a common tertiary drug South Florida: Among the 2,962 toxi- among primary cocaine admissions (as in cology screens performed at a Broward Atlanta, Baltimore, Los Angeles, Minnea- County hospital during the first half of polis/St. Paul, New York City, St. Louis, 1999, 15 percent were positive for and Washington, DC). Less often, it is cannabinoids. Among those patients, reported as a tertiary drug by heroin admis- average age was 3 1.1, but 13 percent sions (as in Atlanta and Minneapolis/St. were teenagers and 47 percent were Paul). younger than 30. Boston: "Survey and focus group USE PATTERNS data indicate that.. .marijuana, often in the form of a blunt (hollowed-out cigar), is the drug of choice among Alcohol is the most common secondary drug young, inner-city crack sellers who of abuse among primary marijuana treatment would never use crack themselves. " admissions in the majority of areas reporting such data (Atlanta, Baltimore, Denver, Los Philadelphia: "For the last three half- Angeles, Minneapolis/St. Paul, New York years, focus group participants estimated the percentages of blunts City, St. Louis, San Diego, and Texas). that are smoked unlaced at 50, 60, and 60 percent. The autumn 1998 Cocaine, by far, is the most common tertiary and spring 1999 groups estimated drug (as reported in Atlanta, Baltimore, that about 20 percent of blunts are Denver, Los Angeles, Minneapolis/St. Paul, laced with PCP (called 'loveboat' or New York City, St. Louis, and Texas). 'wet'), while the autumn 1999 groups estimated a IO-percent level. The Some cities, however, are exceptions to this remaining blunts are laced with general pattern: in Newark, cocaine is the cocaine (called 'turbo'). " most common secondary drug, while alcohol is most common as a tertiary drug; in St. Louis: "This increase in marijuana Washington, DC, cocaine is the most use, which is viewed by young adults as acceptable, is particularly in combi- common secondary drug; and in San Diego, nation with alcohol." alcohol is the most common tertiary drug. Blunt usage continues to be reported in age groups predominate, by relatively several cities, including Boston, Chicago, narrow margins: young adults (age 18-25) and Philadelphia (“Phillies” or “L”).Blunts account for the largest proportion of men- have not yet appeared, however, in Hono- tions in 1 1 of the cities; and the oldest group lulu. Marijuana is increasingly used as a (age 35+) is largest in 8 cities. Only in delivery medium for other psychoactive Newark does the middle (26-34) group drugs. For example, in Chicago, blunts are predominate. often laced with either crack or PCP (“3750s”). Marijuana/crack combinations The youngest (12-1 7) group, while still are also reported in Boston, Minneapolis/St. substantially represented 10 percent of Paul (“fireweed”), and parts of Texas; and marijuana/PCP combinations are also re- ported in Minneapolis/St. Paul (“happy ARE YOUTH-TARGETED PREVENTION stick”), Philadelphia (“loveboat” or “wet’,), EFFORTS PA YING OFF? New York City, and St. Louis. In Philadelphia, blunts are also laced with Between 1996 and 1998, the proportion of 12-17 - year-olds among marijuana ED cocaine HCl (“turbo”). The marijuana/ mentions declined considerably in Dallas, cocaine combination is also reported in St. Denver, Los Angeles, Phoenix, San Louis, where treatment admissions also Diego, and Washington, DC—perhaps combine marijuana with methamphetamine, reflecting the success of prevention Marijuana/embalming fluid combinations are efforts in those areas. reported in Minneapolis/St. Paul (“wets” or Miami: “Both marijuana prices and “amp”), New York City (“duck foot,” which potencies have increased over the de- also includes the pesticide DDT), and parts cade, with both factors directed at an of Texas (where this combination also older market as prevention efforts focus includes PCP). In Texas, joints are also on youth. ” dipped in codeine cough syrup. San Diego: “. .. unlike primary cocaine, heroin, stimulant, or alcohol users, the DEMOGRAPHIC DATA marijuana user in treatment did not have a long history of use. Almost half (46 percent) were admitted to treatment within the first 3 years of use. These statistics showcase the integrated efforts Indicator data show signs of possible stabili- of public health and criminal justice zation in the number of youth initiating agencies and underscore the Board of marijuana use in several cities, suggesting Supervisors’ commitment to treatment on that youth-targeted prevention and treatment demand for adolescents. The board’s desire to get adolescents into treatment efforts might be paying off. In some cities, rapidly led to the Treatment on Demand however, increasing numbers suggest that and Delinquency Court initiatives. ” much work remains to be done.
Among marijuana ED mentions in 1998, all age groups are represented fairly substan- tially (exhibit 27). However, two of the four Executive Summary: Marijuana marijuana ED mentions in 17 of the 20 Exhibit 27. Age distribution of cities), declined considerably in proportion marijuana ED mentions, by percentage, between 1996 and 1998 5 percentage in reporting CEWG cities, 1998 points) in 6 cities (Dallas, Denver, Los Angeles, Phoenix, San Diego, and Wash- Area 12-17 18-25 26-34 35+ ington, DC). Percentage increases (>5 26 31 32 points), however, were recorded for youth in two cities: Newark and San Francisco. Chicago Nevertheless, it was the oldest (35+) group Dallas that showed the most widespread increases: their representation increased somewhat (2-1 5 percentage points) in 15 of the 20 CEWG cities in DAWN, with 7 of those Miami increases fairly substantial 5 points in Denver, Los Angeles, Miami, Phoenix, San St. Paul Diego, Seattle, and Washington, DC). Many of those increases correspond to slight New Orleans declines in the 26-34 group, suggesting an aging older cohort, distinct from the cohort I I of young adults. San Francisco was the only city where the 35+ group declined substan- 37 tially (6 percentage points). St. Louis --- 26 27 31 HSan Diego 16 29 24 30 Younger users are more represented in San Francisco treatment data than in ED figures (exhibit Seattle 28). The youngest age group (I 17) Washington, DC 14 33 accounted for the highest percentages among admissions for primary marijuana use in at NOTE: Bolded areas reflect percentages that have least 8 of the 14 areas where data were increased by points since 1996. available (Baltimore, Chicago, Los Angeles, SOURCE: Office of Applied Studies, SAMHSA, Minneapolis/St. Paul, Newark, San Diego, Drug Abuse Warning Network, 1998 (July 1999 Seattle, and Texas); young adults (18-25) update) predominated in 4 of the areas (Atlanta, New York City, St. Louis, and Washington, DC); A few notable shifts (25 percentage points and the oldest group (35+) was modal in ±) in treatment age distributions were Denver-but only by 1 percentage point reported since the same reporting period 1 more than the two youngest groups, which year earlier: the youngest 17) group accounted for 27 percent each of that city’s declined as a percentage of marijuana marijuana admissions. admissions in three cities (Atlanta, Denver, and Washington, DC) and increased in only Executive Summary: Marijuana
Exhibit 28. Age distribution of primary DC); the 26-34 group remained relatively marijuana admissions, by percentage, stable, except for an increase in Newark; and in reporting CEWG areas, the oldest (35+) group also remained January-June 1999a relatively stable, except for an increase in Denver.
In all four cities where ADAM tested Atlanta 45 28 18 juvenile arrestees—Denver, Phoenix, San Baltimore 32 11 8 Antonio, and San Diego-the percentage testing positive for marijuana in the first half of 1999 was substantially greater (1 1-20 percentage points) than in the adult popula- Los Angeles tion (exhibit 29). Washington, DC, juvenile Minneapolis/ arrestees tested at an even higher level (64 St. Paul percent) than their ADAM counterparts, Newark according to local urinalysis data. Positive New York City' findings among juveniles in all five cities remained relatively stable compared with St. Louis 1998 levels. San Diego San Francisco More than one-third (35 percent) of New York City's 42,030 cannabis-involved arrests Seattle in 1998 involved 16-20-year-olds. A review of juvenile arrests in San Diego for 1990 Washington, through 1998 shows a 43-percent decline in DC felony arrests but a 258-percent increase in misdemeanor arrests for marijuana. NOTE: Bolded areas reflect percentages that have increased by points since the reporting Exhibit 29. Percentage positive for marijuana period 1 year earlier. among adult and juvenile male booked arrestees, first half 1999 aReporting periods are January-June 1999, except Percent Positive for the following: January-June 1998 in Baltimore; Adult males July 1998-March 1999 in Boston; July-September Juvenile males 62 1999 in Los Angeles; full calendar year 1998 in 60 Chicago; and FY 1999 in San Francisco. bPercentage declined 5 points since the reporting period 1 year earlier. 'Age groups reported are < 17, 17-25, 26-35, and 36 +. 20 SOURCE: State drug abuse treatment agencies 10
Diego Denver one (San Diego); the young adult (1 8-25) San Antonio Phoenix group similarly declined in three cities City (Denver, Newark, and San Diego) and SOURCE: National Institute of Justice, Arrestee Drug Abuse Monitoring program, November 1999 increased in two (Atlanta and Washington, files, preliminary data Executive Summary: Marijuana
Gender Race/Ethnicity
In all CEWG cities in DAWN, males consis- Among 1998 marijuana ED mentions, whites tently outnumber females, accounting for 60 and African-Americans each predominated in percent or more of total marijuana ED half of the 18 CEWG cities where sufficient mentions. Boston continues to have the data were collected to warrant analysis. highest representation of females (39 per- African-Americans accounted for the major- cent), while San Francisco has the lowest (19 ity in seven cities (Atlanta, Detroit, Newark, percent). Between 1997 and 1998, females New Orleans, New York, Philadelphia, and increased slightly (3-4 points) as a per- Washington, DC) and were the modal group centage of marijuana ED mentions in eight in two (Chicago and Los Angeles). In the cities (Baltimore, Detroit, Minneapolis/ remaining cities, whites were the majority St. Paul, New York, Phoenix, San Diego, group in five (Baltimore, Boston, Dallas, Seattle, and Washington, DC) and declined Minneapolis/St. Paul, and San Diego) and (3-7 points) in three (Newark, St. Louis, and the modal group in four (Denver, Miami, San Francisco). Phoenix, and San Francisco). Hispanics constituted considerable proportions (220 Males also account for the vast majority of percent) in four cities (Denver, Los Angeles, treatment admissions for primary marijuana New York, and Phoenix). use: in all 15 areas where data were avail- able, females accounted for only 29 percent or less of marijuana admissions. The gender Exhibit 30. Percentage positive for marijuana among male and female booked arrestees, gap was widest in Washington, DC (where first half 1999 (ranked by males) 14 percent were female) and narrowest in San Francisco (where 29 percent were Washington, DC' female). Since the same reporting period 1 Detroit Atlanta year earlier, the percentage who were female Denver increased notably in Atlanta (from 2 1 to 28 Minneapolis Dallas percent) and Newark (from 15 to 20 Philadelphia percent) and declined in Denver (from 29 to Chicago 22 percent). New York Seattle New Orleans In the first half of 1999, male arrestees tested Miami* marijuana-positive at higher levels than their San Antonio Houston female counterparts in every CEWG city in San Diego the ADAM program (exhibit 30). Wash- Los Angeles ington, DC, had the highest percentage of Phoenix males testing positive, and Phoenix had the 0 10 20 30 40 50 60 Percentage Positive lowest. Among cities where females were tested, the highest positive level was in Den- *Females are not tested at these sites. ver and the lowest in Detroit. SOURCE: National Institute of Justice, November 1999 files, preliminary data Executive Summary: Marijuana
Between 1997 and 1998, white representa- breakdown of the marijuana admissions tion among marijuana ED mentions increased approaches that of the underlying popula- substantially in four cities: Dallas (from 50 tion; in other cities, such as San Diego, to 56 percent), New Orleans (from 38 to 43 African-Americans and Hispanics are re- percent), San Diego (from 53 to 65 percent), portedly overrepresented. and San Francisco (from 36 to 44 percent), Conversely, percentages for whites declined Philadelphia: "[Focus group partici- in another four cities: Los Angeles (from 33 pants/ reported that Asians entered to 23 percent), Philadelphia (from 45 to 40 the blunt scene in late 1997 and now constitute an estimated 5-10 percent percent), Phoenix (from 58 to 49 percent), of blunt smokers." and Washington, DC (from 29 to 23 percent). Correspondingly, for African- Since the same reporting period 1 year Americans, percentages increased notably in earlier, racial/ethnic marijuana treatment four cities: Atlanta (from 41 to 5 1 percent), distributions remained relatively stable, with Los Angeles (from 34 to 49 percent), a few exceptions: Hispanic representation Philadelphia (from 47 to 53 percent), and increased in Denver (from 32 to 39 percent) Washington, DC (from 50 to 58 percent). and San Diego (from 28 to 33 percent), And, by contrast, African-American while whites declined in San Diego (from 48 representation declined in three: Chicago to 39 percent). (from 50 to 42 percent), Detroit (from 71 to 64 percent), and New Orleans (from 61 to Racial distribution of felony marijuana 55 percent). Hispanic representation convictions in Seattle more closely parallels remained relatively stable in most areas: the population statistics than does the racial largest shifts were a decline in Los Angeles distribution of heroin convictions. In San (from 28 to 23 percent) and an increase in Francisco, Mexican nationals were involved Denver (from 16 to 20 percent). in about 75 percent of arrests during a major seizure of marijuana plants. As is the case with ED mentions, no one racial/ethnic group predominates in treat- LAW ENFORCEMENT DATA ment admission figures. Whites account for the majority in Atlanta, Baltimore, Chicago, Denver, Minneapolis/St. Paul, and Seattle; Arrestee Data and they are the modal group in San Diego, San Francisco, and Texas. African- In the first half of 1999, marijuana was the Americans account for the majority in most frequently detected drug among adult Newark, New York City, St. Louis, and male arrestees in 11 of the 18 CEWG cities Washington, DC, and they are the modal in the ADAM program (Chicago, Dallas, group in Boston. Hispanics are the modal Denver, Detroit, Houston, Minneapolis, group in Los Angeles, and they account for Philadelphia, Phoenix, San Antonio, Seattle, substantial proportions (>20 percent) in and Washington, DC), and it equaled cocaine Boston, Denver, Newark, New York City, in Los Angeles. These findings ranged from San Diego, San Francisco, and Texas. In a low of 32 percent of male arrestees testing many cities, such as Baltimore, the racial positive in Phoenix to a 5 1- percent high in Executive Summary: Marijuana
Washington, DC (exhibit 30). Among Market Data females, positive findings ranged from 15 percent in San Antonio to 36 percent in Denver: "Users report that the Denver. San Diego was the only city where manipulation of plant genetics is a marijuana was the most frequently detected contributing factor to recent increases drug among females (at 29 percent). in potency. They describe powerful narcotic-like effects from smoking
small quantities of marijuana. " Compared with 1998 levels, percentages of males testing marijuana-positive in the first New York City: "The Street Studies half of 1999 increased substantially in four Unit (SSU) reports that marijuana cities: Atlanta (20 percentage points), Los remains the most sought-after illegal Angeles (9 points), Miami (10 points), and substance in the metropolitan area, and it continues to grow in popularity Washington, DC (13 points). Levels re- and availability. " mained relatively stable elsewhere, with no notable declines reported. Similarly, among Seattle: "The availability of very high- female arrestees, positive findings increased grade Canadian marijauna ("BC bud") in four cities: Chicago (7 percentage points), is in dispute among users on the street: some report that it is widely Denver (6 points), Minneapolis (8 points), available, but most say it is not." and New Orleans (5 points). Only in Seattle did marijuana-positive levels decline substan- Marijuana is readily available in most parts of tially among females (7 percentage points). the country. For example, in Atlanta, where tetrahydrocannabinol (THC) levels increased Despite the decriminalization of possessing from 3.3 percent to 1 1.37 percent between small amounts of marijuana in New York 1984 and 1999, the DEA reports marijuana City, cannabis-involved arrests increased as the most prevalent drug of abuse. The almost ninefold between 1991 and 1998, drug is also readily available in south Florida, with a 53-percent increase between 1997 and where average THC levels since the 1980s 1998 (to a record number). In Boston, the have increased from 1.8 percent to 4.6 per- proportion of arrests for marijuana-mostly cent and, for sinsemilla, from 6 percent to for small quantities and involving juveniles 12-20 percent. Availability is also constant and young adults-rose from 21 percent of in Denver, despite seasonal fluctuations in all drug arrests in 1996 to 26 percent in the quality of marijuana produced by local 1997, but then stayed level in 1998. Mari- cultivators. The abundance and popularity juana possession arrests more than doubled of marijuana across Chicago has led to an in Phoenix between 1989 and 1998 and, as a increased array of varieties and prices in that percentage of total arrests, increased from 5 1 city. to 58 percent. In San Francisco, marijuana- related arrests have varied between 2,000 Exhibit 3 1 presents available marijuana price and 2,400 per year since 1993, with no par- data in CEWG areas. These prices reflect ticular upward or downward trend. And, in stable levels in many cities, including Boston Washington, DC, arrests for sale or posses- (since the previous 6-month period), Denver sion declined slightly between 1997 and (pound prices), Miami, New Orleans (for the 1998, past 2 years), and San Diego (where purity is Executive Summary: Marijuana also stable). Prices have risen slightly in noticeable increase in the number of Phoenix due to the arrival of fresh crops bodegas, candy stores, and health from Mexico. By contrast, Seattle marijuana food stores selling marijuana. ” prices have followed the downward trend seen for both heroin and cocaine prices, but The size of local growing operations has increased in Massachusetts, but most have not been nearly as pronounced. Washington, DC, pound prices declined for cannabis in Boston is shipped from States Mexican and Jamaican marijuana but in- such as Arizona, California, and Texas, as creased for sinsemilla. Prices in Texas well as from Jamaica and Colombia. Mexico remains a primary supplier for Atlanta, with fluctuate depending on quality, quantity, foreign sources transporting marijuana demand, and availability. through interstate highways along with shipments of cocaine and methamphetamine; Seizures however, local Georgia counties are also a source for domestic grade marijuana. Simi- About 240,000 plants were seized in the San larly, in south Florida, marijuana is both Francisco area in 1998, nearly two-thirds of imported and domestically grown (often which were being grown on National Forest hydroponically in sophisticated fully lands. Multipound to multiton seizures are automatic indoor operations). commonplace in Texas. In Seattle, cannabis seizures increased sharply between 1997 and Similar reports emanate from western cities: 1998, but then declined in 1999 (through Denver’s marijuana is both locally grown and October), both in number and average imported from other States and Mexico, and weight (to 43 1 seizures averaging 5.6 Seattle’s most commonly found marijuana pounds, compared with 853 seizures aver- continues to be either high-grade locally aging 34 pounds in 1998). In Boston, grown (indoor) sinsemilla or indica or a low- marijuana submissions for lab analysis rose grade commercially grown product from the steadily from 1992 through 1998, but have southwestern United States or Mexico. stayed level in the first half of 1999 at 35 percent of all drugs analyzed-highest for In the Midwest, indoor production is the any drug, above that for cocaine (32 percent) primary growing method in the St. Louis and heroin (1 5 percent). In Washington, area, with much of the Missouri-grown DC, seizures increased between 1998 and marijuana shipped out of State. 1999 (to 1,966 seizures, totaling more than 76 kilograms during the first 9 months), Distribution patterns vary from city to city. In Washington, DC, for example, street sales Cultivation and Trafficking take place throughout the city, particularly in and around open-air drug markets. By Boston: “Good profit margins and contrast, in Seattle, marijuana is not readily relatively weak penalties are available as a street drug (unlike most other incentives to traffic in marijuana, illicit drugs in the area); rather, the main according to police contacts. ” venues for sale (especially for higher grades) New York City: “Even in the past are known as “house connections” or select several months, there has been a coffeehouses and bars.
65 Executive Summary: Marijuana
Exhibit 31. Marijuana prices and purity in reporting CEWG cities, December 1999 reporting period
Price/Unit City Source/Quality Ounce Pound Sinsemilla $160-$250 $1,000-$2,000 Domestic $120-$240 $1,200 Commercial grade $75-$300 $1,000-$3,000 Sinsemilla $200-$500 $1,000-$3,000 type unspecified $100-$200 $1,000-$4,000 Sinsemilla NR $2,500-$4,000 Colombian NR $1,800-$2,000 Mexican NR $ 900-$ 1,200 Denver Commercial grade NR $800-$1,200 Sinsemilla $1,500-$3,200 Honolulu "Low quality" $250-$500 NR (type unspecified) NR $6,000-$9,000 "High quality" $400-$800 NR Sinsemilla (25-30%THC) $ IO-$80 $300-$6,000 Miami Commercial grade ("regs") NR $800-$1,000 Hydroponic ("crippy") $600+ $2,000-$4,000 I Minneapolis/ NR $250 $800-$850
NR $25-$ 160 $750-$1,000 New York City NR NR $300-$2,400 "Good-quality commercial" $2,000-$4,000 I NR $75-$150 $500-$750 San Diego Commercial grade $50-$75 $400-$600 Sinsemilla (8-16% THC) $200-$400 NR San Francisco NR NR $2,800 Sinsemilla $325-$400 $4,000-$5,200 Texas NR $35-$60 South $500-$850 $400-$700 Washington, DC Mexican or Jamaican $80-$300 $600-$1,300 Sinsemilla $1 50-$500 $4,500 a$2,000/kilogram b$6,000-$8,000/kilogram
SOURCE: CEWG city reports, December 1999 Boston: "For reasons most likely related to the entrenched tradition of cocaine and heroin trafficking, as well as a lack of local manufacture, methamphetamine has not become a significant factor in the street drug scene.... Meth ylenedioxymetham- phetamine (MDMA), gamma-h ydroxybutyrate, ketamine, and crystal methamphet- amine continue to be reported in the club and rave scenes. MDMA in particular has rapidly increased in popularity among youth."
Denver: "The substantial decrease in the quality and potency of methamphetamine may be diminishing drug-related consequences and subsequent treatment and ED admissions. Also, users could be switching to increasingly available and high-quality
cocaine. "
Minneapolis/St. Paul: "Despite significant state wide increases in law enforcement indicators, availability, and clandestine methamphetamine labs, other indicators
declined in the metropolitan area. "
San Francisco: "Ethnographic observers note less use of speed, especially among young people who now appear to prefer heroin. Use remains concentrated among gay men and (to a lesser extent) lesbians.. .. To summarize, admissions and arrests are up, deaths and ED mentions are down, and ethnographic observers believe there
is less use. "
MORTALITY DATA totaling six in 1998 and nine in the first half of 1999. Similarly, stimulant mortality Methamphetamine-related deaths remain re- figures are on a projected course to increase latively few. in three other cities during that time period (based on 1998 versus partial-1999 data): Using 1998 and partial- 1999 data, stimulant mortality projections suggest declines in two Honolulu: Methamphetamine-related of six CEWG areas where data were avail- deaths totaled 27 in 1998 and 17 in the able: first half of 1999.
Minneapolis/St. Paul: Methamphetamine- Phoenix: Methamphetamine-related related deaths appear to be declining deaths totaled 5 1 in 1998 and 36 in the (from eight to two). first half of 1999. San Diego: After an all-time high in .Seattle: Amphetamine/methamphetamine 1997, methamphetamine-related overdose toxicology reports totaled three in 1998 deaths seem to be declining for the second and nine through the third quarter of year in a row, from 52 in 1998 to a pro- 1999. jected 26 in 1999 (based on first-half-year data), the lowest level since 1992. Earlier 1997-98 data showed stable or upward trends: By contrast, methamphetamine toxicology reports have increased in Philadelphia, Colorado: Amphetamine-related deaths remained stable (five in each year). Executive Summary: Stimulants
San Francisco County: Amphetamine- Between 1997 and 1998, methamphetamine caused deaths increased 23 percent (from ED mentions declined significantly (p<0.05) 22 in FY 1997 to 27 in FY 1998), but are in six western cities: Denver, Los Angeles, still well below the 1995 peak (40 deaths), Phoenix, San Diego, San Francisco, and Seattle; mentions declined nonsignificantly Texas: Methamphetamine/amphetamine- but notably (>20 percent) in Atlanta, related deaths increased 18 percent (from Minneapolis/St. Paul, and Philadelphia 17 to 20). (exhibit 33). Conversely, methamphetamine rates increased significantly in two cities EMERGENCY DEPARTMENT (Dallas and Miami), and nonsignificantly in AND POISON CENTER DATA two cities (Chicago and New York).
Boston: “Although MDMA has not Recent declines in western areas follow shown up in treatment or ED generally downward trends (exhibit 34). indicators, other sources suggest a However, since 199 1, methamphetamine ED rapid increase in its use, especially rates increased in Los Angeles, Phoenix, San among high school youth. ” Diego, and Seattle; they declined in San Francisco. In these cities, methamphetamine The highest proportions of methampheta- ED rates peaked in 1993 or 1994, except in mine per total ED mentions in 1998 were in Seattle, where rates peaked in 1997. The western U.S. cities: Los Angeles, Phoenix, most recent rates represent an 8-year low for San Diego, and San Francisco (3, 4, 6, and 5 San Francisco, a 7-year low for Los Angeles, percent, respectively) (exhibit 1). These and a 5-year low for Phoenix. percentages remained relatively stable or declined slightly from 1997 proportions. In Colorado, amphetamine-related poison calls fluctuated between 1994 and 1997 In 1998, among CEWG cities in DAWN, (ranging from 16 to 38 calls), but in 1998, Phoenix, San Diego, and San Francisco had such calls dropped to 11; MDMA-related not only the highest methamphetamine-per- calls totaled 5 in 1998, a slight decline from total-ED-mention proportions, but also the 7 calls in both 1996 and 1997. In Boston, highest methamphetamine ED rates per MDMA poison calls are increasing, and 100,000 population (exhibit 32). prescriptive amphetamines (Adderall) and methylphenidate (Ritalin) have figured Four other western cities followed: Dallas, prominently in calls. Also in Boston, poison Denver, Los Angeles, and Seattle. Atlanta centers reported two calls related to khat, a had the highest methamphetamine ED rate leafy plant used for its stimulant properties. among eastern cities (5.9); Minneapolis/St. Paul had the highest among central cities (4.7). New York and Washington, DC, had the lowest rates.
68 CEWG December 1999 Executive Summary: Stimulants
Exhibit 32. Estimated rate of methamphetamine ED mentions per 100,000 population by metropolitan area, 1998
San Francisco 38.7
Minneapolis/St. Paul
New York 0.4 Washington, DC 0.4 All of United States I I I I I I I 0 5 10 15 20 25 30 35 40 ED Mentions per 100,000 Population
SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 1998 (July 1999 update)
TREATMENT DATA the largest decline (8 percentage points). Stimulant admission proportions remained Chicago: “Youth treatment providers low and stable in other areas of the country reported more [MDMA] use among (exhibit 35). their clients. ” In addition to declining in proportions, Honolulu: “This situation [extremely stimulant admissions declined in number in high methamphetamine treatment admissions] has so far outstripped the treatment system’s capacity that even BEYOND THE CITY LIMITS people who might want treatment ... would not be likely to receive it in a St. Louis: “In rural areas, methamphet- timely manner. ” amine is appearing in treatment data.. . . While the numbers are still relatively low Stimulants continued to account for the in rural programs, methamphetamine is largest percentage of all treatment admis- the drug of choice after alcohol.” sions in Hawaii and San Diego (exhibit 5). Although the proportion of stimulant Seattle: “[State wide treatmen t] data admissions in western U. S. cities generally suggest that methamphetamine clearly has continued to be a problem in rural increased this decade, between the first eastern and southern Washington and halves of 1998 and 1999, all reporting Puget Sound outside of Seattle and King western cities showed declines in stimulant Co un t y. ” admission proportions. San Diego showed Executive Summary: Stimulants
Exhibit 33. Percentage of change in methamphetamine ED mentions by metropolitan area, 1997 versus 1998
Denver (N=120) Philadelphia (N=48) Minneapolis/St. Paul (N=112) Seattle (N=266) Phoenix (N=446) San Francisco (N=616) Los Angeles (N=786) San (N=721) Atlanta (N=162) New Orleans (N=25) St. Louis (N=66) New York (N=36) 13 Chicago (N=33) 14 Dallas (N=186) 17* Miami (N=16) 60* -60 -40 -20 0 20 40 60 Percent of Decrease Percent of Increase
NOTE: (N) refers to 1998 mentions. *p<0.05 SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 1998 (July 1999 update)
Exhibit 34. 7-year trends in methamphetamine ED mentions per 100,000 population in the five cities with the highest mentions, 1991-98
ED Mentions per 100,000 Population 140
120
100 Seattle 80
60
40
20
0 1991 1992 1993 1994 1995 1996 1997 1998 Year SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network (July 1999 update)
70 CEWG December 1999 Executive Summary: Stimulants several areas: Minneapolis/St. Paul (between increased 19 percent during that same time the first halves of 1998 and 1999, from 358 period. In St. Louis, stimulant admissions to 175 clients); San Diego (between 1998 increased between the first halves of 1998 and 1999, from 4,413 to an estimated and 1999 (from 90 to 114). Stimulant 4,024); Texas (between the first halves of treatment admissions in Hawaii remained 1998 and 1999, from 964 to 772); and high in the first half of 1999 (889), increasing Denver (between first halves 1998 and 1999, 22 percent since the first half of 1998. In from 1,101 to 765). Denver, the proportion of new stimulant treatment admissions declined from a 1997 Conversely, although the proportion of peak (from 3 1 to 17 percent) in the first half stimulant treatment admissions declined by 1 of 1999. Chicago's few treatment admissions percentage point in San Francisco between for primary stimulant dependence have FYs 1997 and 1998, the total number historically been abusers of over-the-counter preparations containing caffeine, ephedrine, EXPLANA TIONS FOR LOW METHAM- or phenylpropanolamine. PHETAMINE INDICA TOR NUMBERS...
Minneapolis/St. Paul: "Methamphet- Exhibit 35. Stimulants as a proportion of primary amine can produce addiction; very long, drugs of abuse among treatment admissionsa, extended periods of sleep and food first half 1999b deprivations; marked visual and auditory distortions; and in some cases, paranoid San 38 delusions. For these reasons, metham- phetamine addicts sometimes initially appear for treatment at mental health San Francisco centers or psychiatric units instead of substance abuse treatment centers. " Seattle
Washington, DC: "Although regular use [of methamphetamine] appears to have Los Angeles 7 deleterious consequences, intermittent use of methamphetamine/speed may delay the psychophysiological impairment it produces, reducing the number of Atlanta 2 cases that appear in the problem Minneapolis/St. PaulC indicator data. "
Washington, DC: "In the ?999 [ADAM] I I I I I toxicology reports, none of those 0 20 40 60 80 arrested had treatment for their use of Percentage methamphetamine. The low rates in aTotal admissions number excludes alcohol-only various indicators suggest an incipient but includes alcohol-in-combination. b drug abuse problem, experimental or Reporting periods are January–June 1999, intermittent use, and possibly a lack of except for the following: July-September 1999 (or a perceived lack of) appropriate in Los Angeles and FY 1999 in San Francisco. cAlcohol-only is not excluded. treatment for this drug. " SOURCE: State drug abuse treatment agencies
71 Executive Summary: Stimulants
USE PATTERNS Exhibit 36. Route of administration among primary stimulant/methamphetamine admissions in selected western CEWG areas during the most Boston: "MDMA seems to be expand- recent reporting period* ing outside the rave, dance, and club scenes to include recreational use by 70 younger adolescents in other social
contexts. " 60
Minneapolis/St. Paul: "At rave parties, wearing disposable respiration masks rubbed in menthol-based cold ointments was believed to heighten
the effects of MDMA. "
Route of Administration
Honolulu: "[Methamphetamine Los Angeles Texas smoking in Ha waii] may be related to San Diego Denver the fact that this State has had an Area ongoing marijuana culture for *Reporting periods are January–June1999, decades. The tradition of smoking except in Los Angeles (July-September 1999). 'dope' and the recent emphasis on SOURCE: State drug abuse treatment agencies keeping away from needles because of AIDS are the most probable reasons for this form of ingestion." admissions in three CEWG reporting areas: Atlanta, where injecting is increasing and Minneapolis/St. Paul: "An anecdotal snorting has declined; Seattle; and Texas, report indicated that some young where injecting is particularly common, adults crunch and smoke tablets of a popular ephedrine-based, over-the- accounting for 63 percent of stimulant counter decongestant often used in admissions. Snorting predominates in manufacturing methamphetamine. " Minneapolis/St. Paul and St. Louis, where for the first time it surpasses injecting among Route of administration for methamphet- stimulant admissions. amine varies across the country. Smoking is the most common route among treatment NIDA's Puget Sound Methamphetamine admissions in five of nine CEWG areas Study, conducted in Seattle, found that the reporting such data, and it continues to majority of 65 methamphetamine users increase in those areas (Baltimore, Denver, interviewed were IDUs, followed by snort- Honolulu, Los Angeles, and San Diego) ers. Among stimulant treatment clients in (exhibit 36). During the most recent re- Texas, injectors are, on average, 2 years porting period in Denver, smoking surpassed older than those who smoke or inhale (3 1 injecting among stimulant admissions for the years). first time. In Hawaii, methamphetamine smokers rarely shift from smoking to In Chicago, white IDUs on the North Side injecting. Injecting is the most common inject phenmetrazine (Preludin), while route among primary stimulant treatment African-American stimulant users prefer
72 CEWG December 1999 Executive Summary: Stimulants methylphenidate (Ritalin) (“west coast”), polydrug use (including marijuana, sometimes injecting it with heroin or heroin methamphetamine, and LSD).” and cocaine. Continued MDMA use and new MDMA Multisubstance Abuse combinations were reported in many CEWG areas. In Miami, the practice of “rolling and Washington, DC: “Methamphet- trolling” (combining MDMA with LSD) amine/speed users may use it inter- continues to be common among youth. mittently or on a more continuous MDMA is also mixed with LSD in Texas and basis, commonly with other drugs Washington, DC, where the product is sold (cocaine HCI, marijuana, MDMA) and in a tablet form known as “nexus.” In often to enhance occupational and Miami, ED patients report the use of “rolls,” recreational performance. ” combinations of MDMA and cocaine. In In Seattle, of the nine methamphetamine- Texas, MDMA is mixed with heroin, and in related deaths in 1999, six involved other Chicago, heroin is mixed with methylpheni- drugs. Among primary stimulant admissions date instead of cocaine as a speedball or with in reporting CEWG areas, marijuana and both for increased effect. In Miami, diverted alcohol were mentioned as secondary and pharmaceutical drug abuse seems to be tertiary drugs of choice, except in Texas, increasing, perhaps associated with con- where cocaine was the most common se- comitant stimulant and depressant use (“rol- condary drug. In San Diego, among alcohol- lers”). in-combination primary treatment admis- sions, methamphetamine was the most com- DEMOGRAPHIC DATA mon secondary drug. In Atlanta, unlike admissions for other drugs, nearly one-half New York City: “Given the high cost, of methamphetamine treatment admissions MDMA is generally used by the more affluent. ” reported no secondary drug. Washington, DC: ”Ethnographic re- Interviews with 65 methamphetamine-using ports indicate that methamphetamine/ women and heterosexual men in the Seattle/ speed is used by young heterosexual King County and Puget Sound areas found adults (often younger than 30) pri- marily at dance and music venues, an increased use of multiple substances, in- and by gay men, who may use it at cluding heroin, possibly related to a reported these locations or in sexual engage- decline in methamphetamine purity. In New ments. In addition, methamphet- York City, mushrooms were reportedly dip- amine is used by older heterosexual ped in or treated with methamphetamine (or groups and motorcycle clubs in the PCP or LSD). DC/Virginia area. ”
Washington, DC: “Ethnographic Age information indicates that MDMA is predominantly used by adults younger Boston: “Key informants and focus than 30 who attend dance and music group participants thought that [meth- clubs and raves and are involved in amphetamine] users are generally
73 Executive Summary: Stimulants
students and young adults, especially increased in Denver. The 18-25 group those who frequent raves or those declined notably 5 points) in three cities: recently arrived from the west coast, Dallas, Denver, and Los Angeles. where 'crystal meth or 'ice' is
popular. " Treatment clients older than 25 constitute Minneapolis/St. Paul: "Methylphen - the majority (63-75 percent) of stimulant idate remained a drug of abuse treatment admissions in all reporting CEWG primarily among adolescents and areas (Atlanta, Baltimore, Denver, Los young adults. " Angeles, Minneapolis/St. Paul, St. Louis, New Orleans: "MDMA continues to San Diego, Seattle, and Texas, where the be popular among college students average age of clients continues to increase) and is readily available at nightclubs. " (exhibit 37). The 18-25 age group consti- tutes large proportions (25-33 percent) of St. Louis: "Speed and its derivatives stimulant treatment admissions in Denver, have become more widespread among high school and college students who Minneapolis/St. Paul, St. Louis, and Texas; do not consider these drugs as dan- the 17 group accounts for more than 5 gerous as cocaine. Since it is so percent in four areas: Baltimore, Los inexpensive and easy to produce, it is Angeles, San Diego, and Texas. possible that it will be around for a
long time. " Between 1998 and the first half of 1999, a dramatic age shift in stimulant treatment In FY 1999 in San Francisco, the median age clients was recorded in Denver: the propor- for methamphetamine-related deaths was 35; tion of clients younger than 26 declined in Seattle, during the same period, the dece- dents' ages ranged from 24 to 54. In cities Exhibit 37. Age distribution of primary stimulant/ where methamphetamine ED demographics methamphetamine admissions in selected CEWG were available, percentages among the three areas during the most recent reporting period* oldest age groups (18-25,26 -34, and 35+) were distributed relatively evenly in 1998, with less than 12 percentage-point differen- ces between these age groups, except in San 26-34 Francisco (where the 35+ age group const- ituted 46 percent of methamphetamine ED 40 mentions), Denver, and Phoenix (both with large majorities of mentions constituted by 30 the 26-34 group). 20
10 Between 1997 and 1998, the 3 5+ age group as a proportion of methamphetamine ED 0 Los Angeles San Diego Denver mentions increased notably 5 percentage City points) in five cities: Atlanta, Dallas, Los *Reporting periods are January-June 1999, Angeles, San Diego, and San Francisco. The except in Los Angeles (July-September 1999). 26-34 group declined notably 5 points) in two cities (Atlanta and San Francisco) and SOURCE: State drug abuse treatment agencies Executive Summary: Stimulants
(from 38 to 29 percent), while proportions (exhibit 38). Los Angeles had the narrowest for 35-55-year-olds increased (from 27 to 34 gender gap (5 1 percent males). percent). Female arrestees generally were as likely as Gender their male counterparts to test positive for methamphetamine in almost all ADAM sites Seattle: "[Among women in NIDA 's (though the samples of female arrestees were Puget Sound Methamphetamine small in all sites). Study], the most frequently cited reason for using methamphetamine had to do with its 'socially empower- Race/Ethnicity ing effects. Women reported liking the greatly enhanced confidence and Mortality, ED, and treatment data indicated the social disinhibition that they asso- that methamphetamine users are predomi- ciated with methamphetamine use. Some also reported using the drug nantly white. In San Diego, 77 percent of initially to control weight. Among methamphetamine-related deaths involved males, sexual enhancement was men- whites in FY 1998. tioned frequently as a reason for use, although many reported using the In DAWN areas where ED race/ethnicity drug to facilitate work. " data were reliable (1 0 areas), whites con- stituted the majority (56-100 percent) of In 1999, males accounted for 78 percent of methamphetamine mentions in 1998. methamphetamine-related deaths in Seattle, and 81 percent in San Diego. Among 1998 ED methamphetamine mentions, males out- numbered females in all CEWG areas where Exhibit 38. Gender of primary stimulant/ methamphetamine admissions in selected CEWG that information was available. The gender areas during the most recent reporting period* gaps were particularly wide percent Percent males) in Atlanta, where males have increa- sed from 64 to 74 percent since 1997; Los Angeles; Philadelphia, where males have increased by 5 points since 1998; and San I Francisco. The gaps were narrow in Denver, 53 where males have declined from 65 to 55 points since 1997, and Minneapolis/St. Paul (52 percent males). The gender gap is also narrowing in San Diego, where females have 20 increased by 5 percentage points since 1998. 10 n San Diego Denver Among stimulant treatment admissions, Texas Los Angeles males and females were distributed relatively Area evenly 10 percentage-point difference) in *Reporting periods are January-June 1999, reporting CEWG cities, except in Atlanta (85 except in Los Angeles (July-September 1999). percent males), Denver (61 percent males), SOURCE: State drug abuse treatment agencies and Minneapolis/St. Paul (65 percent males)
75 Executive Summary: Stimulants
Hispanics accounted for a particularly high In Texas, during the past 14 years, whites percentage of ED mentions in Los Angeles have been increasing among treatment ad- (32 percent) and for considerable percent- missions, while African-Americans have been ages in Denver, Phoenix, and San Diego. declining. Also, in Denver, whites as a per- African-Americans accounted for 17 percent centage of treatment admissions increased in Atlanta and 12 percent in Phoenix. slightly between 1998 and the first half of 1999 (to 89 percent). Conversely, in New Whites also were the majority group in all Orleans, whites as a percentage of admis- areas reporting treatment data, ranging from sions declined between 1998 and the first 62 percent in San Diego to 98 percent in half of 1999. Atlanta (exhibit 39). Hispanics held large proportions in Los Angeles (27 percent) and LAW ENFORCEMENT DATA San Diego (21 percent). In San Diego, Asians made up 7 percent of methampheta- Minneapolis/St. Paul: "Federal, State, mine treatment admissions. In some cities, and local law enforcement agencies such as San Diego, the racial/ethnic break reported major growth in metham- down for methamphetamine admissions, phetamine-related activity and, in the course of investigations, reported unlike that for other drug admissions, closely encountering increasing quantities of resembles the general population demogra- the drug. " phics. In Seattle, ethnic minority representa- tion was disproportionately low; whites in Arrestee Data that city constituted 90 percent of treatment admissions for methamphetamine. San Diego, by far, tops the list of CEWG cities in methamphetamine-positive levels Exhibit 39. Race/ethnicity of primary stimulant/ among adult male ADAM arrestees (exhibit methamphetamine admissions in selected CEWG 40). Outside western ADAM sites, metham- areas during the most recent reporting period* phetamine continues to appear only spora- Percent dically; but it has recently appeared in three non-western areas (Atlanta, Minneapolis, and Philadelphia); positive levels there, Americans however, have been small (I 1 percent).
60 BEYOND THE CITY LIMITS... 40 Seattle: "Male arrestees in King County jails outside downtown Seattle had 20 higher [methamphetamine-positive/ rates [than arrestees in Seattle/ in the second 0 Los An! Texas quarter of 1999. " San Diego Denver Area *Reporting periods are January-June 1999, except in Los Angeles (July-September 1999).
SOURCE: State drug abuse treatment agencies
76 CEWG December 1999 Executive Summary: Stimulants
Exhibit 40. Percentage positive for methamphetamine area, methamphetamine arrests increased be- among male and female booked arrestees in tween 1996 and 1998 (from 23 to 103) but selected cities, first half 1999 (ranked by males) fell (to 3 1) in the first three quarters of 1999. San Diego N 44 R Methamphetamine Market Data
Atlanta: “Ethnographic sources found Los Angeles that those who smoke methamphet- amine often refer to it as ‘ice’; how- Dallas ever, it is not the same substance as in Hawaii. Rather, the term is used to
refer to crystal methamphetamine. ”
Honolulu: “The drug ...is a clear or Minneapolis Males cloudy crystalline substance, is Females usually smoked, and has potency lasting from 8 to 36 hours.. .. In the 1990s, the reputation of ice has been 0 10 20 30 40 50 that of a ’cheap and long high,’ an Percentage Positive energy booster, and a sex enhancer, SOURCE: National Institute of Justice, first-half but at the same time it has also 1999 preliminary data (November 1999 update) developed a reputation in Hawaii as a Between 1998 and the first half of 1999, ‘recipe for violence, ’ a ‘crazy drug,’ and a drug of instant addiction.” methamphetamine-positive percentages among adult male arrestees remained rela- Philadelphia: “Focus group members tively stable. Substantial increases were indicated that methamphetamine is recorded in only two cities: San Diego (1 1 available. It is still difficult to obtain, percentage points) and Seattle (7 points). is sold indoors, and requires a During the same time period, percentages connection. ” among female arrestees declined substantially in Phoenix (9 points) and remained relatively In Hawaii, where availability of metham- stable elsewhere. phetamine (called “ice,” “glass,” “shabu,” or “batu”) is high, it appears in two forms: In San Diego, among drug-positive misde- “clear,” a clean, white form; and “wash,” a meanor arrestees, 69 percent tested positive brownish, less processed form.’ In for methamphetamine in 1997 and 62 percent Minneapolis/St. Paul, a variety of in 1998; among arrestees who were low- methamphetamine known as “snow” is level users and relatively new to the criminal available, allegedly containing extra lithium justice system, data were consistent from and producing hallucinations. Ethnographic 1995 through the first half of 1999: meth- data in Washington, DC, indicate the amphetamine was the primary drug involved availability of a range of increasingly refined in two-thirds of the arrests. Honolulu police methamphetamine, differentiated by strength cases involving methamphetamine increased and purity, called “peanut butter,” “bathtub from 253 to 298 between second semester speed,” “crystal,” “hydro,” “glass,” and 1998 and first semester 1999. In the St. Paul “ice.” In New York City, where metham- phetamine indicators are low, the drug is Executive Summary: Stimulants
available in dance clubs and among gay .. .other brand names of pills, known males and is rarely sold on the street. as ‘red devils,’ ‘green Adidas, ‘ and ’purple Adidas, ‘ are available: the Adidas athletic shoe logo appears on Seattle: “lnterviewees reported a the latter two. “ recent decline in the quality of street methamphetamine, although prices are MDMA availability is increasing in many stable. ” CEWG areas and surrounding locations. Methamphetamine prices vary in the re- Prices per dosage are relatively high and porting areas, depending on purity, avail- purity varies, depending on geographical ability, and quantity (exhibit 41). Since the location. On the North Side of Chicago, last reporting period, prices have remained MDMA is sold for $25-$30 per capsule, a relatively steady in CEWG reporting areas, price that has remained stable in recent years; except in Hawaii and the nonmetropolitan home-made MDMA (“wigit”) sells for areas of Minneapolis/St. Paul (prices rose in $15-$20 per capsule. In New Orleans, both places); New Orleans, where prices where MDMA is sold in tablet form and increased at the ounce and pound levels; and embossed with logos such as doves, cupid’s Texas, where prices have decreased since arrows, and smiley faces, it sells for $6-$32 1994. Methamphetamine purity declined in per dosage unit. In New York City, MDMA at least four CEWG areas (Denver, to as low sells for $25-$30 per retail dosage unit (one as 10-20 percent; Los Angeles; San pill) but only $2 per wholesale dosage unit, Francisco; and Seattle). making the distribution of MDMA somewhat lucrative. In Phoenix, the DEA has pur- Market Data for Stimulants chased 13 tablets of MDMA (“Mitsubishi”) and 50 doses ofLSD for $100. MDMA Other Than Methamphetamine costs $5-$25 per dosage in Atlanta, $20-$25 in Dallas, $15-$80 in Houston, and Atlanta: “Ethnographic findings show that many MDMA users have no idea $25 per tablet in Washington, DC, where of the content of what they are recent ethnographic sources report high- taking. They refer to a combined high quality MDMA. of an upper and a downer, and some complain because sometimes the drugs they buy are ‘unbalanced, ’ BEYOND THE CITY LIMITS... causing a shift too much in one or the
other direction. ” Newark: “MDMA and the rave pheno- menon are still unknown in Newark and Miami: “Rave activity has increased other inner cities; however, MDMA is with widescale drug sales, mostly of more available across the State, par-
MDMA, GHB, cocaine, and ketamine. ” ticularly in college towns. Recently, Princeton students reported that the drug Washington, DC: “The Washington has become trendy on campus and is DEA office reports that high-quality usually distributed by students for about MDMA, known as ‘Florida dove’ or $30 per pill. “ ‘doves, is available in the District.. .. Executive Summary: Stimulants
Exhibit 41. Methamphetamine prices and purity in reporting CEWG areas, December 1999 reporting period
Area
Atlanta Boston Denver Hawaii (Oahu)
Los Angeles Minneapolis/St. Paul New Orleans New York City Phoenix St. Louis San Diego Seattle Texas Washington, DC a1 /1 6 ounce ("teener") 'kilogram b1/8 ounce ("eightball") d1 /4 gram SOURCE: CEWG city reports, December 1999
In Chicago, over-the-counter preparations Boston: "Methylphenidate has been containing caffeine, ephedrine, or phenyl- reported by student groups and propanolamine, sell for $1-$2 each. Meth- treatment providers as readily obtainable, especially in middle- and ylphenidate, purchased because of its psy- upper-class communities. Prescrip- choactive effects and low price, is available tions are easily diverted for sale or on the South Side for $3-$4 per pill and personal use. " $2-$2.50 per pill if purchased in quantities of at least five pills. Methylphenidate also Khat (a flowering shrub imported via air continues to be available and is popular from east Africa and the Middle East) is among adolescents and young adults in smoked, chewed, or made into tea because Minneapolis/St. Paul. Phenmetrazine, usually of the stimulant properties of cathinone, its sold on Chicago's North Side, has been primary ingredient. It has been reported in available only in limited amounts during the Boston and Minneapolis/St. Paul. In both past few years. Methylenedioxyamphet- cities, its use seems restricted to small amine (MDA) availability has been noted in enclaves of recent immigrants. Since its St. Louis, and benzphetamine (Didrex) potency declines sharply after 48 hours, wide remains available. Diet pills are being distribution is unlikely. diverted for sale in New York.
79 Executive Summary: Stimulants
Methamphetamine Manufacture, DECREASES IN METHAMPHETAMINE Seizures, Trafficking, and INDICATORS: POSSIBLE REASONS... Distribution State precursor laws:
Atlanta: “Recently, two labs were Help to decrease precursor closed within the city [which is]... . availability and increase precursor interesting because ethnographers price found that most users reside outside
the city limits. ” Cause available methamphetamine to be lower in purity than in earlier Minneapolis/St. Paul: “In July, one reporting periods, possibly resulting methamphetamine lab was discovered in fewer methamphetamine in a fourplex on the north side of consequences Minneapolis after the mishandling of anhydrous ammonia containers Law enforcement crackdowns and caused a major explosion. Six law seizures of clandestine labs: enforcement officers were treated for Help diminish the metham- burn and inhalation injuries. In phetamine supply October, another methamphetamine lab was discovered in a high-traffic National and community prevention neighborhood in a trendy, upscale part programs of south Minneapolis. Three pounds of methamphetamine were recovered, the largest amount of ’finished pro- duct‘ found at a lab in Minnesota to coming increasingly expensive and difficult date. ” to obtain in many CEWG areas, and many Phoenix: “[Methamphetamine] labs methamphetamine manufacturers (“speed typically are portable, makeshift, and cooks”) are using alternate cooking methods, operated by nonchemists, all of which precursors, and cutting agents. New pro- contribute to unsafe and unhealthy duction methods to accommodate hard-to- conditions. ” obtain precursors have been reported: Local methamphetamine labs in Texas (1) the use of diet pill extracts, such as generally use two types of manufacturing phenylpropanolamine, to make amphetamine methods: (1) the “Nazi method,” which uses instead of methamphetamine, (2) the com- ephedrine or pseudoephedrine, lithium, and bination of ephedrine and phenylpropano- anhydrous ammonia, or (2) the “cold meth- lamine, with a mixture of amphetamine and od,” which uses ephedrine, red phosphorus, methamphetamine as an end-product and iodine crystals. The most commonly (verified by recent drug seizures in Denver), diverted chemicals are pseudoephedrine (3) the combination of dimethyl sulfone and tablets (including Xtreme Relief, Mini-Thins, 2-phenethylamine to simulate methamphet- Zolzina, and Ephedrine Release). amine, and (4) the use of ephedra (an organic herb used in “herbal ecstasy” and taken to Due to recently mandated State precursor relieve respiratory ailments) as a precursor. laws, methamphetamine precursors (mostly These alternate manufacturing methods have ephedrine and pseudoephedrine) are be- caused the resulting methamphetamine
80 CEWG December 1999 Executive Summary: Stimulants product to be less potent. Methamphetamine 1997 to 1998, at 20 seizures per quarter- cutting agents, which also decrease purity, year. In Hawaii, 80 pounds of methamphet- include dimethyl sulfone and 2-phenethyl- amine were seized in 1998 and 60 pounds amine. were seized as of September 1999. In Minneapolis/St. Paul, law enforcement Although large retail sales and even larger sources reported encountering increasing wholesale quantities of pseudoephedrine quantities of methamphetamine and an continue to be a problem in Texas, metham- increasing number of submissions: 1,41 1 phetamine labs using pseudoephedrine are grams of methamphetamine seized in 1996 increasing dramatically. Other methamphet- compared with 4,487 grams in the first half amine precursors are difficult to obtain in of 1999; and 404 submissions to the State Texas (again, due to State precursor laws). crime labs in 1996 compared with 614 in the As a result, lab operators often travel to first half of 1999.
Oklahoma and Louisiana to obtain the I chemicals needed. AN ANTICIPA TED SHIFT...
BEYOND THE CITY LIMITS Atlanta: "Although the current meth- amphetamine market in Atlanta is con- St. louis: "The Midwest divisions of the trolled by Mexican trafficking groups, as DEA have decreased the cleanup of local labs increase, this control is likely to clandestine methamphetamine labs. In shift. " FY 1999, 307 clandestine "box" labs were identified in south western Missouri Kansas, and Nebraska. This decrease Law enforcement agencies report increases occurred as funding shifted to local in methamphetamine trafficking in many enforcement for cleanup of these labs. Methamphetamine has become the major CEWG areas, including Atlanta, New focus for this branch of law Orleans, and San Antonio. Although
enforcement. " methamphetamine is sometimes manufac- tured in local labs, much of the metham- phetamine in the United States continues to Increases in methamphetamine labs were come from Mexico, with a recent shift in reported in 5 CEWG areas: Atlanta; importation from California to a more Minneapolis/St. Paul (between 1997 and eastern part of the U.S. -Mexican border. 1999, the number of dismantled labs qua- drupled to 97; two-thirds of the labs were Methamphetamine in Atlanta, Boston, located outside the county metropolitan Minneapolis/St. Paul, New Orleans, New area); Phoenix (420 lab seizures through the York City, and St. Louis is mostly Mexican- third quarter of 1999); Seattle (279 labs made and arrives via California and the through third quarter 1999, more than southwestern States. Likewise, in St. Louis double all seized in 1998; all were located and New Orleans, Hispanic traffickers whose outside of King County); and Texas. supplies originate in Mexico and California dominate distribution networks, rather than In Chicago, street-level seizures of metham- the earlier networks of motorcycle gangs. phetamine remained relatively stable from Sources in New York also cite Filipino drug Executive Summary: Stimulants traffickers, who send multikilogram quanti- According to the DEA and local law ties of methamphetamine by air. enforcement sources, MDMA trafficking has increased in many eastern CEWG areas: MDMA Seizures, Distribution, Boston, where it is transported from Europe and Trafficking via New York; Miami, where supplies reportedly come from Belgium and the MDMA seizures increased in several CEWG Netherlands; New York City, where supplies areas, including Boston; Minneapolis/St. are imported from Belgium, the Netherlands, Paul, where a single case in 1999 involved and Luxembourg; and Washington, DC. 2,200 doses; New Orleans (from 21 to 401 dosage units during the past 2 years); and New York City (from 7 seizures in 1997 to 79 in the first several months of 1999).
INCREASES IN MDMA INDICA TORS: POSSIBLE REASONS.. .
Boston: "The DEA, State Police, Department of Public Health drug lab, and the Massachusetts poison center reported increases in arrests, seizures, submissions, and calls related to MDMA trafficking and use.. . . The rise in MDMA use may be driven by an increase in availability, primarily from Europe via New York (according to the DEA) and by its reputation as a benign, mood- enhancing substance. ''
82 CEWG December 1999 Minneapolis/St. Paul: "Ketamine ("Special K"), an injectable medication primarily used by veterinarians, first appeared as a drug of abuse in Minnesota in 1997 among adolescents and young adults. Since then relatively small amounts of ketamine have
appeared in local crime labs. "
San Francisco: "The most often mentioned ‘club drug' lately, at least among gay men, has been GHB as well as its precursor, gamma-butyrolactone (GBL) or 'Blue Nitro. "'
Texas: "Depressants continue to be a problem because of their availability in Mexico, with clonazepam (Klonopin) being substituted for flunitrazepam (Rohypnol). Mentions of depressants are up in Dallas ED mentions; flunitrazepam treatment admissions are increasing, especially in programs along the border."
This "depressant" section includes four deaths were directly attributed to groups of drugs: (1) nonbarbiturate seda- attendance at a rave and to drug use. tives, anesthetics, and muscle relaxers; (2) Although one of these incidents was a car crash, drugs were found in the car benzodiazepines; (3) antidepressants or and in the toxicology screens. " selective serotonin reuptake inhibitors (SSRIs); and (4) barbiturates. Nonbar- GHB/GHB precursor-related deaths remain biturate sedatives include gamma-hydroxy- few, but they are beginning to appear in butyrate (GHB) and its precursors, gamma- many CEWG areas. In the first half of 1999, butyrolactone (GBL) and 1,4-butanediol. two GHB/GHB precursor accidental over- Ketamine (Special K) is an anesthetic dose deaths were recorded in San Diego, commonly used by veterinarians. Cariso- doubling GHB-related deaths in 1998. In the prodol (Soma) is a muscle relaxant. Miami area, at least six GHB-related fatali- Examples of benzodiazepines include alpra- ties have occurred since 1997, most of which zolam (Xanax), clonazepam (Klonopin or also involved alcohol. In Minneapolis/St. Rivotril), diazepam, flunitrazepam (Ro- Paul, one death due to GHB toxicity was hypnol), oxazepam (Serax), temazepam recorded in 1999. (Restoril), and triazolam (Halcion). SSRIs include amitriptyline (Elavil), fluoxetine In Seattle, deaths involving depressants de- (Prozac), and sertraline (Zolofi). Barbitur- clined between the first halves of 1998 and ates include phenobarbital and secobarbital 1999 (from 25 to 13); benzodiazepines were (Seconal). reported in 60 percent of the 1999 depres- sant deaths. Antidepressant deaths in Seattle MORTALITY DATA also declined (from 24 to 11). In Philadel- phia, most depressant and antidepressant Boston: "Ketamine has.. .been used deaths involved other drugs, and trends as an adulterant in heroin, and may between the first halves of 1998 and 1999 have played a role in some overdose differed according to drug: increases were deaths. " reported for deaths involving sertraline, Los Angeles: "In the past few diazepam, and ternazepam; declines were months, at least two cases of multiple reported for fluoxetine- and alprazolam-
83 Executive Summary: Depressants related deaths; and oxazepam deaths overdoses were reported among Princeton remained stable. In Seattle, depressant- students. In Minneapolis/St. Paul related deaths involving concomitant emergency departments, one to five GHB- injections of heroin and depressants related overdoses are treated per month. (typically diazepam), first noted in 1998, Seattle ED staff continue to report anecdotal continued in 1999 (four cases reported, accounts of three to four incidents per month totaling 27 percent of depressant-related of incapacitation, induced intoxication, and deaths). rape and other criminal behaviors.
EMERGENCY DEPARTMENT Benzodiazepines generally continue to play a AND OVERDOSE DATA relatively small role in ED data. According to 1998 DAWN data, alprazolam had the Atlanta: "Reports of overdoses from highest ED rate per 100,000 population of a combination of GHB and alcohol the depressant category in 8 out of 20 among gay men suggest that the drug CEWG cities; diazepam and clonazepam continues to be available and popular each held the highest rates in 5 cities. in certain settings. '' Among CEWG cities, Philadelphia had the Boston: "Heavy GHB use has been highest alprazolam ED rate per 100,000 reported in some Boston clubs, some- population (2 1.4), followed by Atlanta (1 3.5) times associated with overdoses and Newark (12.9). Between 1997 and requiring ED treatment. " 1998, alprazolam mentions increased significantly (p<0.05) in four cities: Dallas, South Florida: "Eleven of the 26 ED Newark, Phoenix, and San Diego. Con- patients [with GHB toxicity in the first half of 1999] were completely coma- versely, during the same time period, diaze- tose, 3 experienced respiratory failure pam mentions declined significantly (p<0.05) requiring endotracheal intubation, ... in four cities: Chicago, Detroit, Phoenix, and and 9 were combative at some point San Francisco; in 1998, diazepam rates during their visit. " ranged from 2.7 in Minneapolis/St. Paul to 1 1.0 in Phoenix. Clonazepam rates ranged GHB produces drowsiness, increased heart from 2.1 in New Orleans to 19.5 in Boston; rate, depressed respiration, visual distortions, they increased significantly (p<0.05) in Balti- seizures, coma, unconsciousness, and some- more and San Diego and declined signifi- times even death. ED overdoses related to cantly in four CEWG areas (Boston, GHB or its precursors are beginning to occur Detroit,Miami, and San Francisco). in several CEWG areas. A south Florida emergency department treated 26 youth with GHB/GHB precursor toxicity during the first EXPLANATION FOR AN INCREASE? half of 1999, an increase from 18 cases in the second half of 1998, and 6 during the first Texas: "Through 1997, the Dallas ED rate for clonazepam increased; this may half of 1998. GHB/GBL was responsible for have been related to the initial popularity 10 overdoses in the first 3 months of 1999 in of flunitrazepam and then the increasing Baltimore. In Newark recently, a GHB use of clonazepam, legally imported from precursor (GBL) was suspected of sending Mexico, to replace flunitrazepam. " 18 people to hospitals, and 2 GBL-related
84 CEWG December 1999 Executive Summary: Depressants
In 1998, antidepressants (amitriptyline and Conversely, in 1998, GHB-related calls to fluoxetine) continued to show relatively low the Colorado poison center dropped from ED rates (ranging from 0.9 to 6.3) in CEWG the 1997 peak (from 6 to 1). cities. Amitriptyline ED mentions declined significantly (p<0.05) in five cities: Chicago, Flunitrazepam calls in Colorado more than Minneapolis/St. Paul, Philadelphia, Phoenix, doubled between 1997 and 1998 (from 8 to and Seattle; fluoxetine rates declined signifi- 22 calls). In 1998, 237 calls were made to cantly in six cities: Denver, Miami, Phoenix, Texas poison centers regarding fluni- St. Louis, San Francisco, and Seattle. Cari- trazepam. During the same time period, soprodol was the depressant with the highest prescription drugs (including diazepam and ED rate in New Orleans (1 1.3), and its rate clonazepam) were mentioned in 5 percent of equaled the diazepam rate in Phoenix (1 1.0). all calls to Massachusetts' substance abuse Carisoprodol ED mentions increased signifi- hotlines. cantly in three cities: Baltimore, Detroit, and San Diego. TREATMENT DATA
POISON CONTROL DATA Miami: "A 27-year-old woman required a 7-day intensive care unit Boston: "Massachusetts Poison admission to treat her GHB Control reported a surge of calls withdrawal. " involving GHB... many involving St. Louis: "Private treatment youth. " programs often care for benzodiaze- pine, antidepressant, and alcohol Poison control centers in many CEWG areas abusers. Day hospital programs and reported that calls regarding GHB or its 3-day detoxification have become the analogs increased in 1998 and in 1999: treatments of choice. "
Boston: Calls related to GHB/GHB Primary depressant treatment admissions precursors totaled 23 percent of 2 13 remain low in most CEWG areas. For recent calls, a percentage higher than that example, in New York City and Texas, only for LSD and psilocybin mushrooms 1 percent of the adults entering treatment combined, amphetamines, and MDMA. have a primary problem with depressants. However, benzodiazepines are the fourth Los Angeles County: During the first 8 most abused drugs next to heroin, cocaine, months of 1999, 55 GHB-related calls and marijuana in New Jersey, where since were made from Los Angeles County 199 1, benzodiazepines have been mentioned compared with 45 calls in all of 1998. by an average of 6 percent of treatment admissions with only minor year-to-year Texas: In 1998, 167 GHB/GHB fluctuations. In Texas, especially along the precursor poison control calls were U.S. -Mexico border, flunitrazepam treatment reported. admissions are increasing: 159 youth were Executive Summary: Depressants
admitted to treatment with a primary, [including alprazolam and clonazepam] are secondary, or tertiary problem with fluni- commonly available. " trazepam in 1998, and 174 were admitted in the first 9 months of 1999. In addition, 184 In Miami, alprazolam and clonazepam have adults were admitted into Texas treatment replaced flunitrazepam among adolescents. programs during this period with a primary, Similarly, in Texas, clonazepam is being used secondary, or tertiary flunitrazepam problem. by juveniles in combination with beer just as flunitrazepam had been used. DEMOGRAPHIC DATA USE PATTERNS AND Miami: "Local indicators continue to CONTEXTS reveal significant GHB abuse and a shift to younger users. " BEYOND THE CITY LIMITS...
New Orleans: "Flunitrazepam con ti- Phoenix: "The Bureau of land Manage- nues to be popular among white, ment and Maricopa County Sheriff's upper-class high school and college Office reported significant GHB use at students, perhaps due to its low cost rave parties that are held in the rural and the perception that it is safe.. " .. areas of the counties. " Club drugs, including GHB/GHB precursors and ketamine, are easily obtainable in most Club drugs, including GHB and its pre- CEWG areas and are used in clubs, raves, cursors (GBL and 1,4-butanediol), ketamine, and. concerts mostly by white adolescents and flunitrazepam (and some stimulants and and young adults. For example, in a south hallucinogens), are usually taken at parties, Florida hospital during the first half of 1999, raves, and clubs. GHB has appeared in GHB toxicity patients were age 18-33, the indicators in 13 of 20 CEWG areas, and majority were male and white, and the loca- increases in GHB indicators were reported in tion of the incident requiring the ED visit 8 of these areas (Baltimore, Los Angeles, was a local bar/nightclub in 65 percent of the Miami, Minneapolis/St. Paul, Newark, New cases. In Texas, GHB poison control cases Orleans, Phoenix, and San Diego). generally involved persons in their twenties and older, while flunitrazepam-related poison Ketamine has appeared in indicators in six calls involved persons primarily in their areas and its use appears to be increasing teens. In Baltimore, ketamine users are since the last reporting period in Newark. reportedly white youth from middle- and Ketamine is injected intramuscularly in upper-class backgrounds. Similarly in Boston, although it is more often converted Boston, needle exchange personnel reported to a powder and snorted; it is often used as that some younger, white, middle-class an alternate for or in addition to heroin. In clients inject ketamine. New York City, ketamine is either snorted or injected, and it is sometimes mistaken for Boston: "Adolescent treatment providers and youth focus groups cocaine HCl. indicated that prescription drugs
CEWG December 1999 Executive Summary: Depressants
Boston: “Indiscriminate use of these Prevention and Punishment Act.... the drugs [prescription drugs such as drug involved was zolpidem tartrate
alprazolam and clonazepam] in various (Ambien)... . ” combinations and with alcohol seems to have increased recently, according Depressant-positive levels among arrestees to a treatmen t provider contact.. .. remain relatively low in the two CEWG [those drugs] were mentioned by adult focus group participants and treat- areas where data are available: Of adult men t providers as common ancillary male arrestees in Seattle, 4 percent tested or substitute drugs for heroin, the use positive for depressants between July 1998 of which might contribute to risk of and June 1999. In Texas, benzodiazepines overdosing. They are also reportedly were the depressant drugs most often identi- used to potentiate the effects of methadone.” fied by ADAM in the first three quarters of 1999 (with positive findings ranging from 2 “Rollers,” the combination of stimulants and to 9 percent). depressants, remain common among Miami youth. Several ethnographic sources Market Data indicated that some heroin users in Chicago are taking pharmaceutical depressants, Atlanta: “GHB is available in some referred to as “beans,” to potentiate the gyms and is reputed to be widely accessible at gay male party effect of opiates, and field reports from venues.... DEA sources report that Chicago’s South Side indicate an increase in the most common manufactured amitriptyline taken immediately after heroin depressants available in Atlanta to increase its effect. In Philadelphia, crack include GHB and flunitrazepam. “ cocaine users continue to report the frequent use of alprazolam and diazepam. Boston: “One treatment provider for youth reported clients mentioning ‘Enliven, a liquid supplement sold LAW ENFORCEMENT DATA until recently via the World Wide Web, and apparently designed to approxi- Minneapolis/St. Paul: ”Flunitraze- mate the effects of GHB. “ pa m... was suspected but not proved to be involved in a recent rape case at South Florida: “The availability of a fraternity house on the Minneapolis GBL in local commercial products, campus of the University of such as Blue Nitro and Renew Trient, in local nutrition stores further fuels Minnesota. “ GHB overdoses in south Florida.”
Arrest Data New Orleans: “The New Orleans Police Department reports a dramatic Minneapolis/St. Paul: “A 42- year-old increase in GHB availability in both man pleaded guilty to putting a liquid and powder forms. GHB is sleeping pill into the beverage of a prevalent in bars and lounges in the woman without her knowledge with French Quarter area of the city.” the intent of having sex with her. He was believed to be the first person in In many CEWG cities, GHB, known as the country to be prosecuted under the Federal Drug Induced Date Rape “Georgia home boy,” “grievous bodily harm,” “gamma,” “G,” “liquid E,” “liquid Executive Summary: Depressants
X,” “scoop,” and “somatomax,” seems to be Furomax, GH Release, GH Revitalizer, increasingly sold at parties. GHB is often Gamma-G, Insom X, Invigorate, Remforce, manufactured in homes by “kitchen RenewTrient, Revivarant, Revivarant G, and chemists’’ who use recipes and ingredients X-Depress. Four to five capsules of GBL found on the Internet. It is often in liquid or supposedly produce 2 grams of GHB in the powder form and is usually sold in doses body. Like GBL, 1,4-butanediol absorbs (capfuls or thimblefuls) (exhibit 42) quickly, metabolizes into GHB, and causes the same responses as GHB in the body. Exhibit 42. 1999 depressant prices Products containing 1,4-butanediol include Dormir, Enliven, GHRE, Neuro Mod, Price/Unit NRG3, Promusol, Rejuv@Nite, Revitalize Atlanta $10-$25/dose Plus, Thunder Nectar, Serenity, SomatoPro, Miami $5/capful Weight Belt Cleaner, and White Magic. ketamine New York City $20/dose While some of those products list 1,4- alprazolam Atlanta $3-$5/pill butanediol (also listed as tetramethylene clonazepam Seattle $1-$4/pill glycol or 2(3H-)furanone di-hydro), others, diazepam Chicago $1- $4/pill Dallas $1- $3/pill such as Thunder Nectar, have no label. Seattle $1- $4/pill Boston: “Diverted prescription flunitrazepam Atlanta $5-$10/pill New Orleans $5-$10/pill medications, including drugs such as alprazolam, clonazepam, and SOURCE: CEWG city reports, December 1999 oxycodone, are widely available. ”
New York City: “According to the DEA, the major pharmaceuticals on BEYOND THE CITY LIMITS ... the streets are the benzodiazepines
and h ydrocodone. “ Baltimore: “A small but stable market for ketamine is reported in the suburban counties.. .. ketamine is usually taken in Diazepam and alprazolam, the most fre- social venues such as clubs, raves, and quently encountered benzodiazepines, are parties. ” easily obtainable in almost all CEWG areas, with reported prices in the $1-$5 range. In Chicago, diazepam is the most readily avail- GBL and 1,4-butanediol, both precursors to able and frequently used pharmaceutical GHB, are easy to purchase on the Internet. depressant and is a common component in a They are sold as sleep aids, muscle builders, variety of multidrug ingestion patterns. and sexual enhancers. They are distributed Depressants continue to be a problem in in most U.S. cities in health food stores, Texas because of their availability in Mexico, tanning salons, head shops, and gyms. GBL with clonazepam being substituted for fluni- is sold in powder and liquid formulations and trazepam. In Honolulu, barbiturate prices is often referred to as “goop.” Its brand have remained stable at $3-$20 per pill. names include Blue Nitro, Fire Water, Executive Summary: Depressants
Manufacture, Seizures, and United States from Mexico, reportedly Trafficking increased in 1999. The Massachusetts Police drug lab reported that seizures of diverted One seizure of GHB was reported in the prescription drugs have increased dramat- Minneapolis/St. Paul area in 1999, and in ically in recent months, connected with a New Orleans seizures of flunitrazepam, rash of pharmacy break-ins in Massachusetts. which continues to be smuggled into the
89 Boston: "Despite the low treatment and ED indicators for hallucinogens, use of LSD, psilocybin mushrooms ("shrooms "I, and mescaline among adolescents and young adults is not uncommon, as indicated by survey data and focus groups."
Chicago: "Ethnographic reports suggest some increased phencyclidine (PCP)use in Chicago. "
EMERGENCY DEPARTMENT (n=213) in Boston-a percentage equal to AND POISON CONTROL DATA that for MDMA (ecstasy) but below that for amphetamine (16 percent) and GHB and its Philadelphia, by far, had the Nation's highest precursor, GBL (23 percent). a estimated rate of phencyclidine (PCP) ED mentions per 100,000 population in 1998, TREATMENT DATA followed by Los Angeles and Seattle (exhibit 43). Between 1997 and 1998, PCP-related Treatment numbers and percentages involv- mentions declined significantly (p<0.05) in ing primary hallucinogen use generally re- San Francisco (45 percent), New Orleans (38 main low and stable. Two slight increases percent), and Baltimore (37 percent). No were reported. In New Orleans, between the significant increases were reported, first halves of 1998 and 1999, primary PCP admissions increased from 3 percent (n=10) Boston: "In focus groups, lysergic to 6 percent (n=188) of treatment admis- acid diethylamide (LSD) or 'acid' was sions; other hallucinogens, however, in many cases the illicit drug most continued to account for less than 1 percent often mentioned after marijuana and of admissions. And in Chicago, LSD pharmaceuticals. " treatment admissions declined between FYs LSD ED mentions are relatively few across 1996 and 1997 (from 550 to 13 1) but the Nation, with the highest 1998 estimated rebounded in FY 1998 (to 45 5-a 247- rate per 100,000 population (6.4) recorded percent increase). in New Orleans, followed by Seattle and Phoenix (exhibit 43). Moreover, between DEMOGRAPHIC DATA 1997 and 1998, LSD mentions declined significantly (p<0.05) in 7 of the 20 CEWG New Orleans: "High school students are beginning to experiment with cities in DAWN: Detroit (64 percent), New these drugs [LSD and PCP] again. " York (46 percent), Washington, DC (46 percent), San Francisco (41 percent), Minne- Seattle: "Hallucinogenic drugs such apolis/St. Paul (35 percent), Denver (23 as LSD and psilocybin mushrooms percent), and Miami (14 percent). The only continue to appear in area reports significant increases were reported in New involving primarily younger users. The drugs turn up frequently at local Orleans (22 percent) and Dallas (21 percent). concerts or raves. "
LSD and psilocybin were involved in 15 Texas: "In Lubbock, Beaumont, and percent of recent poison control calls Tyler, LSD is used by college and high
CEWG December 1999 Executive Summary: Hallucinogens
school students. In Dallas, LSD is be- Orleans PCP treatment admissions, 45 per- coming more available in the young adult cent were white males, 33 percent were nightclub scene. " white females, and 22 percent were African- New York City: "According to the American males. In a south Florida hospital, Street Studies Unit (SSU), mushrooms all six ED cases of LSD intoxication in- or 'shrooms' have become more popu- volved young white people: four males and lar among teenagers and young two females. adults.. .. the term applied to mush- room users is 'eaters, ' and the ques- tion is openly posed, 'Do you want to Local urinalysis data in Washington, DC, eat?' Since few adults understand the show some recent changes in juvenile arres- jargon, young users take special plea- tee PCP-positive findings: after declining sure in the new meaning.. .. " sharply between 1995 and 1998 (from 18 percent to 3 percent), levels increased some- According to field and indicator data, hallu- what in the first 10 months of 1999 (to 7 cinogen users tend to be adolescents or percent). young adults, they are more likely to be male than female, and racial/ethnic predominance USE PATTERNS varies from city to city. In Phoenix, for ex- ample, all four PCP-related homicides in the In Chicago, PCP is smoked and sold in three first half of 1999 involved young, African- forms: "mint leaf '' or "love leaf'' (a moist, American males age 20-24. Among New
Exhibit 43. Rate of LSD and PCP ED mentions per 100,000 population by city, 1998 LSD PCP
Atlanta Washington,Chicago DC Dallas San Francisco Miami New York San Diego Phoenix 2.9 Dallas neapolis/St. Paul Baltimore Chicago St. Louis Los Angeles San Diego Baltimore Philadelphia 1.6 New Orleans St. Louis Boston 1.4 Washington, DC 1.3 Newark 1.2 New York 0.9 Detroit 0.6 I I I I I I I 0 3 6 9 12 15 ED Mentions per 100,000 Population ED Mentions per 100,000 Population
NOTE: ''...'' denotes that estimate does not meet the standard of precision or is less than 10.
SOURCE: Office of Applied Studies, SAMHSA, Drug Abuse Warning Network, 1998 (July 1999 update)
91 Executive Summary: Hallucinogens loose, tobacco-like substance sprayed with (at 7 percent). Females tested positive at PCP and wrapped in tinfoil); “sherm sticks” much lower levels with the highest at 2 or “happy sticks” (cigarettes dipped in PCP); percent in Houston and Los Angeles. Los and “wicky stick ” or “donk”(PCP mixed Angeles also had the highest level for juve- with marijuana). Similarly, in New York nile males (1 percent). City, PCP is sold in two forms: as a powder sprinkled on green mint leaves or marijuana, The Washington, DC, PCP-positive level for or in liquid form in a small shaker bottle. In adult males represents a dramatic 17-per- St. Louis, PCP is generally used as a dip on centage-point increase compared with levels marijuana joints. And in Texas, marijuana in 1998. Pretrial Services urinalysis data in cigarettes are sometimes dipped in embalm- that city also suggest a possible upturn in ing fluid containing PCP. In New York City, 1999 after a marked decline during the past mushrooms are dipped in or treated with 10 years. The only other notable ADAM PCP, LSD, or methamphetamine. shifts for adult males between the two reporting periods were reported in Dallas (a Emergency department data from a south 2-percentage-point increase) and Phila- Florida hospital reveal several LSD-drug delphia (a 3-point decline). Findings combinations: among six LSD-intoxicated remained relatively stable among adult patients in the first half of 1999, all tested females and juvenile males. marijuana-positive; two were also positive for cocaine; one was also positive for Market Data amphetamines; and two claimed to have also abused MDMA or “rolls” (a combination of BEYOND THE CITY LIMITS.... MDMA and cocaine). “Rolling and trolling” (LSD combined with MDMA) remains Chicago: “LSD hits... are available in both
common among youth in that area. The the city and most suburbs. ” LSD-MDMA combination is also reported in Texas, where some LSD has also been found St. Louis: ”LSD has sporadically mixed with other drugs, such as diazepam. reappeared in local high schools and rural areas. ” LSD is linked to methamphetamine in Texas, but the link is related to distribution rather than combined consumption: it is sold there LSD availability is reported in the majority of by Mexican nationals who also distribute cities and often in the suburbs and surround- methamphetamine. ing rural areas. In Phoenix, it is sometimes referred to as “the mad hatter.” Reports of LAW ENFORCEMENT DATA PCP availability are more sporadic. The drug is rare in most of New England, Arrestee Data according to the DEA, but it is available a little further south, in New York City. During the first half of 1999, Washington, Moving down the eastern seaboard, seizure DC, by far, had the highest PCP-positive data suggest declining availability in urinalysis level among ADAM adult male Washington, DC: PCP seizures there de- arrestees (19 percent); Philadelphia followed clined between 1997 and 1998 (from 68 to
CEWG December 1999 I
Executive Summary: Hallucinogens
44) and appear to be declining further in Reported prices for PCP and LSD vary 1999 (29 during the first 9 months). In some somewhat across the country (exhibits 44 inner cities, such as St. Louis, PCP is avail- and 45). Stable prices are reported for PCP able in limited quantities. Psilocybin in Washington, DC, and for LSD in Boston mushroom availability is reported in Boston, and New Orleans. LSD in New York City is New York City (where they are grown less potent than it was in the 1960s and locally), and Minneapolis/St. Paul. 1970s. Reported mushroom prices include Mescaline availability is reported in Boston, $10-$50 in New York City for large “treat- and peyote availability is reported in ed” mushrooms (sometimes used by groups) Phoenix. and $1 50-$200 per ounce in Minneapolis/St. Paul. New York City: “According to the SSU, PCP (‘angel dust‘) continues to Exhibit 45. LSD prices in reporting CEWG be available in the city. ” areas, December 1999 reporting period
Exhibit 44. PCP prices in reporting CEWG Price/Unit areas, December 1999 reporting period
sheet Price/Unit Atlanta $4-$6 NR Area Ounce Other Boston $5 I $200 I Boston $500-$1,200 $50/1-1.5 g $5 NR Chicago NR $10-$20/ $4-$6 $225-$275 “mint leaf” $1-$5 NR $30/dipped St. Paul cigarette $20/mixed $1.50-$8 $200-$400 marijuana $0.50 NR joint $5 NR New York City NR $10,$20/ NR bag $2-$4 $20/bottle Texas $2-$10 NR Washington, DC $350 NR
SOURCE: CEWG city reports, December I999 SOURCE: CEWG city reports, December 1999 Dracorhodin: A substance with mild American, an 18-year-old male, and a 55- hallucinogenic effects, called “red rock year-old male. In Texas, inhalants were opium,” “red run,” and “red stuff,” is mentionedin 144 deaths between 1998 smoked in Baltimore in combination with and 1999. They included chlorinated marijuana. It contains dracorhodin, a hydrocarbons (such as Scotchguard, compound found in the plant daemon- Liquid Paper, or carburetor cleaner), orops draco (“dragon’s blood”), used in freon, toluene, and nitrous oxide. The varnishes and stains, as an herbal majority of those decedents were male (92 medicine, and to make incense. percent) and white (81 percent), and the average age was 25.6; however, age, Anticholinergic plants: Teenagers in ethnicity, socioeconomic status, and south Florida occasionally abuse two local school/employment status varied widely anticholinergic plants, “devil’s trumpet” according to type of inhalant. Also in and “angel’s trumpet,” by various routes Texas, inhalant abusers constituted 2 (orally or via smoking), for their halluci- percent of admissions to adolescent nogenic properties. The plants’ toxic treatment programs in 1999. Those youth effects led to at least three medical tended to be Hispanic males involved in emergencies involving teenage boys gangs. during March 1999. Philadelphia: “Focus groups held in Jimson weed has been involved in one spring 1999 continued to identify the use of toluene and other recent death and several poison center solvents in certain areas of calls per month in Phoenix. Philadelphia. The practice is referred to as ’huffing,‘ and the Dextromethorphan (DXM): Teens in predominant users are white males some cities, such as Boston and Minne- in their preteens or early teens.” apolis/St. Paul, commonly abuse over-the- counter cough preparations containing Steroids: Needle exchange personnel in dextromethorphan (“robo tripping”) for areas surrounding Boston report that their hallucinogenic properties, their young male bodybuilders inject steroids numbing effects, and their ability to intramuscularly. In Atlanta, law enforce- prolong and enhance the effects of other ment sources note the potential for abuse drugs. of the anabolic steroid clenbuterol (Spiropent) by weightlifters. Inhalants: Toluene was involved in three of four inhalant deaths in Phoenix in the Sildenafil citrate (Viagra): Recent first half of 1999. The decedents were police road stops in Boston have resulted demographically diverse: a 16-year-old in seizures of sildenafil citrate. Anecdotal white female, a 29-year-old Native reports suggest increased illicit avail- ability. Newark: "The rise in injecting drug [mostly heroin] use poses a major health challenge because of its implications for the spread of human immunodeficiency virus/acquired
immunodeficiency syndrome (HIV/AIDS) and hepatitis C among drug users. "
San Francisco: "It appears that the rapid increase in methamphetamine use (primarily by injection) among gay men in the early 1990s has led ... to a corresponding increase in AIDS cases, "
AIDS Mode of Exposure respectively). The proportions of dual exposure of injecting drug use and male-to- Texas: "[According to a 1999 HIV male sex remained relatively stable except for prevention counseling and partner elicitation increases in St. Louis, San Francisco, and data collection system], the most Seattle. significant drug use factors for testing HIV positive for males are selling sex, using cocaine and then having sex, and using Local studies in Seattle-area drug treatment inhalants and having sex; for whites, agencies indicate an HIV seroprevalence of significant factors are using inhalants and 1-4 percent among heroin and cocaine having sex; and for African-Americans, the injectors, but 47 percent among gay and most significant factors are using cocaine bisexual males who inject methamphetamine. and having sex, being an injecting drug user A survey of IDUs recently booked in the King (IDU), and sharing injecting equipment. " County jail in Seattle found that among HIV- According to the Centers for Disease Control positive arrestees, 87 percent reported and Prevention (CDC), one of the most injecting heroin, 69 percent speedballs, 65 common modes of exposure among AIDS percent cocaine, and 25 percent ampheta- cases nationwide continues to be injecting mines; frequency of sharing drug use drug use, second only to male-to-male sex. equipment was high. Through December 1999, injection-related AIDS cases accounted for 32 percent of AIDS Demographic Data cumulative adult and adolescent diagnoses: 26 percent involved injecting drug use as the Nonwhites continue to account for a dis- sole mode of exposure; 6 percent involved the proportionately high number of injection- dual risk categories of injecting drug use and related AIDS cases. For example, in Georgia male-to-male sex (exhibit 46). the rate of injection-related AIDS cases among African-Americans is 15 times the rate Newark and New York City continue to have for whites; in New York City, 47 percent of the highest levels of injecting drug use as the heterosexual IDUs with AIDS are African- sole mode of exposure among reporting American, and 38 percent are Hispanic; and in CEWG areas (57 and 47 percent, respec- Seattle, methadone patients of African- tively). Between 1998 and 1999, injecting American or Native American backgrounds drug use levels as mode of exposure for AIDS have higher HIV prevalence compared with remained relatively stable or declined, except white clients (2.5, 4.2, and 1.5 percent, in Illinois and Newark, where proportions of respectively). Among cumulative AIDS cases IDUs increased (1 and 9 percentage points, in Washington, DC, only 3 percent of white I (I
Executive Summary: Infectious Diseases males with AIDS but about 30 percent of Hepatitis C—Between 1994 and 1998, African-American males report injecting drug hepatitis C cases reported to the Los use as their primary exposure mode. In San Angeles Health Department nearly tripled Francisco, heterosexual IDUs with AIDS are (from 1,254 to 3,670 cases), and it is likely mostly black males, similar to the heroin user that a substantial number of the new cases population; gay and bisexual male IDUs are are related to drug use. According to mostly white males, similar to methamphet- recent studies of hepatitis C among older amine users. IDUs in Baltimore, more than 90 percent had the hepatitis C virus. A Baltimore- The proportion of IDUs is higher among based study of hepatitis C rates among females with AIDS than among males with young IDUs in several cities found high AIDS in all reporting CEWG areas: Texas, 40 hepatitis C-positive levels in Baltimore, percent of females with AIDS are IDUs, while New York City, Chicago, New Orleans, the level for their male counterparts is 21 and Los Angeles (58, 50, 33, 28, and 23 percent (including both singular and dual percent, respectively). Preliminary HIV modes of exposure). Similarly in Los Angeles, serosurveillance results of San Francisco- 26 percent of females with AIDS are IDUs, area IDUs suggest an infection rate in the but only 13 percent of males are IDUs 50-60 percent range. (including both singular and dual modes of exposure). In Georgia, 3 1 percent of females Skin infections-In New York City, with AIDS are IDUs compared with 23 injecting crack cocaine dissolved with percent of males with AIDS. In Washington, lemon juice or vinegar has been causing DC, more than half of the females with AIDS serious skin infections; some needle reported injecting drug use as their exposure exchange programs have been distributing mode, compared with 22 percent of males kits of boric acid and vitamin C to treat the with AIDS. In New York City, female IDUs problem. An increase in abscesses with AIDS are younger than their male secondary to heroin injection is reported in counterparts: 66 percent of the females are 39 San Francisco. or younger, compared with 55 percent of the males. Syphilis-In Colorado, four early latent syphilis cases have been reported in the Infectious Diseases Other Than most recent 8-week time period (fall 1999); AIDS Among IDUs two of these cases have been linked to sex- for-crack cocaine practices, with more than Hepatitis B—The reported cases of 20 at-risk individuals identified by outreach hepatitis B in San Francisco between 1995 workers. and 1999 increased slightly, but IDUs constituted less than half the cases. Hepatitis C seems to be emerging as a far greater health concern for IDUs than hepatitis B.
96 CEWG December 1999 97