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Update on Latest Drug Trends

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Update on Latest Drug Trends Update on Substance Abuse Trends Jane C. Maxwell, Ph.D. Addiction Research Institute The University of Texas at Austin www.utattc.net Data Sources • Death data (DSHS) - 2009 • Poison Control Center cases (DSHS) - 2010 • Treatment admission records (DSHS) – ½ 2010 • Surveys (DSHS) 2010 ad (YRBS) 2009 • Forensic laboratory tests (NFLIS) – ½ 2010 • DEA Dallas, El Paso, and Houston Field Division Intelligence Reports – ½ 2010 • NIDA, R21 DA025029 Community Epidemiology Workgroup Correspondents Seattle Maine Minneapolis Boston Detroit New York Newark Chicago CVG San Francisco Philadelphia Denver St. Louis D.C/Baltimore. Los Angeles Phoenix Atlanta San Diego New Mexico Honolulu Austin Miami Map by JC Maxwell Drug Use Patterns Vary over Time and Space Percentage of Drug Items Identified by Toxicological Labs as Heroin by State, 2006 Source: NFLIS Percentage of Drug Items Analyzed by Tox Labs Identified as Cocaine, by State, 2006 Source: NFLIS Percentage of Drug Items Analyzed by Tox Labs Identified as Methamphetamine, by State, 2006 Source: NFLIS Primary Drug of Abuse at Admission to Treatment: 2007 Cocaine 10% Cocaine 10% Cocaine Heroin 8% 15% Heroin 9% Heroin Cocaine Meth 10% 24% 35% Meth Heroin 22% Meth 10% Meth 8% 42% Meth Meth Heroin 35% Heroin 11% 33% Heroin 31% 15% Heroin Cocaine 31% 22% Cocaine Cocaine 64% 32% Cocaine 47% SISVEA & TEDS Treatment Admissions – Border and Non-Border: 2010 Border NonBorder 35 30 25 20 15 10 5 0 Alcohol Marijuana Powder Heroin Other Meth Crack Coke Coke Opiates Treatment Admissions on the Border: 2010 45 40 35 30 Alcohol 25 Marijuana 20 15 Cocaine 10 Heroin 5 0 El Paso Laredo The Valley % Texas Treatment Admissions by Primary Substance of Abuse: 1987-2010 Heroin Alcohol Stimulants Cocaine Marijuana 60.0 50.0 40.0 30.0 20.0 10.0 0.0 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 Source: DSHS Primary Problem Drug At Admission (excluding alcohol): Texas 1985 and 2010 40% 1985 2010 35% 30% 25% 20% 35% 37% 15% 25% 10% 20% 17% 14% 13% 5% 9% 2% 9% 5% 0% 0% Heroin Other Opiates Barbiturates Amphetamines Cocaine MJ Hash Lifetime Use as Reported in the Texas Secondary School Survey: 1988-2010 90% 80% 70% 60% Alcohol Tobacco 50% Marijuana 40% Cocaine/Crack 30% Ecstasy 20% Heroin 10% 0% 1988 1990 1992 1994 1996 1998 2000 2002 2004 2006 2008 2010 Source: DSHS Methamphetamine: It’s Back (It never went away) Methamphetamine & Amphetamine Indicators in Texas: 1997-2010 1000 1998 1999 2000 100 2001 2002 2003 10 2004 2005 2006 2007 1 2008 # PCC Calls % Tmt # Deaths % of DPS % Purity 2009 Admits Exhibits 2010 Median Methamphetamine Purity in the Continental United States (1985-2005) Canada precursor 100 Overall US pseudoephedrine import/export product regulation regulation 80 US pseudoephedrine 60 retail sales regulation Canada essential 40 chemical regulation Median Purity Median 20 US ephedrine and US ephedrine Canada precursor domestic pseudoephedrine bulk single ingredient distribution regulation US ephedrine combination powder regulation product regulation product regulation 0 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 Months Impact of US and Canadian precursor regulation on methamphetamine purity in the United States. (2009) Cunningham JK, Liu L-M, Callaghan R. Addiction; 104, 441-453. Mexico Methamphetamine Treatment Admissions Cunningham et al., Mexico's Methamphetamine Precursor Chemical Interventions: Impacts on Drug Treatment Admissions, Addiction, in press, 2010 US Money Seized in Closure of Rogue Mexican Chemical Company: 2007 $205 million US Texas Treatment Admissions Mexico's Methamphetamine Precursor Chemical Interventions: Impacts on Drug Treatment Admissions, Addiction, in press, 2010 U.S. Past Year Initiation of Methamphetamine Use and Past Month Use: NSDUH 2002-2009 Past Year Initiation Past Month Use 800 700 600 500 400 300 200 100 0 2002 2003 2004 2005 2006 2007 2008 2009 Source: NSDUH # Methamphetamine Clandestine Laboratory Incidents and % of All Substances Identified That Were Methamphetamine in the US: 1999-2009 # Laboratory Incidents % of All Identified Substances 20000 18% 18000 16% 16000 14% 14000 12% 12000 10% 10000 8% 8000 6% 6000 4000 4% 2000 2% 0 0% 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Source: NFLIS & DEA Methamphetamine Samples Tested at DEA South Central Lab 140 120 100 80 60 # Samples 40 % Purity 20 0 Source: DEA Different Manufacturing Processes I. Methylsulfonylmethane (MSM) being used to cut meth (or sold instead of meth). II. Ephedrine/Pseudoephedrine Based (d-form): A. “Nazi Method”-lithium, anhydrous ammonia B. Cold method-red phosphorus, iodine crystals C. “One Pot” and “Shake and Bake” cooking using dry ammonia nitrite and cough syrup rather than liquid anhydrous ammonia. III. P2P/Phenylacetone (Illegal in US-Schedule II, precursors legal in Mexico) (l and d,l- forms). DEA Methamphetamine Profiling Program • d-meth (made with ephedrine) has more potent physiologic and behavioral effects and higher abuse liability than l- meth (Mendelson et al., 2006). • 69% of DEA samples in 4th quarter of 2010 were from P2P process (dl or l-meth), 9% phosphorus- iodine (d-meth). • If meth is 0% potent, then it is l-isomer only; if 100% potent, it is all d-isomer. For 4th Q 2010, potency was 77%. Purity was 89%. • Mexican cooks are refining the P2P product so very little l-meth is left in the P2P product, which means potent meth is back. Preliminary Results of Survey of Meth Users • 54% female; 83% Anglo, 11% Hispanic; average age 32, SDS 7.5. • Routes: 60% smoking, 46% injecting, 34% snorting, 19% swallowing. • 68% ever taken prescribed meds for psychological problems; 35% ever hospitalized for such (depression, bipolar, anxiety). • Favorite drugs used with meth: cannabis, alcohol, powder cocaine, Xanax, hydrocodone. Preliminary Findings from Survey of 222 Meth Users Early in Treatment Five Biggest Risks of Meth Use Five Biggest Benefits of Meth Use Addiction/dependence 74.8 Increased energy/stay awake 57.1 Paranoia 38.3 Enhanced sexual experience 49.3 Depression 37.9 The high 40.0 Anxiety/panic 35.1 Weight loss 35.7 Legal/police problems 35.1 Fun/good time 34.3 Damage to brain function 28.5 Enhanced mood/euphoria 28.6 Family &child social services 27.6 More social 27.9 problems Financial problems 22.4 Feeling in control/focused 26.4 Social/relationship problems 19.6 Work more hours or more jobs 22.9 Employment problems 19.6 To not be depressed 22.9 Psychosis 18.2 Increased confidence 21.4 Aggressive/violent behavior 17.3 Do more housework/take care of kids 20.7 Alcohol Relationship Between Age of Onset of Drinking and Prevalence of DSM-IV Alcohol Abuse and Dependence: 1994 100 90 80 70 60 50 40 No Alcohol 30 Dependence 20 Abuse 10 0 Percent Alcohol Use by High School Students: 2009 YRBS Texas US 50% 45% 42% 40% 30% 26% 24% 24% 21% 20% 10% 0% Past Month Drink Past Month Binge Drank Before 13 Average # Drinks per Day on the Days Used Alcohol among Past Month U.S. Alcohol Users Ages 12 to 20: 2005-2006 0 2 4 6 8 Total Aged 12 to 20 4.9 Aged 12 to 17 4.5 Aged 18 to 20 5.2 Male 5.8 Female 4 White 5.3 Hispanic 4.9 Black 2.8 SAMHSA, The NSDUH Report: Quantity and Frequency of Alcohol Use Among Underage Drinkers, 4/2008 Percentage of Texas Secondary Students Who Reported They Normally Consumed Five or More Drinks at One Time, by Gender: 2000–2010 35% 32% 30% 30% 26% 25% 24% 22% 22% 23% 22% 20% 20% Girls 18% 18% 17% 15% Boys 10% 5% 0% 2000 2002 2004 2006 2008 2010 Liu, L. Texas School Survey of Substance Use Among Students in Grades 7-12, DSHS. Binge Drinking and Women • Women binge drinkers engaged in anal sex more often than women who drank alcohol without binges (33% vs. 16%) and 3 times the rate of women who abstained from alcohol (11%). • Having multiple sex partners was more than twice as common among women binge drinkers than women abstainers (41% vs. 17%). • Gonorrhea was nearly 5 times higher among women binge drinkers compared to women abstainers (11% vs. 2%). • Among men, rates of risky sexual behaviors/STDs were high, but did not differ by alcohol use. • The findings support the need to routinely screen for binge drinking as part of clinical care in STD clinics. • Women binge drinkers may benefit from interventions that jointly address binge drinking and risky sexual behaviors. • Developing gender-specific interventions could improve overall health outcomes in this population. Hutton, H. et al., (2008). The Relationship Between Recent Alcohol Use and Sexual Behaviors: Gender Differences Among Sexually Transmitted Disease Clinic Patients, Alcoholism: Clinical and Experimental Research Texas STD Case Rates: 2010 10,000.0 1,000.0 Syphilis Male Syphilis Female 100.0 Gonorrhea Male Gonorrhea Female 10.0 Chlamydia Male Chlamydia Female 1.0 Alcoholic Energy Drinks Deciphering Skills Impaired Driving: Not Just Alcohol! % of Weekend Nighttime Drivers with BACs>0.08g/dL or Positive for Drugs in the 2007 National Roadside Survey 16 14.4 14 12 10 8 6 % Drivers 4 2.2 2 0 Alcohol Drugs NHTSA Traffic Safety Facts, 2009 Drug Involvement of Fatally Injured Drivers: US and Texas 2009 Tested Positive 25% 23% 20% 18% 15% 10% 5% 0% US Texas NHTSA Traffic Safety Facts DOT HS 811 415, 2010 Percentage of Texas Seniors Who Had Driven While Drunk or High from Drugs: 1990–2010 35% 30% 25% Driving While Drunk 20% 15% Driving While High 10% From Drugs 5% 0% Source: DSHS Primary Problem of Texas Past-Year DUI Arrestees Entering Treatment 1996 2009 Alcohol Heroin 14% 5% Other Opiates Amphet/ Meth 68% 75% Powder Cocaine Cannabis Crack Cocaine Other Source: DSHS, analysis by Maxwell Use of Alcohol or Other Drugs by Primary Problem at Admission: DWI Arrestees 2005-2009 100% 80% Marijuana 60% 47 19 Cocaine 45 40% 29 Other 66 Alcohol 20% 33 32 None 27 23 0% Alcohol Marijuana Meth Cocaine Other Opiates Severity Indicators of DWI Arrestees at Treatment Admission: 2005-2008 80 % Used Daily Problem Days 16 70 14 60 12 50 10 40 8 30 6 % Used Daily 20 4 # Problem Days 10 2 0 0 Crack Heroin Other Alcohol Powder Cocaine Cocaine Opiates etamine Sedatives Marijuana Methamph Source: DSHS.
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