MYER 1 )3 / 5 PREFACE The Community Epidemiology Work Group (CEWG) was established by the National Institute on Drug Abuse (NIDA) in November 1976. The CEWG meets twice yearly and the meetings are designed to assist NIDA in national drug abuse monitoring by: (1) providing accurate and timely assessment of drug abuse patterns and trends; (2) identifying emerging drugs of abuse; (3) determining at- risk populations; and, (4) developing methodologies for data assessment. The CEWG is composed of researchers, primarily State and city officials, who voluntarily attend the meetings and provide periodic analysis of drug abuse patterns and trends in 20 selected metropolitan communities throughout the United States. Attending these meetings and discussing substance abuse patterns and trends in various locales around the country also provides the researchers themselves with a mechanism for anticipating outbreaks of drug abuse and implementing prevention strategies in their respective communities. In addition to discussion of local and national drug abuse trends, this meeting provided an international perspective with the presentation of research findings by representatives from France, the Federal Republic of Germany, Italy, Mexico, and Thailand. It also provided these epidemiologists from abroad the opportunity to observe the CEWG surveillance process and consider if a similar networking model could form the basis, as it has for NIDA, for a descriptive epidemiology program. Nicholas J. Kozel Division of Epidemiology and Statistical Analysis National Institute on Drug Abuse 2416 3.3 PB Section IL. TABLE OF CONTENTS PRECIS EXECUTIVE SUMMARY CITY PAPERS Metropolitan Atlanta Drug Abuse Report— June 1985 James F. Goss, Jr., and A. James Ruttenber The Buffalo Report—June 1985 Nathaniel Webster Substance Abuse Trend Update for Chicago and Mlinois--June 1985 W. Wayne Wiebel Drug Trends in Colorado—dJune 1985 (Denver) Robert Booth Drug Abuse Trend Update—Detroit/ Wayne County, Michigan, June 1985 Richard F. Calkins Drug Abuse Trends in Miami—June 1985 James N. Hall Drug Use Indicators in The Twin Cities Metropolitan Area, June 1985 (Minneapolis) Bruce A. Hutchinson Drug Abuse Indicators in New Orleans (June 1985) Gail A. Thornton Current Drug Use Trends in New York City, June 1985 Blanche Frank, William Hopkins, and Douglas S. Lipton Drug Abuse Trends in Newark, New Jersey John F. French Report to the Community Epidemiology Work Group Meeting XVIII, June 25-28, 1985 (Philadelphia) Mark R. Bencivengo HV 580] Pag] [185 PUBL Page 1 12 n-1 m-12 I-23 I-31 n-47 1-68 I-73 n-103 II-112 -122 n-131 Section IL Iv. TABLE OF CONTENTS (CONTINUED) Drug Use in Arizona, July-December 1984 (Phoenix) N. Bruce McAlister and Philip H. McAvoy San Diego County Drug Use Indicators Report— June 1985 Earle T. McFarland Drug Use in the San Francisco Bay Area— June 1985 John A. Newmeyer Drug Abuse Trends in St. Louis, June 1985— Increased Cocaine and Phencyclidine Abuse Alphonse Poklis Recent Trends in the Use of Opiates and Cocaine in the Seattle Metropolitan Area Arnold F. Wrede Drug Abuse Indicators Trend Report—District of Columbia—dJune 1985 George C. McFarland COUNTRY PAPERS Patterns and Trends in Drug Abuse: Thailand Perspectives Kachit Choopanya and Anek Hirunraks Recent Trends of Drug Use in France Rudolph Ingold Drug Trends and Patterns in Mexico Manuel Mondragon y Kalb Patterns and Trends in Drug Abuse—Federal Republic Of Germany Wolfgang Heckmann Assessment of Drug Abuse in Italy Ustik Avico SPECIAL PRESENTATIONS Naltrexone Treatment Susan Krill-Smith Page 11-145 -155 o-170 m-177 m-192 1-204 m-13 m-23 I-26 1-34 TABLE OF CONTENTS (CONTINUED) Section Averting Disaster: A Family Treatment Paradigm to Avoid Hospitalization John T. Brewster Drug Use and Homicide Paul Goldstein Designer Drugs James Ruttenber Cocaine Realities George L. Miller V. PARTICIPANT LIST IV-12 Iv-12 Iv-21 EXECUTIVE SUMMARY COMMUNITY EPIDEMIOLOGY WORK GROUP JUNE 1985 PRECIS A meeting of the Community Epidemiology Work Group (CEWG) was held in Denver, Colorado, on June 25-28, 1985. These meetings, sponsored by the National Institute on Drug Abuse (NIDA), Division of Epidemiology and Statistical Analysis (DESA), are held semiannually and provide an opportunity for researchers in selected metropolitan areas of the United States to present and discuss findings on the most current drug abuse patterns and trends in their communities. In addition to the United States, researchers from five other countries participated in this meeting. Highlights of research findings include the following: ® Cocaine continues as the most acute problem facing the country and has the potential for becoming an even greater problem should prices decline further and availability increase. ° A problem facing many communities is the treatment of cocaine abusers in systems that have historically been geared to treating opiate addicts. An additional problem confronting treatment programs is the increasing prevalence of polydrug abuse, especially aleohol in combination. ° Reports from most cities reflect a continuation of the average age increase of the heroin abusing population, thus supporting the conclusion that the preponderance of current heroin addicts are from the cohort that began using heroin in the late 1960s and early 1970s. ° PCP appears to be emerging as an increasing drug of abuse; nine cities noted recent increases in indicators of PCP use. The greatest at-risk population appears to be young black and Hispanic males. @ Methamphetamine continues to be a serious problem of abuse in certain areas of the country, with speculation that use may become even more prevalent among the cocaine abusing population because of its lower price and longer action. ® Data regarding heroin and cocaine presented by researchers from abroad, both Europe and Southeast Asia, generally parallel the U.S. experience, viz., similar peaks in heroin incidence, an aging effect among heroin abusers, an increase in adverse health consequences several years after initiation of cocaine use, and an increase in polydrug abuse. COMMUNITY EPIDEMIOLOGY WORK GROUP JUNE 1985 EXECUTIVE SUMMARY A meeting of the Community Epidemiology Work Group (CEWG) was held in Denver, Colorado, on June 25-28, 1985. Semiannual meetings of the CEWG, which are sponsored by the Division of Epidemiology and Statistical Analysis (DESA), National Institute on Drug Abuse (NIDA), allow researchers from selected major metropolitan areas throughout the United States to present, compare, and discuss substance abuse patterns and trends in their communities. CEWG researchers collect and analyze relevant data from direct and indirect indicators for specific drug categories—cocaine, heroin and other opiates, marijuana, hallucinogens, stimulants, and sedatives/hypnotics. Major data sources include: general and select population surveys, treatment programs, hospital emergency rooms, medical examiners, prison detoxification centers, public health departments, police departments, and other law enforcement agencies. These quantitative data are supplemented by ethnographic and anecdotal information obtained from a variety of sources unique to each city, e.g., the Street Studies Unit in New York. In addition to the national drug abuse patterns and trends discussed at the CEWG meeting, an international perspective was presented by researchers from Thailand, France, the Federal Republic of Germany, Mexico, and Italy, who discussed the epidemiology of drug abuse in their respective countries. PATTERNS AND TRENDS IN COCAINE ABUSE In Atlanta, reports from the Medical Examiner for cocaine-related deaths increased sharply during the latter half of 1984—from 9 in the third quarter to 19 in the fourth quarter. However, the number of deaths related to cocaine declined to 10 during the first quarter of 1985. Significantly, there were more fatal overdoses involving cocaine than heroin. Atlanta continued to be a wholesale marketplace for cocaine transactions between Florida's supply sources and distributors to other sections of the country. The cocaine that is available has a street-level purity of between 50 and 55 percent. Among treatment admissions for cocaine, 97 percent reported that they were entering treatment for the first time. Cocaine is the only drug that has shown consistent increases based on indicator data from Chicago. In 1978, reports from Chicago indicated that less than 2 percent of the treatment population had reported cocaine as their primary drug of abuse; presently 15 percent of the publicly funded treatment program population indicate a problem with cocaine. However, this understates the cocaine problem since there has been an increase in the number of private programs in Chicago that treat cocaine dependence but do not report on the State's formal data gathering system. Approximately 25 percent of Denver's treatment population reported a problem with cocaine during the first quarter of 1985. The average age of the clients presenting for treatment in Denver is 27.8 years; males account for almost 70 percent. One-half of treatment admissions reported using cocaine on a daily or binge basis and approximately 64-76 percent of all users reported consuming a I-2 secondary drug, most commonly alcohol or marijuana. The Colorado Bureau of Investigation reported that retail cocaine in Denver has an average purity of 41 percent. : Reports from Miami indicated changing patterns of cocaine use evidenced by the increasing number of users seeking a quicker reaction than intranasal admin- istration provides. Consequently, Miami is experiencing an increase in both the availability of processed freebase cocaine and intravenous cocaine use, In Detroit, the Police Narcotics Unit made 225 arrests for cocaine during 1984—a 26 percent increase over the 179 arrests reported for 1983. Thus far in 1985, police have made 84 cocaine arrests, a 27 percent increase over the same time period in 1984, The purity of cocaine in Detroit is 80-90 percent. With regard to the treatment population in Detroit, 73 percent of admissions are males, 66 percent are black. Approximately two-thirds of clients admitted for treatment reporting primary cocaine use indicated a secondary drug abuse problem. Of these, alcohol was most commonly cited. Overall reports of cocaine as a secondary drug at admission have increased 36 percent. A consistent pattern that has occurred in Detroit's treatment programs during the past 3-1/2 years is that for approximately 50 percent of admissions, cocaine use was initiated 5 years or less before entry into treatment. This pattern differs from that of heroin users, one-third to one-half of whom report having used heroin for between 11 and 15 years. The number of emergency room episodes involving cocaine in Los Angeles increased from 266 in 1981 to 996 in 1984—an increase of 274.4 percent. Of these mentions, the proportion of females increased from 36.8 percent in 1981 to 41.0 percent in 1984, Cocaine-involved deaths showed a similar proportional increase from 33 in 1981 to 121 in 1984—an increase of 281.8 percent. According to the Florida Cocaine Task Force, availability, purity, intensity of use, and adverse health consequences have increased while price decreased for the cocaine available in Miami. The Task Force was created by the State of Florida in late 1984 as a strategy to combat the widespread effects of cocaine abuse. The increased purity is apparent by the growing number of emergency room mentions (from 8.6 percent of total drug-related emergencies in 1982 to 12.5 percent in 1983) and by the increasing percentage of cocaine-related deaths reported by the Medical Examiner—from 22.8 percent of total drug-related deaths in 1982 to 30.2 percent in 1983, "Speedballing," i.e., using heroin in combination with cocaine, accounted for one-third of all cocaine-related emergency room mentions in Miami. Mentions of cocaine from hospital emergency rooms in Minneapolis increased from 13 in the fourth quarter of 1981 to 22 in the fourth quarter of 1984—a 69 percent increase. Prices for cocaine in Minneapolis varied from $100 to $140 per gram, and from $2,300 to $2,500 per ounce, with purity levels of 20-60 percent. In New Orleans, cocaine prices ranged from $90-$120 per gram and from $1,700-$2,000 per ounce with a purity of 33 percent. Of the 38 drug-related homicides in New Orleans, 22 decedents had cocaine in their systems at the time of death. Cocaine as the primary drug of abuse at treatment entry increased from 4.1 percent of total admissions in 1983 to 7.3 percent in 1984 in New Orleans. Cocaine-related emergency room reports in New York from hospitals reporting to the Drug Abuse Warning Network (DAWN) for the first 9 months of 1984 indicated 2,260 episodes—the greatest number for any comparable period during the past 3 years. The number of cocaine treatment admissions rose 63 percent between 1983 and 1984—from 1,936 to 3,159. The New York Department of Health reported 91 cocaine-related deaths in 1984 compared to only 7 deaths in 1983. The City Police Laboratory analyzed a peak number of cocaine exhibits in 1984—12,299 compared to 9,229 in 1983, a 33 percent increase. The median street-level purity of cocaine was between 40 and 60 percent. During the first two quarters of FY 1984-85, there were 331 cocaine treatment admissions reported for Philadelphia. If this trend continues, there could be an increase of more than 50 percent over the 439 admissions reported for FY 1983- 84. By the third quarter of 1984, cocaine mentions ranked second in Philadelphia among all drugs specified in DAWN. Cocaine prices in Philadelphia ranged from $80-$120 per gram. San Diego cocaine-related deaths increased 85 percent between 1983 and 1984, from 7 to 13. The street price for a gram was reported at $100-$200, with 20-30 percent purity levels. Among treatment admissions, cocaine continues to rank second as the primary drug problem—24 percent of total admissions in 1984, Emergency room mentions increased 60 percent between 1983-1984, In Newark, treatment admissions for primary cocaine use increased from 75 in 1979 to 334 in 1984. As a percentage of total admissions, cocaine increased from 1.2 percent in 1979 to 14.0 percent in 1984, However, when considered as a percentage of non-heroin admissions, cocaine admissions increased from 9.7 percent in 1979 to 40.0 percent currently. In 1984, 838 clients cited cocaine as their secondary drug abuse problem; 49.2 percent of all admissions reported cocaine as a major substance abuse problem. The price for cocaine remains at $1,500-$2,000 per ounce with a purity of 70 percent. Grams are sometimes available in Newark for as little as $75, although $80-$90 are more common prices. St. Louis experienced a decrease in the average street level price of a gram of cocaine, from $100 to $80 per gram. However, the quality of the cocaine in that city also has declined from the 40-50 percent purity reported in 1983 to about 25 percent as reported by the Drug Enforcement Administration (DEA) for April and May 1985. In 1984, the number of clients reporting cocaine as a primary drug of abuse at treatment admission was 210 percent greater than in 1982—38 such admissions were reported during 1982 while 80 admissions were reported in 1984, Results of client urine drug screens performed at treatment programs in St. Louis showed that "speedballing" is increasing among intravenous narcotic addicts. A total of 154 DAWN emergency room episodes were recorded for the fourth quarter of 1984 in San Francisco; this amount was nearly three and one-half times the quarterly rate recorded during 1982 and early 1983. The San Francisco Police Department reported that arrests in the "dangerous drug" category are dominated by cocaine and methamphetamine users. DAWN emergency room data from Seattle documented a consistent increase in cocaine-related admissions since 1978. The price of cocaine has remained stable in the area over the past 3 years—with gram units selling for between $100 and $150. Present purity figures indicate that gram lots are usually 30-40 percent pure, while ounces are 50-60 percent pure and pounds, 90 percent pure. I-4 As an indication of increased cocaine activity, the office of the Chief Medical Examiner in Washington, D.C., for the first time reported three overdose deaths that were attributed directly to cocaine overdoses. Another indication of increased cocaine activity in Washington, D.C., was the 75 percent increase in emergency room mentions between 1983 and 1984, from 276 to 484. In 1984, DEA agents in Phoenix seized over 52 kilograms of cocaine. With purity continuing at 70-90 percent, grams are selling for $100 to $150. Although treatment entries for cocaine decreased 21 percent during the past 6 months in Phoenix, this was less than the 32 percent overall decline in treatment admissions recorded during that time period. For the last 2 years, cocaine has ranked third, after marijuana and heroin, in the number of treatment entries. In the Erie County Medical Center in Buffalo, cocaine has replaced diazepam (Valium) as the second most frequently cited drug upon admission to treatment. Emergency room mentions for cocaine doubled in that city; a gram of cocaine sells for $100-$110, PATTERNS AND TRENDS IN HEROIN AND OTHER OPIATE ABUSE Since 1981, emergency room mentions for heroin in Atlanta have been declining steadily. However, the combined use of heroin and cocaine has increased recently. Among treatment admissions in that city, heroin continued to be the most common primary drug of abuse. The heroin in Atlanta is reportedly of very low purity—2.5 percent—and sells for $7.85 per milligram. Although heroin originating in Southwest Asia dominates the market, heroin from Southeast Asia and Mexico has become increasingly popular. Abuse rates for hydromorphone (Dilaudid), a traditional heroin substitute, appear to have declined. Street reports from Chicago also indicated a decrease in the availability of Dilaudid. Treatment admissions for heroin in Chicago have remained stable over the past 3 years at slightly less than 50 percent of total admissions. Since 1981, treatment programs in Denver have reported a fairly stable population using heroin and other opiates—18.3 percent. The average age of the heroin users in Denver has increased from 30.5 to 33.6 years since 1981, The heroin available in the city sells for $100 for a quarter gram and $300 for a gram. The 40 heroin emergency room episodes reported during the second half of 1984 were the largest number ever observed in any 6-month period in Denver and the 278 hepatitis mentions for 1984 are the largest number since 1977. If the present rate continues, the 1985 total will exceed the rate for 1984, Other opiate abusers in Denver do not use drugs as frequently as heroin users and are more likely to enter treatment within a few years of use. Anglos accounted for the largest percentage of these admissions, with females comprising 41-48 percent of treatment clients. During the second quarter of 1984, the DEA Monitor Program in Detroit reported an average heroin purity of 2.5 percent—up slightly from the 2.3 percent reported for the prior quarter—and an average price of $3.36 per pure milligram (a 13 percent increase over 1983). Historically, the majority of heroin in Detroit originated in Southwest Asia. However, during the second quarter of 1984, 31 percent of samples obtained by law enforcement sources were derived from Southeast Asia. Brown heroin, originating in Mexico, represented 7 percent of samples in 1983, but accounted for 28 percent of the samples in the second quarter of 1984, Some of this "Mexican brown" is "brown gummy balls" of high purity that are first frozen and then diluted in a blender. Reports from the Detroit Police Narcotics Unit indicated a decline in heroin confiscations—from 15 %=5 pounds in 1983 to 10 in 1984—while DAWN data for 1984 showed an average of 618 mentions per quarter, a 23 percent decline compared to DAWN mentions for 1983. Thus far in 1984-1985, the proportion of treatment admissions for heroin as the primary drug at intake also has declined from 23 percent of the total admis- sions population in 1982-1983 to 20 percent of the population in 1984-1985. With regard to other opiates, the Detroit Narcotics Unit cited codeine as the fourth most common drug responsible for arrests during 1984. Thirty-two percent more was seized in 1984 than in 1983 and, through March 1985, police made 51 codeine arrests compared to 41 during the same period in 1984. Based on DEA's latest Automated Retrieval of Consummated Orders System (ARCOS) data, Michigan ranks second in both per capita distribution of hydromorphone (Dilaudid) and codeine products. Heroin-related emergency room mentions for hospitals reporting to DAWN in Los Angeles have increased 90 percent, from 459 in 1981 to 872 in 1984, while heroin- related deaths increased 21 percent, from 177 in 1981 to 214 in 1984. In 1984, the total amount of heroin seized by Los Angeles County law enforcement agencies increased 26 percent, from 75.9 kilograms in 1983 to 95.3 kilograms. In 1984, the number of treatment admissions for heroin as the primary drug of abuse decreased approximately 10 percent, from 22,767 in 1983 to 20,447. However, emergency room mentions for glutethimide (Doriden) increased 28.7 percent to 103 in 1984 from the 80 reported in 1981. This increasing glutethimide use also was reflected in medical examiner data. New heroin users in Miami reported that their introduction to that drug generally was through the use of cocaine—either by combining the drugs in an intravenous "speedball" or using heroin intranasally. In late 1983, waiting lists were established at both methadone clinics in Minneapolis. Consequently, 100 additional treatment slots were added, bringing the total number of available methadone slots to 230. Drug seizures reported by the Hennepin County Law Enforcement agencies during the last 6 months of 1984 and the first 4 months of 1985 indicated the limited availability of small amounts of white heroin with a purity ranging from 16-27 percent. Four-milligram Dilaudid tablets, priced between $40-$50 per tablet, remain the most popular opiate among addicts in Minneapolis. The New Orleans Police Department reported 3,108 narcotic arrests in 1984—a 12.5 percent increase from 1983. Both Mexican and, to a lesser extent, Southwest Asian heroin are available with reports indicating an increase in the availability of heroin being transshipped through Nigeria. Abuse rates for "T's and Blues" (Talwin in combination with pyribenzamine) have continued to decline despite a reported demand among users for this combination. The price and purity of heroin in New Orleans remained stable during 1984, with a purity of 15-20 percent for a bundle selling for $300-$400. In New York, the four-milligram tablets of Dilaudid currently sell for $14 in the 14th Street area of Manhattan. The number of narcotic-related deaths in New York declined 27 percent in 1984—from 582 in 1983 to 427 in 1984. In 26 percent of these cases, AIDS was listed as the cause of death. DAWN emergency room mentions for heroin declined 8 percent from 4,387 in 1982 to 4,032 in 1983 and apparently leveled off in 1984 based on a comparison of the first 9 months of 1983 and a comparable period in 1984 (the number remained almost unchanged—at 2,753 from 2,832). The most notable characteristics of clients entering treatment for primary heroin use are their increasing age (the percentage of clients 30 years and older continues to increase) and the change in ethnicity (the proportion of black clients has been declining while the number of Hispanics has been inereasing). Observations by the Street Studies Unit indicated an increasing use of "Hits" or "Loads"—the combination of glutethimide and codeine. In Philadelphia, glutethimide is regarded by the DEA as a problem of both drug diversion and abuse, with the majority of the drug coming from pharmacies that fill forged prescriptions. Philadelphia reported a 20.5 percent increase in treatment admissions for heroin abuse, with the 1950-1954 birth cohort (currently aged 31- 35) continuing to produce the majority of admissions reporting heroin as the primary drug of abuse. Approximately 45 percent of clients entering treatment between July and December 1984 reported first heroin use between 1967-1972. With regard to narcotic and dangerous drug mortality, there were 127 deaths reported for the second half of 1984, contributing to a total of 226 for the year— an increase of 29.1 percent over the 175 reported in 1983. San Diego reported a 28 percent increase in heroin-related emergency room episodes between 1983 and 1984. The total number of narcotic drug-related deaths during 1984 was 167—a 12 percent increase over 1983 and the largest number noted since 1980. An increase in heroin-related deaths also was noted— with heroin responsible for 37 percent of the category of accidental deaths among males in the age range of 20-39. The price of small quantities of street-level heroin remained relatively expensive at $25 per balloon (.13 gram) with a purity of 8-10 percent. The majority of heroin available in San Diego is Mexican brown. Fentanyl-like compounds were identified as the cause of death among 24 cases in San Diego. The percent of all admissions entering treatment for primary heroin use in Essex County (Newark) decreased to 65.0 percent in 1984 from 71.3 percent in 1983 and 81.6 percent in 1982, Other opiates were reported as a major problem among 9.6 percent of all admissions. Reports from narcotic law enforcement officers, forensic laboratories, and new clients in treatment indicated that "Hits" continued to be available despite the rescheduling of glutethimide. The cost for a "Hit" was stable at $12-$15. Heroin remained widely available in Newark with a purity of 1- 5 percent and a street price of $10 for a nominal 100 mg bag. In San Francisco, DAWN fourth quarter 1984 data indicated 254 heroin/morphine mentions, which is four times the average quarterly number for 1982 and 1983. Heroin has increasingly become the primary drug of abuse reported by admissions to treatment programs. In FY 1982, 69 percent of clients reported heroin as their primary substance abuse problem, while in the first quarter of 1985, 82 percent of clients reported heroin. In contrast, the Coroner's office reported that deaths attributed to morphine-type alkaloids so far in 1985 are significantly fewer than the 1984 rate, which resulted in 16 deaths. The median age of the heroin users in San Francisco was 32.7. Informal observations indicated that the quality of both the Mexican brown and "Persian" heroin available in the city has improved during the past year. In St. Louis, the white heroin that is available is apparently a white grade of heroin originating in Mexico. Analysis of the heroin seized by DEA between July 1984 and March 1985 identified wholesale purity levels of 35-48 percent. The price of a capsule of heroin remained at $15-$20. In 1984, treatment admissions for "T's and Blues," which from 1977 to 1983 was the most prevalent combination I~-7 used intravenously, declined to 28 percent of the number of 1981 admissions, from 623 to 177. Although the reformulated pentazocine (Talwin)—Talwin Nx— currently is not a frequently mentioned primary drug of abuse, it is occasionally used by a small population of polydrug abusers. Dilaudid, prevalent among white intravenous narcotics addicts in St. Louis, remained relatively expensive at $50 for a four-milligram tablet. Heroin-related emergency room mentions in Seattle reached a quarterly average of 45.8 for 1984, after averaging at 29.8 from 1981 through 1983. Both the Seattle police and DEA confirmed increased availability of higher quality heroin. The primary form available is "black tar," which originates in Mexico and has a reported purity ranging between 45 and 60 percent. Information from law enforcement agencies and street sources indicated that "black tar" is available for $325-$400 per gram, while Mexican brown remained available in the area with gram quantities selling for $80-$160. In 1984, 70 percent of accidental overdose deaths in Seattle were related to the use of opiate drugs compared to 56 percent and 50 percent reported in 1983 and 1982 respectively. Both Minneapolis and Seattle reported a continuing problem with the use of opium in the Indochinese refugee community. In Washington, D.C., the number of heroin-related emergency room mentions increased by 41 percent between 1982 and 1983, and the number of narcotic- related overdose deaths reached a record of 140 deaths. Between 1983 and 1984, Washington, D.C., experienced a 103 percent increase in the total number of narcotic overdose deaths and the purity of heroin averaged about 6 percent. Between 1983 and 1984, the number of Dilaudid emergency room mentions showed a slight decline, from 110 in 1983 to 103 in 1984. In Buffalo, Dilaudid tablets sell for $15-$20 per tablet. The low purity of available heroin in Buffalo (reported to be from 3 to 6 percent) may be a possible explanation for an increase in Dilaudid abuse in that city. Four-milligram tablets of Dilaudid sell in Phoenix for $50-$60 each, while oxycodone (Percodan) tablets sell for $25 each. The DEA in Phoenix reported that most heroin that is available is Mexican "tootsie roll." The prices for this heroin range from $400-$600 per gram and $5,500-$8,000 per ounce. Few of the younger clients that have been entering treatment reported heroin as their primary drug of abuse at intake, although the drug continued to be available throughout Arizona. During the last half of 1984, of the 357 clients presenting themselves for treatment for primary heroin abuse, 64 percent were aged 25-34 and 23 percent were between 35 and 44. PATTERNS AND TRENDS IN MARIJUANA ABUSE In Atlanta, marijuana continues to contribute the greatest number to total drug abuse arrests. High quality sinsemilla (at $1,000-$1,500 per pound), commercial grade domestic (at $250-$300 per pound), and Colombian (at $400-$450 per pound) are reported to be readily available in the city. Treatment admissions for marijuana in Denver increased to 35 percent of total admissions during the first quarter of 1985, with the result that marijuana users constituted the largest treatment group. This percentage is the largest since these figures have been collected. Denver also reported sales of "sole," an exotic type of marijuana named for its resemblance to a large shoe sole. I-8 Detroit police reports noted relatively stable levels of marijuana use, although it has remained the second most commonly used drug among persons arrested since 1980. Reports from Miami indicated that although use of marijuana appears to be stable, the price of and complications from more potent domestic varieties of marijuana are increasing. Emergency room mentions for marijuana in Los Angeles increased 141.2 percent— from 221 in 1981 to 533 in 1984. The amount of marijuana confiscated was almost four times greater in 1984 (10.4 metric tons) than 1983 (2.7 metric tons). Reports on age of first use of marijuana for clients in treatment in Los Angeles indicated that first use for males both in 1983 and 1984 was 14.9 years; for females, the figures were 15.8 and 15.6 years, respectively. Marijuana also is used more extensively as a secondary drug of abuse than any other substance. Minneapolis reported that marijuana continued to be the most widely used illicit drug in that city. In New York, problems associated with marijuana use are indicated by an increasing percentage of treatment admissions citing marijuana as the primary drug of abuse at intake—9 percent in 1983, 11 percent in 1984, and 13 percent for the first quarter of 1985. Reports from Newark treatment programs identified marijuana as the third major substance abuse problem, with 13.6 percent of admis- sions. In Phoenix, marijuana led all other drug categories, with 34 percent of total treatment admissions. PATTERNS AND TRENDS IN HALLUCINOGEN ABUSE Atlanta reported moderate availability of both purple micro-dot LSD and cartoon strip acid. Reports from the Denver police also indicated a slight increase in LSD availability. Although there were few emergency room episodes, reports from Chicago suggested substantial LSD use among high school students. Drug seizures in Minneapolis indicated that LSD is available for approximately $5.00 a hit. In Los Angeles, emergency room mentions for PCP increased 82 percent from 1,341 in 1981 to 2,443 mentions in 1984. PCP-related deaths increased 95 percent from 62 deaths in 1981 to 121 in 1984, and the proportion of PCP treatment admissions increased from 33.9 percent in 1983 to 39.4 percent in 1984. These increasing statistics indicate the continuation of an epidemic pattern of PCP abuse in that city. There is increasing evidence of PCP use in Chicago, parti- cularly in the black community. Street reports from Chicago also indicated that it is one of the few areas where the drug is being inhaled. Michigan State Police located two PCP laboratories in Western Michigan that reportedly manufactured 2.75 million dosage units of PCP per month. Since this action, PCP activity in Michigan has diminished greatly. In New York, DAWN emergency room data showed an increasing trend, from the quarterly average of 124 PCP-involved episodes in 1981-1982 to 163 during 1982-1983, and 260 in 1983-1984. In Newark, PCP use is on an upswing as evidenced by the increased number of samples of PCP being received (from 1 to 3 cases a month 3 or 4 years ago to 12 cases a month presently) by the police laboratory. Treatment admissions for PCP in San Diego increased 63 percent between 1983 and 1984. However, this increase was attributed primarily to the opening of a new clinie in the Southeast area of the city. The street price for a cigarette dipped in PCP in San Diego was $10 per "one-third Sherman." A gallon of PCP sold for $13,000. In San Francisco, PCP use increased particularly among the Hispanic population. The rising trend was indicated in the Coroner's report for PCP-related 1-2 deaths--from one to five between FY 1983 and 1984—as well as in the DAWN data, which increased from 61 mentions during 1982 to 131 in 1984. In St. Louis, PCP is commonly available on cannabis or cigarettes for approxi- mately $20 per stick. Its use, which became widespread in predominantly black areas in 1982, continued to increase at alarming rates. Wholesale quantities of PCP solution for dipping joints or cigarettes are available at $300 per fluid ounce. Treatment admissions reporting PCP as the primary drug of abuse increased nearly 400 percent between 1982 and 1984—from 28 to 111. Further indication of prevalent PCP use in St. Louis comes from statistics for Driving Under the Influence of drugs (DUD. Of 55 cases reported for January 1984 through May 1985, 51 percent involved PCP-intoxicated drivers. When compared with other drugs of abuse, the use of PCP in Washington, D.C., has shown the single greatest increase over the past 4 years. Between 1983 and 1984, the number of emergency room mentions of PCP increased 89 percent from 510 to 965. With 41 percent of police drug seizures and purchases involving PCP, the substance is one of the most prevalent drugs in Washington, D.C. Inhalant abuse in Minneapolis, particularly by adolescent American Indians, remains a problem noted both in detoxification facilities and by adolescent treatment program staff. The use of solvents continued to be a problem of concern in areas of Philadelphia among both young white males and females with use beginning at an early age, often preteen. In Phoenix, the number of juveniles sniffing solvents apparently peaked during 1982 and has been declining steadily since that time. PATTERNS AND TRENDS IN AMPHETAMINE ABUSE Methamphetamine was reported to be widely available in Atlanta. Area motoreycle gangs are heavily involved in the drug's manufacture and trafficking, and the city is reported to be a major wholesale methamphetamine distribution center for the entire Southeastern United States. Motorcycle gangs in Arizona also monopolize the methamphetamine traffic in that State, where "street" methamphetamine prices are quoted at $85-$100 per quarter gram. In Denver, a decline of 1.1 percent in the treatment population—from 7.0 percent during the second quarter of 1984 to 5.9 percent during the first quarter of 1985— marked the lowest number of amphetamine admissions observed in that city to- date. The price and purity of the methamphetamine available in Denver parallels that of the available cocaine—with purity levels of 40-80 percent selling for $100 per gram. Detroit experienced a decrease in per capita distribution of prescription methamphetamine—from 36 percent of the Nation's total distribution to 24 percent during the third quarter of FY 1984, This decrease has been attributed in part to increased law enforcement and regulatory activity—in 1984, the Michigan State Police Narcotics Unit seized over 140,000 methamphetamine dose units as compared to approximately 1,500 in 1983. During 1984, the State Board of Medicine implemented rules that restricted the prescription of meth- amphetamine. Currently, Michigan ranks second in the distribution of methylphenidate (Ritalin). Los Angeles showed conflicting patterns of amphetamine abuse; mentions in the death data dropped 16.7 percent, from 252 in 1981 to 210 in 1984. Admissions for treatment and rehabilitation also declined from 438 in 1983 to 361 in 1984, a 17.6 percent decrease. Conversely, emergency room mentions increased 8.6 percent— from 2,234 in 1981 to 2,425 in 1984, In general, DAWN mentions for stimulants in Minneapolis declined steadily from the fourth quarter of 1981 through the fourth quarter of 1984, with two noticeable peaks occurring during the second quarter of 1983 and the first quarter of 1984, At the same time, methamphetamine seizures by Minneapolis law enforcement agencies increased dramatically during the last 6 months of 1984—1,400 grams of methamphetamine in 38 seizures—with very little decrease in this activity reported for the first 4 months of 1985. Emergency room episodes for amphetamines continued to increase in both Philadelphia and San Diego. San Diego reported a 100 percent increase in ER mentions continuing a steep upward trend. Reports from programs in Philadelphia continued to indicate that individuals born between 1955 and 1959 constituted the largest percentage of the treatment population for amphetamine abuse. Intense efforts by the San Diego Narcotic Task Force to close down clandestine methamphetamine laboratories (17 were closed in 1985) have not diminished the supply of the drug, which reportedly has remained plentiful at street prices of $20 per one-quarter gram and $14,000 to $16,000 per pound. In San Francisco, amphetamine/methamphetamine ranked third (behind cocaine and heroin/morphine) among illicit substances detected in decedents. DAWN emergency room data for San Francisco also indicated an upward trend—from 60 amphetamine episodes in 1983 to 84 in 1984, and from 35 methamphetamine episodes in 1983 to 65 in 1984, The price of methamphetamine is similar to cocaine in San Francisco. A recent development in Chicago was the use of pharmaceutical phenmetrazine (Preludin) among intravenous drug users. In Philadelphia, DEA reported that phenmetrazine (Preludin) was a diversion more than an abuse problem with the bulk of the diverted phenmetrazine (Preludin) being exported to Washington, D.C. PATTERNS AND TRENDS IN SEDATIVE/HYPNOTICS ABUSE The most prevalent sedative/hypnotic drugs mentioned in Atlanta emergency room data are the major tranquilizers and barbiturates—each of which represented 20 percent of all drug mentions. Chicago reported a decrease in the availability of diazepam (Valium) and an increase in price for the first time in several years. Although diazepam continued to be the fourth most frequently mentioned drug in the DAWN data in Detroit, overall mentions have been declining since 1982, In New York, diazepam mentions from emergency rooms are leveling off. However, these episodes are the most numerous among the prescription psychoactive drugs. A quarterly average of 289 was reported for 1982-1983 and 298 episodes were reported for 1983-1984, San Diego also reported a leveling trend for diazepam, but the drug continued to be cited as the tranquilizer that brings the most people into city emergency rooms. An increase in amitriptyline (Elavil) mentions has been reported recently in San Diego. Los Angeles reported decreases for diazepam both in emergency room mentions— down 45 percent, from 1,335 in 1981 to 736 in 1984—and in deaths which declined 6.8 percent (from 44 deaths in 1981 to 41 deaths in 1984). Reports also indicated a declining trend in all indicators for sedatives/hypnotics. Death data showed a decline of 63.8 percent from 1981 to 1984, police seizures dropped 75.2 percent, admissions to treatment decreased 43.2 percent, and emergency room mentions decreased 46.4 percent from 1,943 episodes in 1981 to 1,042 in 1984. Diazepam abuse appears to be continuing its gradual decline in San Francisco, but remains significant as a secondary drug of abuse among heroin users. In Phoenix, although the number of diazepam tablets that were stolen increased from 4,917 pills during the first half of the year to 13,105 during the second half, emergency room mentions are down and drug-related arrests have not changed significantly. In New Orleans, ethchlorvynol (Placidyl) continued to replace methaqualone in street popularity. ACQUIRED IMMUNE DEFICIENCY SYNDROME As of mid-May 1985, 10,282 cases of AIDS were reported nationally with 3,765 cases being reported during the past 7 months. Thirty-six percent of these cases were reported in New York City where the monthly average of AIDS cases continued to increase dramatically. In 1983, an average of 78 cases were reported monthly in New York City. During the first half of 1984, an average of 111 cases were reported monthly, increasing to an average of 134 cases during the second half of 1984. A monthly average of 171 cases were reported for the first 4 months of 1985. Serological studies indicated that approximately 60 percent of intravenous drug users have been infected with the AIDS virus. Of the 3,700 AIDS cases reported in New York City, 33 percent (1,239 cases) involved intravenous drug users. Since 18 percent of these cases were females, intravenous drug use is considered the most prevalent risk factor for women. New York City also reported that deaths due to AIDS among intravenous drug users increased from 88 in 1983 to 293 in 1984. In reaction to the concern regarding AIDS, reports have indicated that many of the drug users have begun to alter their needle-sharing behavior. In Harlem, for example, several vendors have begun packaging a combined bag of heroin with a hypodermic needle—called "Checkmate." This combination sells for $25 a bag. Based on statistics through early June 1985, San Francisco reported 8 heterosexual AIDS cases for intravenous drug users—0.7 percent of the 1,200 AIDS cases reported for that city. In New Orleans, the State of Louisiana Health Department reported 105 cases of AIDS for that city between 1975 and April 1985. Of these, 3.8 percent were intravenous drug users. In Newark, 53 percent of the drug abuse treatment population were diagnosed as having positive antibodies for AIDS. PATTERNS AND TRENDS IN DRUG ABUSE: AN INTERNATIONAL PERSPECTIVE THAILAND With 15 percent of the country located within the "Golden Triangle," the use of opium has been endemic in Thailand for several centuries. Currently, it is estimated that there are as many as 300,000 addicts in Thailand and that 64 percent of these addicts are located within the Bangkok metropolitan area; male addicts represent 94.3 percent of the addict population, The treatment program in Thailand consists of 99 treatment centers, which treat a population of 40,000 clients using modalities such as methadone maintenance, therapeutic communities, and traditional methods. Sixty percent of the treatment population is located within Bangkok. The average age of clients in treatment is 29 years. The most recent data indicate that new treatment admissions are down slightly and polydrug use seems to be increasing. FRANCE The emergence of drug abuse in France basically follows a pattern similar to that in other European countries. Since there is no centralized monitoring system currently in operation, it is difficult to describe national drug abuse indicator trends. Consequently, there has been a strong reliance on national surveys as well as special population studies that have been conducted. The main findings of one survey—Health Statistics in the Army—indicated that the number of drug users in France may be leveling off. Law enforcement statistics obtained from a 1985 study conducted in Paris suggested that a large number of drug addicts presently are in prisons and estimated that another 25-30 percent of those entering jail are drug addicts. Results of another study conducted in three treatment programs located in Paris indicated that 55.9 percent of all clients entering treatment were first-time clients who were primarily heroin addicts. For 76 percent of these addicts, 2 years had elapsed between first heroin use and their first treatment request. The price of heroin, which has become increasingly more available, ranges between $60 and $80 per gram. A decrease in heroin use was reported in 1982 and data suggest a recent leveling off. However, heroin continues to be a problem of major concern. The most noticeable change in substance abuse patterns in France has been for cocaine which has shown a dramatic increase in availability recently. This increase has been reflected in drug seizure data that confirm the growing use of cocaine since 1982. Cocaine presently retails in France at approximately $60 per gram. The use of LSD experienced a marked increase in 1982, in contrast to a decline that had been noted since the late 1970s. Compared with the drug addicts of the late 1970s, drug users currently presenting for treatment are older and have a more pronounced history of delinquency. MEXICO The major drug abuse problem in Mexico is the use of inhalants, such as glue, paint thinner, and industrial solvents. The use of these substances is particularly serious among the young (12 to 18 years) and poor. In addition, Mexico noted a problem with marijuana and some use of amphetamines and tranquilizers. The use of marijuana and inhalants, however, account for the greatest number of clients entering treatment programs. Reports indicate little cocaine use and almost no heroin use. One exception is the northeast zone, primarily Tijuana, which has a small number of heroin users in treatment as well as in detention centers and jails. To combat the problems associated with drug use, the government has organized prevention action programs with the intention of developing drug awareness. One of the programs established in Mexico, called ADEFAR (Program of Attention to Drug Dependence) provides a mechanism for obtaining statistical information on frequency of use and other characteristics of drug dependence, and attempts to motivate teachers, parents, and communities to provide information on street sales so that authorities can investigate drug suppliers. In addition to ADEFAR, the President of Mexico established the National Council Against Drug Dependence in February 1985. This program is comprised of four working groups that focus on health, education, research, and legislative aspects of drug abuse. FEDERAL REPUBLIC OF GERMANY Drug abuse trends in the Federal Republic of Germany appear to have remained stable since 1981, Three hundred and sixty drug-related deaths were reported during 1984, with 32 in West Berlin. One explanation for these deaths involves the fluctuating quality and purity of the heroin—between 2-60 percent—so that users are not sure of the purity of the heroin that they are injecting. Currently, there are an estimated 50,000 to 80,000 heroin addicts in the Federal Republic of Germany. Although reports indicate that incidence rates are not as high as those reported 5 years ago, new heroin use is still occurring. In Berlin, with a population of 9,000 heroin addiets, there is an incidence rate of 500 per year. Fewer heroin addiets than 5 or 6 years ago are below the age of 18. Currently, adolescents are more involved with marijuana and medications obtained from their parents’ medicine cabinets. The Federal Republic of Germany has not had any reports of epidemic cocaine use at the street level. Cocaine users are classified as upper-class consumers, middle- aged people experiencing stress on their jobs, and a small proportion of heroin addicts who also are trying cocaine. Substance abuse among "punks" consists primarily of heavy drinking, marijuana smoking, and glue sniffing—also a small but serious problem among a very young (some below 10 years old) population of 500 to 1,000 in Berlin. By the end of May 1985, 180 cases of AIDS had been diagnosed in the Federal Republic of Germany—seven of these cases involved intravenous drug users. ITALY After being level for the past several years, drug abuse trends in Italy appear to be declining. The decline in heroin use is believed to be the result of policies enacted by the government, including improving treatment facilities and adding 400 public service programs to the 100 treatment facilities previously available. Of the estimated heroin addict population of 100,000 to 200,000, 20,000 persons currently are enrolled in these public service programs, which offer treatment modalities including methadone and, on a limited experimental basis, morphine. Italy has experienced differences in regional patterns of abuse. In 1980, the majority of drug abuse problems were concentrated in the larger cities. However, during the past 5 years, abuse patterns in the urban areas have stabilized, while spreading to the outlying areas. In many instances, the latter are coastal areas that are susceptible to drug smuggling from the Middle East. Surveys conducted in the school systems have indicated a decrease in the number of new users among students, but an increase in the problems associated with drug abusing dropouts. I-14 Although no precise data currently are available, the problems associated with cocaine use are on the rise. Reports also indicate that Italy is experiencing a new type of drug dependence—the use of legal drugs (analgesics) available from physicians by prescription. As a consequence, treatment programs have experienced an increase in polydrug abuse among clients who are using heroin in combination with these analgesics. CITY PAPERS METROPOLITAN ATLANTA DRUG ABUSE REPORT - JUNE 1985S. James F. Goss, Jr., M.P.H., Emory University Department of Community Health A. James Ruttenber, Ph.D., M.D., Centers for Disease Control The Atlanta metropolitan area consists of seven counties in north central Georgia: Clayton, Cobb, Dekalb, Douglas, Fulton, Gwinnett, and Rockdale. The 1985 population of the metro area is estimated to be 2,010,000. Seventy-four percent of metro residents are white, 22% percent black, and 4% percent are of other racial origin. The City of Atlanta, with a 1985 population of 427,000, is located in Fulton and Dekalb counties. Sixty-eight percent of city residents are black or of other racial origin, and 32% are white. Data for this report were analyzed in late May and early June, and contain the most recent data from the following sources: Medical Examiner Cases Data on drugs detected in autopsy samples of medical examiner (ME) cases are abstracted for the three largest counties in the metro area: Fulton, Dekalb, and Cobb. These data were obtained directly from the computer files of these ME offices for the period between April 1984 and March 1985. The time lag between submission of samples and receipt of toxicology reports from the state crime lab precludes the reporting of more current data. As seen in Table 1, no samples contained heroin or morphine. According to DAWN data, neither heroin nor morphine has been detected in a ME case in over three years. The number of cocaine mentions increased dramatically in the fourth quarter of 1984 but then decreased just as dramatically in the first quarter of 1985. Emergency Room Admissions These data for non-fatal drug-related emergency episodes are from Grady Memorial Hospital, the largest hospital in the metro area. They were obtained on a monthly basis directly from computer tapes, and reflect admissions between January 1985 and May 1985. Arrangements have been made to abstract data directly from the files of the private laboratory that performs toxicology analyses for the remaining hospitals in the metro area. Hopefully, our next report will include toxicology data from all metro emergency services. As with ME data, Table 2 shows an absence of heroin or morphine. Barbiturates, major tranquilizers, and cocaine are the most prevalent drugs in emergency admissions, with each representing approximately 20% of all drug mentions. Ix-1 DAWN data for emergency room admissions for 1981 to 1984 are presented in Table 3. Though the ratio of heroin mentions to those for all drugs have remained consistently low, the absolute number of heroin mentions has been declining steadily since 1981. Methaqualone also has been steadily decreasing in popularity, but cocaine mentions have steadily increased. Treatment Admissions These data, summarized in Table 4, have been extracted from the same CODAP computer tapes that are sent to NIDA. They include data from all treatment centers in the metro area that report to the CODAP system. The tapes are received and analyzed monthly and include data from January 1985 to March 1985. Table 4 indicates heroin to be the most common primary drug of abuse. Only 25% of these were first time admissions, however. On the other hand, 97% admissions for cocaine abuse and 85% of admissions for marijuana abuse were for the first time. Cocaine, marijuana, and the category consisting of other opiates and synthetics are also frequently mentioned as primary drugs of abuse The median age for all admissions is 28. Persons admitted for abuse of heroin and cocaine have the highest median age, 31, and persons admitted for abuse of sedative/hypnotics the lowest, 21. Sixty-five percent of all admissions are males (Table 5) and 60% are white. The majority of persons admitted for heroin or cocaine abuse are black, but those admitted for abuse of other opiates are almost exclusively white. Admissions for marijuana are fairly evenly distributed among blacks and whites. Law Enforcement Price and purity data are reported by the Atlanta Regional Office of the U.S. Drug Enforcement Administration for January 1981 to December 1984. Reports of drug-related arrests by local and state law enforcement agents are received semi-annually from the Georgia Bureau of Investigation's Georgia Crime Information System. The purity of heroin in the Atlanta area remains very low in comparison with other cities. Southwest Asian heroin continues to be the predominant type of heroin available in Atlanta. Reports from DEA indicate that southeast Asian and Mexican heroin are becoming more popular, and that there has been an increase in the availability of all types of heroin in the Atlanta area during the last year. The DEA also reports that Mexican heroin of high purity has been found on the street in recent months. Heroin samples were most frequently cut with either mannitol, lactose, or quinine. Approximately 37% of all heroin samples also contained cocaine. Enforcement officials predict the combined use of heroin and cocaine will continue to be popular. 11-2 Table 7 indicates arrests for marijuana to be the most frequent of all drug abuse arrests. For the period 1981-1984, increases were noted in arrests for cocaine, hallucinogens, heroin, narcotic equipment, and synthetic narcotics. Supplemental Data Law Enforcement sources consider cocaine to be a very popular drug of abuse. Trafficking trends indicate that Atlanta continues to be a wholesale marketplace for cocaine transactions between Florida supply sources and distributors from other sections of the country. Cocaine reportedly is much cheaper in Atlanta now than it was a year ago. The street level purity has risen to approximately 50-55%, which is considered very high for this area. As mentioned earlier, the combined use of heroin and cocaine has increased recently. This may be due to the increased availability of low priced cocaine. Despite the law enforcement reports of a recent increase in heroin availability and quality, abuse rates for heroin are among the lowest of any city reporting to DAWN. The heroin substitute, Dilaudid, has traditionally been a narcotic of choice in Atlanta. Abuse rates for this synthetic narcotic appear to have declined, however. High quality sinsemilla , commercial-grade domestic, and Colombian varieties of marijuana are readily available in the Atlanta area. Colombian marijuana reportedly sells for $40-50 per ounce and for $400-450 per pound in 500 pound lots. Commercial domestic marijuana sells for approximately $250-300 per pound while sinsemilla ranges from $1,000-1,500 per pound. LSD is reported to be moderately available with both the purple micro-dot and cartoon strip acid varieties available. Methamphetamine is widely available and remains a popular manufacturing and trafficking specialty for outlaw motorcycle gangs in Georgia. Atlanta is reportedly a major wholesale distribution center for methamphetamine for the entire Southeastern United States. Discussion Our data indicate ethanol to be the primary drug of abuse in the Atlanta area. Heroin, however, is surprisingly infrequent. Toxicologic evidence for this drug in medical examiner cases and emergency room admissions has declined since 1981. There is no reason to believe this decline is a problem of availability or changes in drug use practices. These data could indicate the use of other opiates that are not detected in routine drug screens-- such as analogs of meperedine or fentanyl. The data may also reflect the fact that morphine is not detected when in combination with cocaine. 11-3 Cocaine is readily available in moderately high concentrations. The use of cocaine should be considered the major drug abuse problem of public health concern in the Atlanta area. Medical examiner data support this point, as there are significantly more fatal overdoses involving cocaine than heroin. Discussions with medical examiners suggest that some of the deaths attributed to cocaine may, in fact, be due to the combination of heroin and cocaine. Also of note, is that even though Atlanta has a large black population, PCP is not as significant a drug of abuse as it is in other black communities. The use of barbiturates appears to be more popular here than in other areas as evidenced by the number of mentions in medical examiner cases and in emergency room admissions. It is not clear at this time if this trend is due to prescription abuse or to the diversion of commercially manufactured barbiturates. I1-4 S-11 TABLE 1 Drugs Detected in Medical Examiner Cases, Fulton, Dekalb, and Cobb Counties, 1984-1985 2nd Quarter 1984 3rd Quarter 1984 4th Quarter 1984 1st Quarter 1985 % of % of % of % of Over- Total Over- Total Over- Total Over- Total dose Other Drug dose Other Drug dose Other Drug dose Other Drug Deaths* Deaths Total Mentions Deaths* Deaths Total Mentions Deaths* Deaths Total Mentions Deaths* Deaths Total Mentions Heroin/morphine 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Meperidine 0 0 0 0 0 1 1 1.3 0 0 0 0 0 0 0 0 Codeine 1 3 4 5.6 0 1 1 1.3 0 2 2 1.8 2 3 5 4.8 Other Opiates 0 3 3 4.2 0 3 3 3.8 1 3 4 3.35 2 3 5 4.8 Barbiturates 0 10 10 14.1 2 18 20 25.3 2 18 20 17.5 3 7 10 9.5 Major Trangs. 3 1 4 5.6 0 2 2 2.5 3 4 5 4.4 0 1 3 1.0 Minor Trangs. 1 9 10 14.1 2 8 10 12.7 0 15 a5 13.2 6 17 23 21.9 .Tricyclics 1 4 5 7.0 0 5 5 5.3 1 2 3 2.6 2 4 6 5.7 Cocaine 3 6 9 12.7 2 7 9 11.4 1 18 19 16.7 2 8 10 9.5 MJ/THC 0 3 3 4.2 0 1 1 1.3 0 2 2 1.8 0 10 10 9.5 PCP 0 0 0 0 0 1 1 1.3 1 3 2 1.8 0 0 0 0 Amphetamines 0 3 3 1.4 0 1 1 1.3 1 2 3 2.6 1 4 5 4.8 Quinine 0 4 4 5.6 1 0 1 1.3 0 7 7 6.1 1 3 4 3.8 Ethanol** 4 14 18 23.4 2 22 24 30.4 5 27 32 28.1 7 19 26 24.8 Quarterly Total 13 58 71 9 70 79 13 101 114 26 79 105 *For a single death, each drug that is detected is counted. *XEthanol in combination with another drug o-J1 TABLE 2 Drugs Mentioned in Emergency Room Admissions, Grady Memorial Hospital, Atlanta, 1985 January February March April May Freq. Fox Freq. Fox Freq. FX Freq. Fox Freq. Heroin/Morphine 0 0 0 0 0 0 0 0 0 Meperidine 0 0 0 0 0 0 3 5 0 Codeine 1 3 0 0 0 0 0 0 0 Dilaudid 0 0 0 0 0 0 0 0 0 Pentazocine 0 0 0 0 0 0 0 0 0 Non-Specific Narcotics/Opiates 0 0 0 0 0 0 0 0 Barbiturates 9 24 11 29 6 15 10 18 12 Methaqualone 0 0 0 0 0 0 0 0 0 Major Tranquilizers 8 21 8 21 6 15 4 7 5 Minor Tranquilizers 0 0 0 0 1 3 4 7 6 Tricyclics 2 5 8 21 7 18 6 11 1 Cocaine 7 18 5 13 9 23 20 35 4 PCP 2 5 0 0 0 0 0 0 0 Amphetamines 1 3 2 5 4 10 3 5 2 Quinine 0 0 0 . 0 0 0 0 0 0 Quinine/Quinidine 2 5 1 3 3 8 4 7 2 Diphenhydramine 6 16 3 8 4 10 3 5 4 Sedative Hypnotics 0 0 0 0 0 0 0 0 0 Ethanol*x 335 90 365 91 510 93 416 88 385 *Reported from DAWN, Statistical Series G, #13, 1984. *%*Reported from DAWN Drug Alert, May 1985. "G86T ABR ‘3J0TVY 3na@ NMVA Woaj pejJoded xx "9861 ‘€I# ‘O SOTJeS TBOTISTIBIS ‘NMVA Woaj pejaodsy x 0°0 SY6T 0°0 6v0¢ 0°0 oveéec 0°0 14144 SUOTJUSH TB3j0L 0°S¢L 8SYT L°TL OLY 9°89 9102 6°S9 2962 Sasylo TIV 6°CL 162 9°91 00€¢ 8°0 4:14 9°81 9¢8 UoT3euUTquOD—uUT-TouBylyg S°0 6 v0 6 8°0 27 S’ 0c as‘ 6°T 9¢ L°T SE LT 1s 6°1 L8 OHL/ICR £0 S v0 8 v0 €T S°0 ve dod cS 201 17 v8 9°¢€ 901 £2 SOT auTeO0) 8°0 SE 2't 99 v's 6ST 9°'9 96¢ auotenbeyjspi 0°'T 6T "1 ve LO 0c T1 6v PIPNBT IA 9°0 IT 8°0 91 L°0 61 6°0 iv sutptaadeR 0°'1 6T €°'1 LZ 8°'1 Zs L'T 14 autydaol/utoasy % ‘baag 4 ‘baag % ‘boag % ‘baag *x¥86T xx€86T *x%C86T xI86T NMVQ 03 po3jaodea se y86T1-1861 ‘BIUBTIY OJIJSH UT SUOTISSTWPY wooy ALouslaswy UT PIUOTIUSH S8nag ¢ A19VL II-7 TABLE 4 Treatment Admissions by Primary Drug of Abuse, Metro Atlanta, 1985 January February March Freq. % Freq. % Freq. % N 0 N Oo Heroin 27 28 32 27 Other Opiates/ Synthetic Narcotics 2 Barbiturates Sedatives/Hypnotics Tranquilizers Cocaine Marijuana/THC Amphetamines Hallucinogens Inhalants Methadone Alcohol Others 1 = nN Ww = MNNOOO®®MOHOOO® 2 N= OHHHEMUMOOKHW De OHMHHMHEBMANOOH OG — OCOHHOWMANOHKHW = OO HMFHOWONVLVOHMKEO®O N= NNO OONDMDOOOO VN O © oo O O w Total Ix-8 TABLE 5 Treatment Admissions for Primary Drug of Abuse by Race and Sex, Metro Atlanta, January - March, 1985 z Black Male Female Male Female w on = Oo - Ww — w Heroin Other Opiates/ Synthetic Narcotics Barbiturates Sedatives/Hypnotics Tranquilizers Cocaine Marijuana/THC Amphetamines Hallucinogens Inhalants Methadone Alcohol Others N N= OCO0OO0O0OON®®OOOH OCo0o0cOoOrHOGONOOODM> nN OCWHNOOUV®OOHOK fet coHOOULMMULOON WO ~ ~ N [+] Oo Oo Nn Oo Total 11-9 TABLE 6 Price & Purity of Heroin Street Samples*, Metro Atlanta, 1981-1984 1981 1982 1983 1984 Average Price ($/mg) 6.07 7.11 8.58 7.85 Average Purity*x 1.7 2.2 2.0 2.5 % SWA 89 97 77 59 % SEA 4 0 14 27 % MEX 7 3 9 14 *From the Atlanta Regional Office, U.S. Drug Enforcement Administration SWA = produced in southwest Asia. SEA = produced in southeast Asia. MEX = produced in Mexico. *%x % dry weight heroin content 11-10 T1-IX TABLE 7 Drug Arrests for State of Georgia, 1981-1984 1981 1982 1983 Drugs, etc. Arrests % Arrests % Arrests % Arrests Heroin 18 0.2 8 0.1 105 1.5 160 1.9 Other Opiates 181 2.0 189 2.3 121 1.7 10 0.1 Synthetic Narcs. 41 0.5 110 1.3 139 1.9 174 2.1 Barbiturates 118 1.3 177 2.2 94 1.3 62 0.7 Hallucinogens 7 0.1 33 0.4 37 0.5 51 0.6 Cocaine 322 3.6 314 3.9 636 8.8 1,128 14.6 Marijuana 5,635 63.0 4,991 60.9 4,129 57.2 4,484 53.3 Amphetamines 149 1.7 208 2.5 100 1.4 86 1.0 Other, Misc. 2,475 27.7 2,154 26.3 1,832 25.4 2,113 25.1 Narcotic Equip. 1 0.1 10 0.1 28 0.4 40 0.5 Yearly Totals 8,947 8,194 7,221 8,408 COMMUNITY EPIDEMIOLOGY WORK GROUP JUNE 1985 THE BUFFALO REPORT OVERVIEW In Buffalo the trend back to true narcotics continues to be the order of the day as the primary substances of abuse in the area. It should be stated that pentazocine (Talwin) is no longer a significant substance in the patterns of abuse for Buffalo. Of continued significance also is that cocaine has replaced diazepam (Valium) as the second leading substance of abuse for the area. All available indicators suggest that cocaine use continues at an increased pace. Valium use in the area has not diminished, however, its position relative to other abusable substances has been reduced to third from second as the most mentioned cause for treatment. Other than alcohol, marijuana remains the most frequently used substance among the treatment population. INPATIENT DATA Heroin continues to lead causes for admission to inpatient treatment services accounting for fifty-one percent (51%) of the primary substances listed on admission, Dilaudid accounted for another nine percent (9%) of all admissions for dependence. : Narcotics as a group accounted for sixty-nine percent (69%) of all admissions and in most cases any narcotic was used when the preferred substance was not available, For the second reporting period, cocaine represents the second most mentioned substance as a cause for admission to inpatient treatment. Twelve percent (12%) of all admissions were for dys- functional states associated with this drug as compared to three and one-half percent (3%%) for the same period in 1983. Valium the third place drug, continues to account for approx- imately the same number of admissions as a primary substance, with only its relative rank decreased. Valium accounted for six percent (6%) of all admissions during the period. In addition, other than alcohol, Valium was the substance most frequently mentioned where a co-dependence was involved on admission. 11-12 Demographic data for this period shows that black admissions outnumbered Caucasian admissions fifty-five percent (55%) to thirty- nine percent (39%) and the Hispanics accounted for six percent (6%) of all admissions. Males outnumbered females sixty-two percent (62%) to thirty-eight percent (38%). The average age continues to rise and for this period was 32 years. Request for inpatient treatment remains high with waiting lists growing as high as forty-five (45) for twenty (20) bed slots, Average delay in admission has been fourteen (14) to sixteen (16) days. OUTPATIENT DATA Canvasses of outpatient programs support the inpatient statistics with a shift away from Talwin to standard narcotics. Admission to “outpatient services for cocaine use is also on the increase, : The demand for treatment remains high with most programs operating at or above static capacity. METHADONE MAINTENANCE Of the three available programs in the area, one is at static capacity and slots are available at the other two. The Niagara Falls program, which is one of the three, continues to move toward full utilization with sixty-two percent (62%) at the end of 1984. EMERGENCY ROOM MENTIONS The significant figure for this indicator is that emergency room mentions for cocaine have doubled for the period while heroin and Valium have remained virtually the same. DEATH DATA The Medical Examiner's office reported one death where heroin/ morphine was found, however, no deaths were seen where heroin or cocaine were listed as the sole cause. Considerable concern still remains in the area for the details related to sedatives/hypnotic drug group as well as the antidepress- ants (eight (8) collectively). Also of particular note is the fact that propoxyphene (Darvon) was responsible as the sole cause in six (6) deaths during this period. PRICE & PURITY Heroin and cocaine continue to be readily available at a slightly higher price for heroin and slightly lower price for cocaine. Heroin purity remains in the range of three to six percent (3-6%) and street cocaine in the range of thirty to fifty percent (30-50%). See Chart, VI. I1-13 CRIMINAL JUSTICE DATA Felony drug arrests for the period totaled 113 with no specific breakdown as to the type of drug involved. Over 100 arrests were involved in a single raid. HEPATITIS DATA The relative distribution of reported hepatitis cases remains consistent with some reduction in total Non-A; Non-B Hepatitis. Type B represented sixty-eight percent (68%) ,Type A represented twenty-six percent (26%) and Type Non-A, Non-B accounted for six percent (6%). ; : AIDS CONCERNS Of twenty-three (23) cases of identified AIDS treated in the area during this period, the data on IV drug use among those treated is not available for this report. More detailed information will be reported in the future. SUMMARY Narcotics as a group continue to be the major concern for the area with a projection that this trend will continue especially for heroin and Dilaudid. Talwin is no longer a significant substance of abuse in the area. Cocaine continues to be the fastest growing problem for the area with all programs gearing to meet this trend. 11-14 BUFFALO REPORT LS ar COMPARISON OF DRUG TYPE AS CAUSE OF ADMISSION CHART 2 SUBSTANCE INTERVENTION UNIT - ERIE COUNTY MEDICAL CENTER - BUFFALO, NEW YORK 7/% to [W/L to 17/1 to |1/Vl te |7/1:t0 | 1/Lto 19/1 to 12/31/81] 6/30/82|12/31/82 30/83 Amitriptyline : . 1 2 DRUG TYPE Amobarbital Amphetamine Barbiturate Butalbital Butisol Sodium Butorphanol Cannabinol Carisoprodol Chlordiazepoxide Chlorpromazine Cocaine (Metabolites) Codeine Desipramine Dextromethorphan Diacetylmorphine Diazepam Diphenhydantoin Diphenhydramine Diphenoxylate Ethchlorvynol Fluphenazine Flurazepam Glutethimide Haloperidol Hydrocodone Hydromorphone Imipramine Loperamide Lorazepam Lysergic Acid Diethy Meperidine Meprobamate Methadone Methamphet Methaqualone Methylphenidate 11-15 BUFFALO REPORT JUNE 1985 COMPARISON OF DRUG TYPE AS CAUSE OF ADMISSION - Page 2 CHART I SUBSTANCE INTERVENTION UNIT - ERIE COUNTY MEDICAL CENTER - BUFFALO, NEW YORK DRUG TYPE - Cont'd. 7/1 to 1/):tol 7/1 to. {1/kto ] to 1/1 to 7/1 to 3112/31/83{6/30/84 | 12/31 1 Morphine 1 3 Methyprylon Nalbuphine Nalorphine Oxycodone Pentazocine Solitary With Tripelennamine With Diphenhydramine Pentazocine Nx Pentobarbital Perphenazine Phencyclidine Phenhydramine Phenmetrazine Phenobarbital Phentermine Prazepam Propoxyphene Secobarbital Tetrahydrocannabinol Thioridazine Triazolam Trifluoperazine Tripelennamine Triprolidine Ethanol (Co-diagnosis) Clorazepate II-16 ADMISSIONS BUFFALO REPORT CHART II JUNE 1985 COMPARISON OF DRUG TYPE AS CAUSE OF ADMISSION TOTAL SUBSTANCE INTERVENTION UNIT ADMISSIONS - 205 ERIE COUNTY MEDICAL CENTER, BUFFALO, NEW YORK Inpatient Number: E.R. Mentions Significant in DRUG TYPR Admissions E.R. Mentions | Last Quarter Cause if Death | NUMBER | PERCENT Amobarbital - - - - - Amitriptyline - - 15 6 3 Amoxapine ve - - - 1 Butalbital 4 Py. 3 8 1 Butorphanol = = - - 4 Cannabinol 2 .1 13 35 - Carisoprodol = - - ~ - Chlordiazepoxide 1 ol 9 2 Chlorpromazine - ~ 9 - Cocaine (Metabolites) 23 11.0 7 16 - Codeine 16 8.0 2 11 Desipramine - - 3 5 Dextromethorphan - i - - = Diacetylmorphine 105 51.0 4 4 1 Diazepam 12 6.0 52 57 2 Diphenhydramine 2 - 9 2 2 Diphenoxylate - - - - - Diphenhydantoin - a 2 1 4 Doxepin - 5 3 3 Ethanol wa 1 100 105 158 Ethchlorvynol - - - 1 - Fluphenazine - - - - - . Fluorazepam - - 13 9 rs Glutethimide 2 +) - 1 - Haloperidol - - 3 4 - Hydrocodone 2 - - - 1 Hydromorphone 19 9.0. . 2 we = Imipramine ge - 4 2 4 Loperamide = - - - - Lorazepam = - 5 5 - 11-17 TOTAL ADMISSIONS - 205° July 1, 1984 to December 31, 1984 BUFFALO REPORT JUNE 1985 CHART II .......Page 2 DRUG TYPE Inpatient Admissipns Number: E.R. Mentions NUMBER PERCENT Lysergic Acid Diethylami Meperidine Meprobamate Methadone Methamphetamine Methaqualone Methylphenidate Methyprylon Nalbuphine Nalorphine Oxycodone Pentazocine Solitary With Tripelennamine With Diphenhydramine Pentazocine Nx Perphenazine Phencyclidine Phenmetrazine Phenobarbital Phentermine Prazepam Propoxyphene Secobarbital Tetrahydrocannabinol Triazolam Trifluoperazine Tripelennamine Triprolidine de eid .1 II-18 E.R. Mentions Last Quarter Ww HS —-Ww Significant in Cause if Death 6T-1II BUFFALO REPORT - JUNE 1985 TRENDS IN LEADING DRUG CAUSES FOR ADMISSION SUBSTANCE INTERVENTION UNIT ERIE COUNTY MEDICAL CENTER BUFFALO, NEW YORK JULY 1984 - DECEMBER 1984 CHART III July-Dec.'82 Jan.-June'83 | July-Dec.'83 Jap.-June'84 Inly-Dec '84 DRUG TYPE No. = No J No % NO . No % AMPHETAMINES 13 5,0 5 2.0 6 2.3 8 3 0 0 BARBITURATES 10 4.0 3 1.3 2 0.8 2 3 3. i COCAINE 17 1.0 5 2.0 43 16.4 45 x7 23 12 CODEINE 16 2:0 10 4.0 37 8.5 8] 16 | DIACETYLMORPHINE 107 44.0 7x 30.5 98 372.9 150 56 105 51 DIAZEPAM 37 15.0 - 2) 2.0 45 17.2 40 158 12 6 HYDROMORPHONE 39 16.0 11 4.0 28 10.7 49 18 19 9 LYSERGIC ACID DIETHLAMIDE i 1.0 : 0.5 1 0.4 = 0 1 +1 MEPERIDINE 5 2.0 3 0.5 6 2.3 4 1 0 0 METHADONE 2 1.0 3 1.3 - — 24 9 0 0 MORPHINE 3 2.0 - - 1 0.4 3 1 0 0 OXYCODONE 7 3.0 1 0.5 7 2a] 2 1 0 0 PENTAZOCINE 58 24.0 74 31.8 22 8.4 14 5 7 3 PENTAZOCINE Nx » ih = - 2 =o 10 4 0 0 PHENCYCLIDINE 3 1.0 4 1.7 17 6.5 9 3 1 ol PROPOXYPHENE 13 5.0 8 3.4 16 6.1 14 5 5 2 CHART IV BUFFALO REPORT JUNE 1985 DEMOGRAPHIC CHARACTERISTICS BASED ON ADMISSIONS SUBSTANCE INTERVENTION UNIT ERIE COUNTY MEDICAL CENTER Buffalo, New York July 1, 1984 to December 31, 1984 TOTAL # ADMISSIONS: 205 CAUCASIAN 80 397 BLACK 112 55% HISPANIC 13 6% OTHER 0 E 128 62% FEMALE 77 382 VERAGE AGE 32 Years 11-20 BUFFALO REPORT JUNE 1985 CHART V REPORTED VIRAL HEPATITIS CASES IN ERIE COUNTY July 1, 1984 - December 28, 1984 Hepatitis Total A 17 B a4 Non A & Non B 4 11-21 CHART VI BUFFALO REPORT JUNE 1985 BUFFALO AREA PRICE & PURITY SIX-MONTH PERIOD JULY 1, 1984 - DECEMBER 31, 1984 4 SAMPLES AVERAGE PRICE AVERAGE PURITY ITEM BPD ECSD BPD ECSD BPD ECSD $25,%$50 “> 3% to HEROIN $75 $50 Bags 6% POISON $25 BAGS 12% to (HEROIN) $50 BAGS 15% $100/Gram COCAINE 2100/ounce rm $90/Gram 50% to 1800/ounce 90% = $100/Gram : STREET 2100/ounce 30% to 50% ROCK CRYSTAL Pa tc almost pre INFORMATION SOURCES: Buffalo Police Laboratory Total cases reported: Erie County Sheriff's Narcotics Division, Iz-22 SUBSTANCE ABUSE TREND UPDATE for Chicago and Illinois June 1985 W. Wayne Wiebel, Ph.D. Illinois Department of Alcoholism and Substance Abuse The generally consistent substance abuse trends noted over the past year through- out Illinois continue to be reflected, without significant variation, by epidemio- logical indicator data. Of the commonly abused illicit substances, cocaine remains the only drug to have shown consistent patterns of escalating abuse over the past half decade. Depressants, stimulants, and hallucinogens, on the other hand, have shown decreasing patterns of abuse within the past year or two. The two drugs most frequently associated with the need for treatment, however, heroin and marijuana, have remained relatively stable in recent years. The issue of drug availability, mentioned in the previous report as confounding trend analysis, seems to have significantly decreased as a factor impacting drug prevalence over the past six months. For the most part, the major drugs of abuse have been reported to be available on a relatively constant basis, within the Chicago area, this reporting period. As traditionally dictated, the analysis of drug trends is organized in this report by pharmacologic category in order to simplify analysis and facilitate the orderly presentation of data. Readers are reminded, however, that individual drug trends rarely vary independently of other drugs and that multiple drug use is the norma- tive pattern within the broad range in types of drug abusers. NARCOTICS The long established association of narcotic abuse with physical dependence, over- dose deaths, and criminal activities related to addict lifestyles, has continued to maintain narcotic trends in the spotlight of professional and public attention. Of particular concern over the past few years has been the fear that Chicago might follow other major metropolitan areas in a resurgence of heroin purity and popu- larity. Following a precipitous drop in treatment admissions beginning in the mid-1970's, primary narcotic dependence problems have accounted for approximately one half of all public treatment admissions since 1979. The relative stability of client race and sex composition in conjunction with a gradual increase in the age of admitees over the past five years strongly suggest the existence of a common pool of older addicts feeding into the treatment system. To date, there is no indication that substantial numbers of newer and younger addicts are requiring treatment for nar- cotics dependence within Illinois. 11-23 Admissions to treatment for heroin dependence have remained stable at approximately 45% of total admissions for substance abuse over the past four years. During the same period of time, admissions to treatment for dependence on other opiates have declined by almost half, from approximately 6% in 1982 to 3% in the first three quarters of 1985. Toxicology results for clients entering treatment at the Central Intake screening facility (Medical Referral Services), while closely correlated to admissions data, offer some additional insights. For example, over the past few years positive urine tests for morphine have fluctuated between 50% or over each September to 40% or less each March. DAWN data, on the other hand, show a steady increase of in- puted emergency room mentions for heroin/morphine from a mean of 82 in 1982, to 102 in 1983, and 127 in 1984. Other opiate drugs and drug combinations which have traditionally gained greatest favor during periods of relatively low heroin purity seem to be declining in pre- valence of abuse. Talwin, the drug often combined with pyribenzamine as "T's and Blues", experienced its most dramatic drop in prevalence of abuse from mid 1981 to mid 1983. At its peak period of abuse, 20% of all admissions to treatment at the Central Intake referral service registered positive toxicology reports for the presence of Talwin in urine samples during June of 1981. By September of 1983 abuse of Talwin had nearly extinguished as reflected in only 2% positive toxicology tests for the drug at the Central Intake facility. Since that time there has been some fluctuation in results of tests for the drug among clients entering treatment (a return to almost 10% in March 1984 followed by a decline to 2% in December of 1984 and an increase to over 9% by April 1985). However, the introduction of the reformulated Talwin NX pill and a change in patterns of use marked by a decline in the popularity of the drug combination as a preferred intoxicant, suggest the un- likelihood of Talwin returning to previous, high levels of abuse. One of the more common pharmaceutical analgesics taken by narcotic addicts as part of multiple drug regimens to potentiate the effect of other opiates has been Darvon. Toxicology results from clients entering treatment, however, indicate a substantial decline in the use of this drug among this subgroup of narcotic addicts. From a peak of over 15% positive toxicology tests from Darvon at Central Intake in December 1981, there has been a gradual decline to less than 5% positives over the past nine months. Although reports indicate that codeine abuse, both alone and in combination with depressants, remains a problem in Chicago, some indicators suggest a decline in prevalence of abuse. Street reports point toward reduced availability of codeine based cough syrups but little change in ready access to pills containing the drug. Toxicology results from Central Intake show a decline from 15% positive in June 1984 to less than 10% over the first quarter of 1985. Depressants frequently associated in combination with codeine, especially Doriden and Valium, have also shown evidence of decreasing patterns of abuse (see Depressant section). II-24 MARIJUANA Following a period of unusual fluctnations in the availability of marijuana throughout 1984, the first six months of 1985 have shown evidence of a return to the more generally abundant supply patterns typical in previous years. Of parti- cular note, the commercial ,''Columbian' grade of marijuana which had been in scarce supply for over a year and a half, is reportedly available throughout the city. This particular grade of marijuana is favored by many users because of its rela- tively reasonable price (approximately $80 per ounce) and good quality. With the influx of Colombian marijuana this year, demand for lower grades of ''pot'" has been markedly reduced. Among adolescent drug users, many joints being sold for $1 or $2 as "Colombian' are believed to actually contain the less desirable, so called ''ditch weed". Many users who were reportedly buying % or % ounce quantities of the more potent exotic grades of marijuana during those periods when Colombian was not available have switched back to the less expensive but "good" quality Colombian. A market for the nighest grades of marijuana continues, however, among more affluent users who are willing and able to pay the $150 to $300 per once price for the exotic, resinous strains of this plant. Admissions to treatment for primary marijuana abuse have historically represented young (over half under age 20) and primarily white (over three quarters) clients within the treatment system. Within publicly funded programs for drug abuse treat- ment, marijuana has continued to account for approximately 20% of all admissions since 1981. DEPRESSANTS Depressant drugs, including tranquilizers, sedatives and hypnotics, have shown some moderating trends of abuse in the first half of 1985 yet they are still a common component within the multiple drug taking regimens of a wide variety of drug users. Unlike many of the other commonly abused categories of drugs, depressants are much more frequently associated with patterns of use in combination with other drugs than they are as primary drugs of abuse alone. While this has resulted in fewer individuals becoming physically dependent on depressants than was the case a decade ago, the dangers associated with overdose and accidents while intoxicated on these drugs makes their misuse no less of a concern today. In the Chicago area, depressant-in-combination users have been categorized as tending to follow one or more of three major abuse patterns. The first pattern of abuse ‘includes depressants in combination with narcotics to potentiate the effect of the opiates being taken. Such is the case with heroin addicts and methadone clients who take Valium or, more recently, with codeine cough syrup users who drink the syrup along with '"bean' (Doriden or Valium). The second type of depressant abuser uses these drugs to counteract the effects of chronic stimulant abuse. "Speed freaks' often take barbiturates to induce sleep after extended periods of Ix-25 stimulant abuse and chronic cocaine users often use depressants to minimize the undesirable effect of high dose cocaine abuse. The final variety of depressant-in- combination user mixes alcohol, which also is a central nervous depressant, together with sedative-hypnotics or tranquilizers. While potentiating the effects of the i taken, alcohol use greatly increases the risk of accidental overdose and eath. Mandrax, the foreign pharmaceutical preparation suspected now of being manufactured illictly, appears to be the major drug being used lately as a Quaalude substitute. Supplies of the drug have remained plentiful and the price decrease, from $10 a piece to $7 or $8, mentioned last report continues. Of particular note this reporting period, many of the drugs contained in this general category have shown signs of moderating patterns of abuse. In FY (fiscal. year) 1984, barbiturates, sedative-hypnotics and tranquilizers together accounted for 4.7% of primary treatment admissions within State supported programs. In the first three quarters of FY 1985, this declined to 3.4%. More revealing are the toxicology reports from the Central Intake screening facility. Following a peak of over 40% positive for benzodiazepines among clients entering treatment in June of 1981, positive tests have dropped gradually, with some minor fluctuations, to less than 20% during the first quarter of 1985. In a similiar downward trend, barbiturates fell from over 10% positive in clients entering treatment at Central Intake during June 1984 to 5% or under throughout much of this current reporting period. Following rescheduling in September 1984, glutethimide (Doriden) abuse appears to have been dramatically curtailed. Since its classification as a Schedule II Designated Product, positive toxicology tests for glutethimide at the Central In- take screening facility have dropped from less than 1% to no positives in the first quarter of 1985. Aside from street reports regarding the rising popularity of Mandrax, the only other commonly abused depressant to have shown signs of increasing abuse has been Placidyl. In clients admitted to treatment through Central Intake, positive toxi- cology tests for Placidyl have increased from less than 5% in 1984 to over 10% in the first quarter of 1985. As noted in the last report, Placidyl has been linked to a number of inadvertant overdoses among users seeking an acceptable substitute for the once popular, but no longer available, depressant Quaalude. STIMULANTS The abuse of stimulant drugs, excluding cocaine, is attributed to a number of dis- tinctly different types of drug users in the Chicago .area. As a consequence of the recent advent of a pharmaceutical stimulant becoming available in significant quantities in illicit Chicago Markets, the possibility of increased use among popu- lations with previous low levels abuse patterns is a distinct possibility. In particular, Didrex has been reported as being increasingly available among Northside multiple drug user networks. Over the preceding five or more years, the only stimulants available in significant quantities have been to these drug users 11-26 either look-alike pills or Preludin. Among multiple drug users in their twenties or thirties, look-alikes (containing caffeine, ephedine and phenylpropanolimine) are looked down upon as "kiddie speed' and, for the most part, avoided. Preludin, on the other hand, while a true controlled stimulant, sells for $12-$15 apiece on the street and is not thought to be worth the expense bv any group other than the intravenous ''speed freaks'. With Didrex now available at a price of $5-$8 each, many previously inexperienced stimulant users are said to be experimenting with" and adopting this stimulant within their multiple drug ingestion regimens. Among the traditional groups of stimulant abusers in the Chicago area, the largest group are the primarily white, youthful consumers of look-alike pills. At a price of $1-$2 each, look-alike stimulants are readily available in high school aged, white drug user networks and are popular particularily among females. For many youthful drug users, look-alikes follow only alcohol and marijuana in frequency of consumption. The second and much smaller type of stimulant abusing group in Chicago is composed of intravenous ''speed freaks.' Concentrated predominantly on Chicago's Northside, these individuals heavily favor the pharmaceutical stimulant Preludin, which commands a street price of between $12-§$15 per pill. This group of older and more intensive drug users tends to develop more serious problems in relation to their drug use due to the more potent stimulant drugs they abuse and their preferred route of administration. COCAINE Cocaine is the only drug to have shown consistently increasing patterns of abuse within Illinois over the past seven years. With cocaine accounting for 15% of primary treatment admissions so far in FY 85, Illinois is experiencing over seven times the rate of admissions for cocaine in public programs compared to 1978. Even more distressing is the fact that these figures represent only the '"'tip of the iceberg’ in that there are now numerous private, nonreporting programs specializing in the treatment of cocaine dependence. Almost all of these hospital based private programs have emerged within the past few years and have treated an unknown, though presumably large, number of clients who are not included in the State's formal data gathering system. Further, - underscoring the extent of the current cocaine epi- demic, cocaine, for the first time in 1984, surpassed all other single drugs in contributing to emergency room episodes as reported in the Drug Abuse Warning Net- work (DAWN) for Chicago. Traditionally, heroin/morphine and diazepam have signi- ficantly outranked cocaine in contributing to emergency room mentions. Following the dramatic drop in wholesale cocaine prices noted in the first half of 1984, kilo level prices of approximately $45,000 have remained stable so far this year in comparison to the less than $30,000 price of one year ago. One ounce prices are said to vary between $1,600-$2,000 with consumer level gram costs seemingly ever constant at. $100. No slumps in availability have been noted to this point in 1985 and purity levels are reported to be quite high among most user networks. As previously reported, the growth in cocaine's popularity and increased prevalence of use has seemingly been immme to fluctuations in purity or wholesale price to this point in time. II-27 HALLUCINOGENS The initial drop in treatment admissions for primary hallucinogens problems noted six months ago has continued through this present reporting period. From a high of 4.1% of all admissions to State supported programs in FY 1983, the percentage of new admissions dropped to 2.8% in FY 1984 and to 1.8% in the first three quarters of FY 1985. Although the factors contributing to this decline are still not fully understood, the continued availability of LSD among most primarily white, adolescent drug using networks suggests that declining supply is not a major con- sideration. While LSD and, to a lesser extent, hallucinogenic mushrooms are most popular among high school age, primarily white multiple drug using networks, MDA and mushrooms are the most common hallucinogens used by older drug users. MDA is most readily available among multiple drug users networks of gays as well as among followers of "new wave' music. Mushrooms, on the other hand, have more of a following among groups in their thirties who previously used LSD during the 1960's and early 1970's. MDMA or Ectasy, the MDA ''designer drug' analog which has been receiving so much recent attention in the press, has yet to show any signs of widespread availability in Chicago. PCP As reported last December, official indicator data sources show PCP abuse to be moderating in Chicago. Admissions to treatment for PCP related problems in State supported programs have declined from 3% in FY 1983 to 1.8% in the first three quarters of FY 1985. Toxicology tests for PCP at the Central Intake screening facility show positives for the drug among clients entering treatment dropping from a recent high of 4.3% in September of 1984 to less than 1% through the first quarter of 1985. ’ This evidence, however, continues to stand in opposition to street reports of a major PCP problem in some of Chicago's urban black communities. Among inner city adolescent and young adult black drug using networks, 'Happy Sticks" or 'Joy Sticks" impregnated with PCP and/or embalming fluid are popular and often more readily available than marijuana. Anecdotal reports from younger white multiple drug user networks, however, suggest that the popularity of PCP use has not grown and may in fact be declining. If this is the case, it may help explain some of the disparity between official indicators and what may be a relatively isolated, albeit serious, PCP problem. I1-28 I11inois Treatment Admissions by Primary Drug of Abuse in State Supported Programs FY 1982 FY 1983 FY 1984 Joser eer aed PRIMARY DRUG OF ABUSE | # % 7 ET % 7 ; 1. None Reportad ‘0 o.0 4] 0.1 29 | 0.3 43 | 0.6 2. Heroin 3,782 | 45.6 | 3,414 | 46.0 | 3,648 | 42.8 | 3.230 | 43.7 3. Methadone “a0 08] 22} 02] 107 0.27% 15] v2 4. Other Opiates 457 | 5.5 379] 5.1 357 | 4.2 236 | 3.2 5. Alcohol 64 | 0.8 55] 0.7 165 | 1.9 201 1° 2.7 6. Barbiturates 223 2.7 200 2.7 171 2.0 103 1.4 7. Sedative Hypnotics|] 124 | 1.5 95| 1.3] 8 | 1.0 57 | 0.8 8. Amphetamines 535 6.4 514 6.9 537 6.3 262 3.6 9. Cocaine 492 | 5.9 581 | 7.8] 1,027 | 12.0 | 1,117 | 15.1 10. Marijuana/Hashish | 1,666 | 20.1 | 1,263 | 17.0 | 1,781 | 20.9 | 1,663 | 22.5 11. Hallucinogens 280 | 3.4 307 | 4.1 236 | 2.8 133 | 1.8 12. Inhalants 43 0.5 43 0.6 52 0.6 50 0.7 13. Over-the-Counter 22 | 0.2 14] 0.2 27] 0.3 311 0.4 14. Tranquilizer 157 | 1.9 152 | 2.0 147 | 1.7 88 | 1.2 15. Other 175 | 2.1 165 | 2.2 73] 0.9 25 | 0.3 16. PCP 239 | 2.9 222 | 3.0 181 | 2.1 129] 1.8 TOTAL 8,299 [100.0 | 7,429 }100.0 | 8,530 |100.0 | 7,384 }100.0 Source: CODAP *July 1984 - March 1985 II-29 0c-11 Illinois Treatment Admissions By Primary Drugs of Abuse in State Supported Programs *July 1984 - March 1985 a 4 vee FY '82 FY 33 FY '88 Ist JiLes Uuartens ITEN : z 0 3 : 1 ¢ 3 SEX: Male 5,780 69.6 5,052 67.9 | 5,93 69.6 | 5,136 69.6 Female 2.527 30.4 2.385 32.1 | 2.59 30.4 | 2.288 30.4" 8,307 100.0 7.437 100.0 | 8,533 190.0 | 7,384 100.0 RACE: White 4.470 53.8 | 4.116 55.3 | 4,766 55.9 | 3,888 52.6 Black 3,256 39.2 2,754 37.0 | 3,200 37.5 | 2.958 40.1 Latino 537 6.5 519 7.0 520 6.1 479 6.5 Other 3% 0.4. a 0.6 a“ 0.5 59 0.8 Unknown 8 0.1 8 0.1 3 0.0 0 0.0 8,307 100.0 7.437 100.0 | 8,533 100.0 | 7,388 | *100.0 AGE: < 18 1,510 18.2 1,382 18.6 | 1.852 17.0 | 1,206 16.3 18-19 532 6.4 as 6.0 674 7.9 467 6.3 20-24 1.543 18.5 1,256 16.9 | 1,220 15.0 | 1,103 15.0 25-29 2.067 24.9 1,830 24.6 | 1,95 22.3 | 1.490 20.2 > 29 2.655 32.0 2.524 33.9 | 3,222 37.8 | 3.118 42.2 8,307 100.0 7.437 100.0 | 8,533 100.0 | 7,388 100.0 Source: CODAP DRUG TRENDS IN COLORADO: JUNE 1985 Robert Booth, Ph.D. (Colorado Department of Health, Alcohol & Drug Abuse Division) Data for the present report were collected and analyzed during June, 1985. Al- though these indicators, other than DAWN and Denver's Vice and Narcotic Section, reflect trends throughout Colorado, they are dominated by the Denver metropolitan area. The metro area contains more than half of Colorado's population and the majority of treatment centers. Consistent with past reports, the following sources were utilized to assess trends: A. The Drug/Alcohol Coordinated Data System (DACODS). DACODS are completed at admission and discharge from all alcohol and drug treatment agencies in Colorado receiving public monies. Data elements include demographics, severity indicators (e.g., arrests, prior treatment episodes, drug use patterns, employment, etc.). DACODS is the source document for creation of quarterly tapes with CODAP items for the National Institute of Drug Abuse. B. Drug Abuse Warning Network. These data consist of emergency room mentions and medical examiner reports. C. Heroin Price and Purity. This information was obtained through the Denver Drug Enforcement Agency; the Denver Police Department, Vice and Narcotics Section; and, the Colorado Bureau of Investigation. D. Hepatitis Type B data are available from the Disease Control and Epidemiology Division of the Colorado Department of Health. E. Drug Treatment Program Directors were also contacted in order to obtain data not available through DACODS, including anecdotal information. In addition to updating information from these sources, this paper will include an analysis of the cocaine, heroin and other opiate populations entering treatment. Treatment Data The treatment data assessed included admissions through March, 1985. Table 1 depicts the percentage of clients admitted according to primary drug of abuse. As this shows, the number of admissions in the latest report period will be nearly identical to the last period, if the rate continues at its present pace. According to individual drugs, heroin and other opiate abusers made up 18.3% of the treatment population, a figure fairly stable since 1981. Marijuana abusers increased their percentage of admissions to 35%, the highest since these figures I1-31 have been gathered. They continue to constitute the largest single group in treatment followed by cocaine abusers who represent nearly 25% of all clients. This percentage for cocaine users is nearly identical to that in the previous time frame and the same as that for the first half of 1984. Thus, a leveling- off may be indicated. Among the remaining substances cited only amphetamine users appear to be a large enough sample to warrant discussion (the "other" cat- egory consists primarily of alcohol clients seen in rural drug programs, where no alcohol program exists). Amphetamine users presently represent 5.9% of the total, a decline of 1.1% over the last report and the lowest observed. Another way of assessing drug trends is to look at the number and percentage of new users entering treatment. New users for this exercise were defined as those entering treatment within three years of first use. Table 2 presents these fig- ures for heroin, other opiates, cocaine, marijuana and all drugs combined. Overall the smallest percentage of new users entering treatment were heroin addicts. “Their admission rate has remained fairly consistent since 1981, ranging from 12.5% of the total heroin population to 9.5%. Other opiate abusers are far more likely to enter treatment within three years of use. Since 1981 this group has made up between one-third and one-fourth of other opiate users in treatment. Both new cocaine and new marijuana users entering treatment, as well as the total new user population have steadily declined since 1980. Nearly one-half of the cocaine users admitted in 1980 were new users compared to approximately one- fourth in 1985. New marijuana users entering treatment have declined from 41% in 1980 to 27% currently. The total new user group admitted has decreased from 36% (1980) to 23% in 1985. In light of the earlier discussion from Table 1 re- garding cocaine and marijuana (where it was reported that marijuana users are at their highest percentage to date among all drug clients and cocaine admissions have stabilized at 25% of the population) these findings may indicate another problem: new cocaine and marijuana users are not coming into treatment at the rate they did several years ago. Indeed, the actual numbers of new cocaine and marijuana users admitted to treatment have varied only slightly since 1980 (i.e., marijuana range = 208-278; cocaine range 160-216) while the total numbers of clients using these substances have increased. In fact, the range for old mari- juana users entering treatment is 355 (1980) to 684 (1983) and that for cocaine users 181 (1980) to 523 (1984). The decline, proportionally, of new users entering treatment may indicate either a decrease among those using cocaine and marijuana, or simply that new users are not as likely to come into treatment as they were a few years ago. To address this issue we need to look at other substance use indicators. Prior to examining other indicators, however, a further analysis of changes in the population of heroin, other opiate and cocaine users over time will be under- taken. Table 3-5 present these findings. ; As Table 3 illustrates, the average age of heroin users in treatment is increas- ing from 30.5 to 33.6. Males account for approximately two-thirds of these admissions although it appears that females are increasing their representation, particularly in the first three months of 1985. Ethnically, while Anglos have the largest percentage of users in every year, they are greatly under represented in comparison to the general population of Colorado. Hispanics and blacks, on the other hand, are over represented among heroin admissions as they make up II-32 17% and 2%, respectively, of Colorado residents 13 and older. Over the years displayed, blacks appear to be declining among heroin clients while Anglos are increasing. Statistics regarding educational levels have exhibited only slight fluctuations. Con- sistently, only one out of five heroin admissions has gone beyond a high school degree, while clients have averaged less than a 12th grade education. From 1982 through 1984 income averages have declined from $946 to $838 yet they rose sharply to $1,154 in 1985. Due to the small sample represented this year such an increase may not hold up. Approximately three-fourths of admissions have had prior drug treatment and one out of ten prior alcohol treatment. Both of these figures have, generally, de- clined since 1982. Overall, nearly one-half of these clients reported a prior non-DUI arrest and 10%-15% a prior DUI arrest. The vast majority in every year have been daily heroin users averaging 11-13 years of use and 8-9 years of abuse. Over time these averages have consistently increased, with the exception of 1985 abuse data based upon three months. Table 4 presents these same variables for the other opiate user population. Excepting 1985 (N = 48) average ages have increased as observed among heroin admissions. Although males made up the majority of other opiate admissions in each year females accounted for 41%-48% of the population. Ethnically, Anglos not only accounted for the largest percentage of admissions for this substance in each year, their representation has increased while .other ethnic groups have declined. In terms of education, other opiate users are more educated than heroin users, averaging nearly 13 years. Interestingly, their incomes hav generally been lower, however, ranging from $713-$992. ; According to prior treatment experiences, more than one-half reported prior drug treatment in each year although the percentage has declined from 71% in 1982 to 54% presently. Approximately one out of ten had previous alcohol treatment, a figure which has fluctuated very little. The percentage reporting prior non-DUI arrests has consistently decreased since 1982, from 48% to 30%. DUI arrests, on the other hand, have consistenly been reported at 10%. Other opiate users do not use drugs as frequently as heroin users although the majority consumed daily. Clients averaged 7-8 years of use and 6-7 years of abuse prior to entering treatment. As observed among heroin users, these figures have generally increased over the years. Table 5 summarizes these findings among cocaine users. As shown, the average age increased from pre-1982 (X = 26.6) to 1984 (X = 28.5) but is currently declining (X = 27.8). Consistently, males account for approximately. 70% of cocaine admis- sions and the vast majority are Anglos (86%-91%). Users averaged over 12 years of education, more than heroin clients but, interestingly, not as much as other opiate users. Cocaine admissions typically had a higher income average than users of other substances although incomes fluctuated greatly from year to year. According to prior ‘treatment, presently 24% report past drug treatment and 10% a previous alcohol admission. These figures represent declines over past years. Of interest is the finding that heroin, other opiate and cocaine users are fairly similar in their prior alcohol treatment percentages but differ greatly in past drug treatment episodes. Generally, nearly three out of four heroin clients reported previous drug treatment compared to approximately 55%-60% for other opiate clients and less than one-third among cocaine admissions. 11-33 As with the two opiate populations nearly one-half of those admitted for cocaine treatment had a prior non-DUI arrest and slightly more than one-tenth a DUI arrest. For the past three years these figures have been fairly constant. Approximately one-half of these cocaine admissions used the drug on a daily or binge basis. Their figures for daily use were, expectedly, far less than those for the opiate populations but they were more likely to go on binges. They averaged 5-7 years of use and 4-5 years of abuse prior to admission. Both of these averages are lower than heroin users, who had the highest averages, and users of other opiates. Table 6 presents the final set of figures from this data set: secondary drug choices among primary cocaine users. As shown, most (64%-76%) cocaine users consume a secondary drug. The most common secondary substances were alcohol and marijuana followed by amphetamines. Of note is the relatively small usage of heroin as a secondary drug. From 1982 to the present use of secondary substances has increased, particularly among those using alcohol and marijuana. DAWN Although emergency room data are available through 12/84, that from medical examiners has not been updated since 1983. The figures below represent all that has presently been received. DAWN FIGURES Emergency Rooms 1978 1979 1980 1981 1982 19813 19084 Cocaine 33 64 93 154 143 112 159 Heroin/Morphine 53 48 27 53 42 65 71 Medical Examiners 1978 1979 1980 1981 1982 1983 Cocaine X X 6 6 7 7 Heroin/Morphine 0 0 2 [52 3 2 Emergency room figures reveal both cocaine and heroin/morphine to be increasing problems in the Denver area. Cocaine and heroin admissions surpassed any pre- vious report year. In fact, there were 40 heroin emergency room mentions in the second half of 1984, the largest number ever observed in any six month period in Denver. Medical examiners data present a similar trend with seven reported cocaine mentions in 1983 and two heroin mentions. Although these figures are small, they are at or close to the highest reported. Drug Price And Purity Price and purity information was obtained from the Colorado Bureau of Investiga- tion, Denver's Drug Enforcement Agency and Denver Police Department's Vice and Narcotics Laboratory. According to figures provided by the CBI, cocaine purity I1-34 averaged 41% (50 samples tested) and heroin 8% (4 samples tested). The Denver Police Department also reported cocaine at an average purity of 41% (4 samples tested) and heroin at an astounding 39% (8 samples tested). The DEA in Denver also found very high purity levels for heroin (50%-93%) and cocaine (50%-83%). Heroin cost is typically $100 for a quarter gram and $300 for a gram. All three sources indicated the high purity heroin is a dark tar type substance, known as "GOMERO" . In terms of other substances, LSD appears to be on the increase according to the Denver Police Department. Methamphetamines are also increasing although a number of clandestine labs have been busted within the last few months. The purity and cost of methamphetamine parallels that of cocaine (40%-80%, $100 per gram). Marijuana generally appears to be Mexican or domestic in origin although it is frequently sold as a more exotic variety. The Denver Police Department reported that very little true exotic marijuana is being found. One type that is seen occasionally is known as "sole". It resembles a very large shoe sole and is packaged with pride by the manufacturer who puts his seal on the package. Hepatitis Type B Hepatitis data are available through June 14, 1985 from the State of Colorado Health Department. These are shown below Hepatitis Type B 1976 1977 1978 1979 1980 1981 3982 11983 1984 1985* 306 303 243 166 235 220 198 227 278 127 * to 6/14/85 In the last three reports to this group it was reported that hepatitis mentions were on the increase. Last December it was estimated that 1984 figures would be 274, the largest number of hepatitis mentions since 1977. In fact, 278 hepatitis mentions occurred and, if the present rate continues, this figure will be slightly exceeded in 1985. ; Program Directors Program directors in Denver and the Western Slope were contacted to ascertain their feelings and thoughts about Colorado's current drug problem. Their observations were as follows: 1. Very little speed balling is being seen. 2. Cocaine is the drug most commonly abused by those in treatment. Users frequently also use methamphetamines. 3. "Ecstasy" and "Designer Drugs" users are not coming into treatment. Ecstasy does appear to be readily available; however, no one was aware of designer drugs being sold. 11-35 LSD users are increasing slightly among admissions. Fewer opiate users are turning to Dilaudid, the typical drug of choice among Denver's opiate population, as more are turning to the high purity heroin that is available there have longer histories of use. Summary I. II. Heroin/Other Opiates A. B. Treatment Data: Heroin and other opiate abusers continue to make up nearly 20% of the treatment population. However, this figure is based upon only those programs reporting on DACODS. As reported last meeting, in the past the majority of opiate abusers were seen in publically funded agencies, hence on DACODS. Currently, there are several new "for profit" methadone clinics operating with a caseload of nearly 150 clients. The largest of these began dispensing methadone in July, 1984 and has received approval to increase its caseload from 100 to 150 as they have filled all 100 slots. Among those clients 82% are new treat- ment admissions while 18% have had past experience. The addition of 150 opiate abusers would more than double the figure reported earlier. DAWN: These figures indicate an alarming trend toward an increasing heroin problem. In the second half of 1984, for example, the highest number of ER heroin mentions recorded was observed (based upon the latest DAWN report). Price and Purity: According to the Colorado Bureau of Investigation, the Drug Enforcement Administration, and Denver's Vice and Narcotic Laboratory, heroin price and purity are at an all time high (8%-93%). Hepatitis Type B: If the current trend continues through December, 1985, Colorado will have its greatest number of hepatitis mentions since 1977. Treatment Directors: Although the agency directors contacted have not observed an increase in the overall number of opiate abusers admitted (probably due to "for profit" methadone clinics), they expressed concern that those who used to prefer Dilaudid are now turning to the new heroin. Cocaine A. Treatment Data: Cocaine admissions remain at 25% of the treatment popu- lation. However, the percentage of new users entering treatment is the lowest in the past seven years, an indication in light of other indi- cators that the problem is increasing but fewer, proportionally, are willing to enter treatment. Consistently, those who did enter treat- ment in 1985 reported more years of use and more years of abuse on the average than their counterparts in prior years. New users are simply not entering treatment as they did in the past. II-36 B. DAWN: If the current trend continues we will see the largest number of emergency room cocaine mentions ever observed in Colorado. Similarly the number of medical examiner mentions of cocaine will reach an all- time high. C. Price and Purity: The CBI, DEA and Denver's Vice and Narcotics Labora- tory all report cocaine. is readily available year- round Purity averages 41% and a gram costs $80-$120. D. Program Directors: Cocaine was mentioned as the major drug of abuse in Colorado due both to the numbers of clients and the difficulty of their treatment. III. Marijuana A. Treatment Data: Presently, marijuana abusers make up the largest per- centage of any drug category in treatment and the largest percentage, proportionally, to date. B. Law Enforcement: According to all agencies contacted,marijuana is available although it is seasonal. The majority comes from Mexico or is grown domestically, usually on the west coast. C. Treatment Directors: Among younger clients marijuana is the major drug of abuse and among nearly all clients it is used to some degree. The above findings, although based upon indicators which have weaknesses, must be viewed with some alarm. If these are correct, it appears that Colorado is seeing an increase not only in its cocaine problem, but in its opiate and marijuana problems as well: new cocaine and marijuana users are not entering treatment as in the past; heroin is increasingly available, yet addicts, if they do seek treatment, may opt to enter "for profit" clinics where they receive much higher dosages of methadone then in publically funded facilities; and marijuana abusers are currently at their largest percentage for admissions to date. These and other indicators should continue to be monitored very closely. II-37 8¢-II TABLE 1 PRIMARY DRUG OF ABUSE X TREATMENT ADMISSIONS JAN. 80 | JAN. 81 | JULY 81 | JAN. 82 | JULY 82 | JAN. 83 | JULY 83 |JAN. 84 | JULY 84 | JAN. 85 PRIMARY SUBSTANCE | DEC. 80 | JUNE 81 | DEC. 81 | JUNE 82 { DEC. 82 | JUNE 83 { DEC. 83 (JUNE 84 | DEC. 84 { MARCH 85 Heroin 16.7 12.1 11.4 10.2 13.2 11.6 13.3 12.8 10.9 11.1 Other Opiates 11.3 10.6 9.4 10.8 8.5 9.5 9.3 759 5.6 T.2 Non-RX Methadone od “2 dl «> il 0 “2 3 a 0 Barbiturates 2.7 1.7 1.8 1.6 1.5 1.4 1.1 .8 .8 l.4 Sedatives 1.8 1.0 i.0 1.0 .6 4 .6 4 od 2 Tranquilizers 5.3 4.7 4.8 4.0 2:2 3.0 2.9 2.1 1.5 2.3 Amphetamines 13.1 12.5 11.3 12,2 10.0 10.9 8.6 7.0 7.0 5.9 Cocaine 13.0 18.3 17.7 20.5 21.9 20.8 23.8 24.5 25.9 24.5 Marijuana 23.6 25.6 26.1 27.2 26.9 30.2 30.0 28.6 32.7 35.4 Hallucinogens 5.3 5.2 5.3 3.6 4.7 4.1 2.4 2.5 2.4 2.0 Inhalants 2.8 2.7 3.0 2.0 3.5 1.7 1.3 3.3 2.8 2.6 OTC "o .4 +5 wD .4 oD .4 eS .4 oe Other 3.7 5.0 7.3 6.1 6.5 542 5.9 9.6 9.1 7.4 N 3,138 1,541 1,334 1.316 1,101 1,358 1,433 1,544 1,340 671 TABLE 2 NEW DRUG USERS SUBSTANCE 1980 | 1981 ( 1982 | 1983 | 1984 | 1985* Heroin N New 24 36 27 40 39 28 % New 6.7112.5 9.711.971 11.4 9.5 Other Opiates N New 109 95 59 79 55 48 % New 41.1 33.83% 25.21 31.21 27.9 {25.5 Cocaine N New 172 216 199 202 198 160 % New 48.71 42.9 139.3 { 33.6 | 27.5 | 24.5 Marijuana N New 245 278 208 256 244 252 % New 40.8 137.9, 31.99131.7}{ 27.91 26.9 All Drugs N New 875 983 736 765 705 620 % New 35.5 35.0 | 30.6 28.5 { 24.6 123.4 * Estimate Based Upon Three Months' Data I1-39 TABLE 3 HEROIN TREATMENT ADMISSIONS ITEM PRE-1982 1982 1983 © 1984 1985% N=871 N=279 N=336 N=342 N=74 Age >i 21 2.5% 3.2% 3.6% 2.6% 1.4% 21-25 17.9% 13.6% 9.5% 9.4% 9.4% 26-30 36.0% 36.6% 30.1% 30.2% 33.8% 31-35 24.2% 26.2% 29.4% 29.9% 24.3% < 35 19.4% 20.4% 17.4% 27.9% 31.1% Mean 30.57 31.12 32.57 32.55 33.60 Median 30.00 30.00 31.00 32.00 32.00 Sex : Male 77.1% 65.6% 64.0% 69.9% 55.4% Female 27.9% 34.4%. © 36.0% 30.1% 44.6% Race White 45.9% 47.7% 46.7% 53.15% 51.4% Black 14.1% 10.8% 10.7% 10.3% 6.8% Hispanic 38.6% 40.4% 40.2% 34.6% 37.8% Native American .5% 4% 1.2% 1.2% 1.4% Other .9% +73 1.2% .9% 2.7% Education > 12 37.8% 41.4% 45.5% 38.5% 44.6% 12 36.3% 34.9% 35.4% 40.9% 40.5% 13-16 24.6% 22.7% 18.8% 19.7% 12.3% < 16 1.3% 1.1% 3% .9% 2.7% Mean 11.67 11.63 11.30 11.60 11.45 Median 12.00 12.00 12.00 12.00 12.00 Monthly Income 0 35.3% 17.2% 25.5% 18.9% 12.5% 1-500 26.6% 29.9% 28.0% 29.6% 36.1% 501-1,000 25.6% 27.4% 25.5% 26.4% 25.0% 1,001-1,500 6.5% 10.2% 6.4% 12.5% 8.3% 1,501-2,000 2.9% 8.0% 4.0% 7.2% 4.2% 2,000+ 3.1% 7.3% 10.6% 5.4% 13.9% Mean 537 946 878 838 1154 Median 315 600 500 540 529 Prior Drug Treatment Yes 78.1% 79.2% 74.4% 72.8% 68.9% No 21.9% 20.8% 25.6% 27.2% 31.1% Prior Alcohol Treatment Yes 9.4% 10.8% 10.4% 8.5% 8.2% No 90.6% 89.2% 89.6% 91.5% 91.8% Prior Arrests: Non-DUI Yes 52.1% 48.4% 45.4% 42.4% 51.4% No 47.9% 51.6% | 54.6% 57.6% 48.6% II-40 Table 3 - Continued Heroin Treatment Admissions ITEM "PRE-1982 1982 1983 1984 1085%* Prior Arrests: DUI Yes 10.0% 9.7% 14.6% 11.8% 10.8% No 90.0% 90.3% 85.4% 88.2% 89.2% Frequency Of Use Monthly 7.3% 3.2% 3.0% 5.9% 0 Once A Week 2.4% 1.8% 1.2% .9% 5.4% Several Times A Week 7.5% 7.2% 7.7% 6.2% 2.75 Once A Day 11.6% 7.5% 5.7% 7.0% 9.5% Several Times A Day 139.8% 46.6% 46.4% 45.5% 63.5% More Than Several Times A Day =31.1% 033.3% 36.0% 34.6% 19.0% Binge .3% 4% 0 0 0 Years Used <3 6.2% 6.8% 8.3% 9.4% 6.8% 3-5 11.1% © 9.8% 10.5% 9.9% 9.5% 6-10 36.3% 735.1% 22.0% 18.4% 27.0% > 10 46.4% 48.4% 59.2% 62.3% 56.8% Mean 10.80 10.82 12:11 12.25 13.03 Median 10.00 10.00 12.00 12.00 12.00 Years Abused <3 14.5% 11.8% 16.1% 15.8% 20.3% 3-5 22.3% 18.6% 15.9% 19.6% 22.7% 6-10 36.3% 36.9% 27.6% 27.9% 23.1% >:10 26.9% 32.6% 40.9% 36.8% 35.1% Mean 7.91 8.71 9 vob 9.45 8.62 Median 7.00 8.00 9.00 9.00 8.00 * Through 3/85 II-41 TABLE 4 OTHER OPIATE TREATMENT ADMISSIONS ‘ITEM ‘'PRE-1982 | © 1982 1983 1984 1985%* N=607 N=234 N=253 N=197 =48 Age <2] 4.8% 1.7% 3.6% 4.1% 0 21-25 20.7% 20.5% 13.4% 7.6% 19.6% 26-30 36.5% 31.6% 25.7% 25.9% 26.1% 31-35 22.4% 24.4% 34.8% 27.4% 26.0% > 35 15.6% 21.8% 22.5% 35.0% 28.3% Mean 30.32 31.56 31.87 33.31 32.89 Median 29.0 30.00 32.00 Ja d« 00 31.00 Sex Male 59.3% 53.4% 53.2% 57.9% 52.1% Female 40.7% 46.6% 45.8% 42.1% 47.9% Race White 87.0% . 85.0% 85.0% 92.4% 93.8% Black 3.3% 4.3% 4.7% 4.1% 0 Hispanic 9.6% 9.4% 8.7% 2.5% 4.2% Native American 0 .9% 1.2% 1.0% 2.1% Other 23 .4% .4% 0 0 Education : < 32 27.4% 20.9% 22.5% 23.9% 17.0% 12 30.7% 36.3% 33.2% ‘33.0% 36.2% 13-16 37.1% 36.3% 35.9% 38.0% 38.4% > 16 4.8% 6.4% 8.3% 5.1% 8.5% Mean 12.46 12.88 12.77 12.80 13.13 Median 12.00 12.00 12.00 12.00 12.00 Monthly Income 0 29.5% 27.9% 27.6% 18.6% 11.4% 1-500 23.6% 19.7% 25.7% 21.3% 31.8% 501-1,000 27.3% 26.6% 21.5% 30.8% 36.3% 1,001-1,500 7.3% 10.1% 13.0% 12.3% 9.1% 1,501-2,000 5.9% 8.3% 4.9% 7.4% © 6.8% 2,000+ 6.4% 7.4% 7.3% 9.6% 4.5% Mean 713 862 795 992 944 Median 500 550 480 800 600 Prior Drug Treatment Yes 60.9% 71.4% 58.9% 57.4% 54.3% No 39.1% 28.6% 41.1% 42.6% 45.7% Prior Alcohol Treatment : Yes '. = 10.2% 12.0% 11.5% 10.2% 12.8% No 89.8% 88.0% 88.5% 89.8% 87.2% Prior Arrests: Non-DUI 3 : Yes : 43.7% 47.9% 44.7% 35.0% 30.4% No 56.3% 52.1% 55.3% 65.0% 69.6% 11-42 Table 4 - Continued Other Opiate Treatment Admissions ITEM "PRE=1982 | 1982 1983" 1984 1985* Prior Arrests: DUI Yes 10.1% 9.8% 10.3% 9.1% 10.9% No 89.9% 90.2% 89.7% 90.9% 89.1% Frequency Of Use Monthly 2.7% 7.3% 4.0% 8.8% 2.1% Once A Week 1.8% 3.4% 1.2% 2.1% 2.1% Several Times A Week 13.6% 11.1% 15.1% 13.4% 14.9% Once A Day 6.7% 6.4% 6.8% 8.8% 6.4% Several Times A Day 36.7% 38.9% 34.3% 32.5% 42.6% More Than Several Times A Day 37.5% 32.0% "37.1% © 33.0% 29.8% Binge 1.6% .9% 1.6% 1.5% 2.1% Years Used <¢3 27.9% 16.7% 22.5% 18.3% 21.3% 3-5 23.7% 26.0% 20.1% 27.9% 23.5% 6-10 25.2% © 30.8% 29.6% 18.8% 25.5% > 10 23.1% + 26.5% 27.7% 35.0% 29.8% Mean 6.70 7.55 7.60 8.43 8.32 Median 5.00 6.00 7.00 7.00 6.00 Years Abused <3 15.0% 25.6% 32.0% 29.9% 27.7% 3-5 16.1% 32.9% 22.5% 25.4% 36.2% 6-10 24.0% 24.8% 26.5% 23.8% 14.9% > 10 14.7% 16.7% 19.0% 20.8% 21.3% Mean 5.86 5.98 6.32 6.60 6.83 Median 4.00 5.00 5.00 5.00 5.00 * Through 3/85 I1-43 TABLE 5 COCAINE TREATMENT ADMISSIONS ITEM PRE-1982 | 1982 1983 1984 1085% N=902 N=512 N=604 N=721 N=163 Age <7 21 16.6% 10.7% 9.9% 7.6% 9.8% 21-25 30.5% 28.9% 24.2% 30.1% 27.6% 26-30 28.4% "31.1% 32.8% 27.1% 35.0% 31-35 17.6% 20.7% 22.0% 22.2% 17.2% > 35 6.9% 8.6% 1i.15 13.0% 10.4% Mean 26.61 27.75 28.22 28.52 27.77 Median 26.00 27.00 28.00 27.00 28.00 Sex Male 71.5% 72.3% 70.4% 71.2% 69.3% Female 28.5% 27.7% 29.6% 28.8% 30.7% Race White 88.4% 90.6% 84.2% 86.1% 87.0% Black 5.2% 5.5% 8.8% 8.0% 4.3% Hispanic 5.1% 3.1% 6.0% 4.7% 8.0% Native American 7% 0 «3% 7% .6% Other .6% .8% 1% 4% 0 Education <:12 25.3% 25.0% 25.6% 22.0% 11.0% 12 ; 31.0% 30.9% 31.7% 36.4% 42.9% 13-16 41.1% 39.2% 039.7% 37.0% 28.8% > 16 2.6% 4.9% 3.0% 4.6% 3.6% Mean 12.72 12.79 12.52 12.71 12.32 Median 12.00 12.00 12.00 12.00 12.00 Monthly Income 0 29.7% 19.6% 22.9% 18.7% 19.7% "1-500 : 22.0% 20.6% 20.7% 21.1% 21.1% 501-1,000 25.0% 29.1% 30.0% 28.8% 24.8% 1,000-1,500 10.1% 12.3% 12.7% 9.8% 14.7% 1,501-2,000 5.9% 7.9% 7.3% 11.3% 8.2% 2,000+ 7.3% 10.5% 6.4% 10.1% 11.5% Mean 763 1005 839 1010 989 Median 500 750 600 750 800 Prior Drug Treatment Yes © 31.6% 33.4% 35.4% 29.5% 24.2% No 68.4% 66.6% 64.6% 70.5% 74.2% Prior Alcohol Treatment Yes 10.9% 12.1% 12.3% 10.1% 9.8% No 89.1% 87.9% 87.7% 89.9% 90.2% Prior Arrests: Non-DUI : Yes 43.0% 40.6% 46.8% 45.7% 45.6% No 57.0% 59.4% 53.2% 54.7% 54.6% II-44 Table 5 - Continued Cocaine Treatment Admissions ITEM PRE-1982 1982 1983 1984 1985+% Prior Arrests: DUI Yes 9.5% 11.2% 11.6% 11.8% 12.9% No 90.5% 88.8% 88.4% 88.2% 87.1% Frequency Of Use Monthly 14.4% 12.3% 9.5% 13.6% 13.5% Once A Week 9.1% 7.2% 7.8% 7.1% 11.0% Several Times A Week 29.7% 28.0% 35.2% 33.1% 33.7% Once A Day 8.0% 13.3% 6.0% 8.7% 5.5% Several Times A Day 15.3% 13.1% 12.3% 11.5% 14.1% More Than Several Times A Day 18.6% 13.7% 18.3% 12.0% 13.5% Binge 4.9% 12.3% 11.1% 13.9% 8.6% Years Used <3 30.6% 24.3% 17.8% 17.5% 16.0% 3-5 34.5% 35.3% 37.0% 31.8% 25.8% 6-10 26.3% 27.2% 28.4% 35.1% 39.9% > 10 8.6% 13.2% 16.8% 15.7% 18.4% Mean 4.93 5.56 6.30 6.56 6.69 Median 4.00 4.00 5.00 6.00 6.00 Years Abused <3 44.6% 39.1% 35.2% 36.1% 35.6% 3-5 33.4% 35.1% 33.9% 33.1% 27.0% 6-10 16.4% 18.5% 21.9% 24.2% 27.6% > 10 5.6% 7.3% 9.0% 6.5% 9.8% Mean 4.33 4.32 4.95 4.66 4.96 Median 3.00 3.00 3.00 4.00 4.00 * Through 3/85 11-45 TABLE 6 SECONDARY DRUG CHOICES AMONG PRIMARY COCAINE USERS 1980 {1981 | 1982 {1983 | 1984 | 1985* None 23.6 128.3.1'36.2.. 33.7 1{33.01.26.4 Heroin 4.3 1 :1.6 1.6 3.0 1.9 .6 Other Opiates 2.0 2.6 27 2.8 1.4 2.5 Non Rx Methadone .6 “2 2 vd 0 0 Alcohol 20.5 124.6 (28.2 127.9{31.71]:35.0 Barbiturates 2.0 1.2 .8 5 +3 0 Other Sedatives 3.4 2.8 2 7 wl 0 Tranquilizers 4.8 3.0 3.1 2.0 6 3.1 Amphetamines 9.7 7-1 7.0 8.0 5.5 6.1 Marijuana 23.9 124.6 [17.4 {18.7 1.24.0] 25.2 Hallucinogens 51 4.0 242 2.0 1.4 1.2 Inhalents «3 0 0 0 0 0 PCP 0 0 2 +5 +1 0 Other 0 0 +2 "2 0 0 N 352 505 511 603 722 163 * Through 3/85 11-46 DRUG ABUSE TREND UPDATE DETROIT/WAYNE COUNTY, MICHIGAN JUNE, 1985 Richard F. Calkins, Chief Evaluation and Data Services Office of Substance Abuse Services Michigan Department of Public Health Introduction The Detroit/Wayne County population of 2.4 million people represents 26% of Michigan's total population. Combined with the two adjoining counties, southeastern Michigan Is composed of more than 4 million residents, or about 44% of the state population. The data reflected in this report is relevant only to Detroit/Wayne County, although some parallels are drawn to statewide data. This report reflects the use of a variety of Information sources as cited In prior reports. Heroin Heroin continues to be the major focus of law enforcement activity In narcotics for the Detroit/Wayne County area, although cocalne continues to Increase across all Indicators. Police activity Is shifting to more cocalne targeting. The Drug Enforcement Administration's Domestic Monitor Program Is a retail level (i.e. street level) heroin sampling program Intended to provide Information regarding availability, price, purity, adulterants and other Information for several major metropolitan areas. Detroit has been a target city since 1981 for this effort. An average of 10 samples a month are obtained In different areas of the local geography. The DEA conducts tests with the Heroin Signature Methodology to Identify origin. Reports have been produced on a quarterly basis In the past. These will be produced on a semi-annual basis in the future. The average heroin purity as reflected In the DEA Monitor Program was 2.5% for the July thru December, 1984 perlod. This represents a slight increase (9%) from the 2.3% average In the prior period, but a substantial decline from 1983 (l.e., purity fell to almost two thirds of that In 1983). The current 2.5§ purity is the second lowest since the Monitor Program began in Detroit. This latest data represents a 39% decrease In purity over the 1983 level. The range In purity across samples has shown considerable variation In the past. Samples of high purity are excluded In calculation of average purity (as are samples containing no heroin at all); during the latest pericd eight samples containing no heroin and seven samples with very low purity were not included In the calculations. The DEA Monitor Program also provides data on average price of heroin (as based on 100¢ purity). The June, 1983 report noted an apparent sharply increasing trend In average price/pure mg. during the perlod from April, 1983 thru March, 1984. In fact the average price would appear to have tripled between the October, 1982 and October, 1983 quarters. However, the average price for the per lod January thru II-47 June, 1984 was $2.90; this was an average decline of $1.34/mg or 32%. However, the data for July thru December, 1984 shows an average price of $3.36 per pure milligram. This Is a 13% Increase In price over 1983, This may reflect an Increased demand for heroin or it may be more a factor of the ongoing competition for the market by dealers. I+ Is also believed to be influenced by changes In the distribution channels. The DEA Signature Analysis procedure al lows for identification of place of origin of the heroin samples. The majority of the heroin In the Detroit area has traditionally originated In the Middle East: Turkey, Pakistan, Italy and Lebanon. However, heroin of South East Aslan origin represented 31% of the samples for July thru December, 1984; this compares to 22% during January thru June, 1984, Mexican heroin (brown color) represented seven percent of the samples in 1983, while In the July thru December, 1984 period Mexican heroin accounted for 28% of the samples. Mexican heroin In the Detroit area has not been significantly found since the mid 1970's (although the Michigan State Police reports that Mexican heroin is routinely found In out-state areas such as Saginaw and Muskegon which have substantial populations of Hispanic origin). It remains to be seen whether this change In source of heroin Is confirmed over time. Some of the Mexican heroin Is in "brown gummy bal ls" of high purity which reportedly are first frozen and then diluted In a blender. Other Information on the most recent DEA Monitor samples reflects adulterants (or "cuts") of lactose, mannitol and diphenhydramine. There were seven samples (nearly one quarter of the samples vs. 10% during the first six months of 1984) which contained both heroin and cocaine. Samples were packaged In aluminum foll, manila packets and coin envelopes. Some were label led as fol lows; "TRUE-1984", "CONEY ONLY #2», "CuJOo", "BEEF", "GHOST BUSTERS", "BOMB", "PAID", "BRAND NEW", "NUT" and "MANIAC", The Detrolt Police Narcotics Unit also continues to focus on heroin (as well as more and more on cocaine). The proportion of cases processed to court for heroin has remained at 55-58% since 1980, although it seems to be declining slightly as cocaine increases. However, the absolute number of such cases (179 for the first three months of 1985) would appear to be down almost 17% on an annual basis from 1984; the 1984 heroin total was also down by 44% over 1983. This is belleved to be Influenced in part by difficulties In penetrating the "new organizations" which sought the market after the arrests of the "Young Boys, Inc." and the "Davis Family Group" In 1982 and 1983, as well as the large Increases In cocaine activity. (There are reports that at least ten homicides have occurred In attempts to control the market from prison on the part of "Young Boys, Inc." former leaders.) This decline was also Influenced by the level of pol ice manpower availability in Detroit, Also of significant note Is what appears to be a fundamental change In the "marketing" of drugs. Heroin Is now more often sold "on the street" vs. the traditional method of obtaining It in "shooting galleries". Cocaine, on the other hand, Is more and more sold in "coke houses" because of the complicated equipment involved In the "free base" method of administration. Heroin confiscations by the Detroit Pol ice Narcotics Unit were over 10 pounds In 1984 as compared to over 15 pounds for 1983, However, almost an ounce of morphine was seized (none In 1983) and four pounds of opium (none In 1983), IT-48 Young persons under 20 years of age continue to represent over one of every four persons arrested by the Detroit Police Narcotics Unit. Almost half of those arrested are not confirmed as drug users themselves based on admittance, denial, observation of physical signs, or withdrawal symptoms. The Detroit area section of the Michigan State Police Narcotics Unit arrested 26 individuals for heroin in 1984 compared to 84 such arrests In 1983. The "out-state" section arrested another 54 individuals for heroin, all but three were for delivery. A major bust Involving Mexican heroin took place in Cadillac and Traverse City (northern Michigan resort communities with no prior occurrences of this type). The Wayne County Medical Examiner has been analyzing cases specific to drug abuse and narcotics Involvement since 1974. The data available through May, 1985 (87 narcotics deaths) suggest that narcotic deaths are somewhat less than the 1982 level (192 deaths) which was the highest since 1976 (206 deaths) but are higher than for 1983 and 1984. The 1984 figures were projected to reach 144 narcotic deaths in the last report, however final figures show there were 16¢ such deaths vs. 136 in 1983 and 192 in 1982. The Drug Abuse Warning Network (DAWN) as operated by the National Institute on Drug Abuse (NIDA) provides another indicator on drug usage trends over time. Drug abuse involvement in hospital emergency room visits to major metropolitan area hospitals are col lected and summarized through DAWN, The most recent DAWN data available for the Detroit area Is through December, 1984, In 1982 there was en average of 521 heroin mentions per quarter, while In 1983 there was a quarterly average of 805 such mentions, or a 55% Increase over the one year period. During 1984, heroin mentions averaged 618 per quarter. This represents a 23% decline over 1983 yet a 19% increase over 1982. This changing pattern Is belleved to be strongly Influenced by the vigorous law enforcement actions during 1983 which resulted In disruptions of the major heroin distribution networks. + may be Important to note that changes continue to occur within the hospital care network In the Detroit area particularly In terms of treatment for indigents. Future data on DAWN may be effected by this occurrence as well as by the recent Implementation of the Diagnosis Related Group (DRC) payment systems for hospital care by the state Medicaid Authority. Treatment admissions to Detroit/Wayne County programs have been averaging about 4200 cases per quarter since 1980; however in FY 1983/84 there were almost 4600 per quarter. This Is an average 10% quarterly increase (as noted in the last report) that has continued in FY 1983/84; however thus far In FY 1984/85 (six months through March, 1985), the quarterly average was 4352 admissions to treatment. The proportion of total Detroit/Wayne County treatment admissions which Involved heroin as the primary drug was 24% in FY 1982/83 and 23% In FY 1983/84. Thus far In FY 1984/85 heroin represents 20f of total admissions (however, cocaine has doubled in proportion thus far Into FY 1984/85 as discussed later In this report). The absolute number of heroin admissions was 4221 in FY 1983/84, or a three percent increase over the prior year. However, at the current rate in FY 1984/85 there wil | be about 18% fewer admissions with heroin as the primary drug problem. Heroin admissions In Detrolt/Wayne County continue to make up 83-84% of the statewide heroin admissions, Ix-4° Almost half of Detrolt/Wayne County heroin admissions (44%) were between 30-35 years old during FY 1983/84, while thus far in FY 1984/85 this age group makes up 45% of heroin admissions. The 26-29 year old group made up 21% (down from 23% last year) while the 36-44 age group remained the same at 19% of heroin admissions. Eight percent were aged 21-25 while one percent were less than age 21 at admission. Three of every four heroin admissions In Detroit/Wayne County during FY 1983/84 were bjacks while 24% are whites. Over two-thirds (68%) are males. These figures are virtually the same as last year. Data on employment status among heroin admissions shows that 17% were employed ful | time while 76% were unemployed yet in the work force during the first six months of FY 1984/85. This represents a decline in those employed full time which was 16% last year. Overall, It would appear that the apparent increase in full-time employment among total opiate admissions may be more a function of greater numbers of non-heroin/other opiate admissions who are working than changes in the proportion of heroin admissions who are working. The last report noted that the age of first use of heroin among admissions In FY 1983/84 was under 21 years of age for about two of every three admissions. This trend Is also reflected in admissions during the first six months of FY 1984/85. About three of every ten heroin admissions began use between 14 and 17 years of age (31%) and a similar proportion began between 18 and 20 years of age (29%). Four percent reportedly began at age 13 or younger. There Is a considerable "lag period" between first use of heroin and admission to treatment. As noted In the last report, the largest single group of heroin admissions began during the period between 1970 and 1974; at least one of every three heroin admissions began during this period. About another one third of the admissions began between 1965 and 1969. These figures are consistent across the past three and one half fiscal years admissions data. The data also show that 10-11% of admissions use heroin for five years or less before entering treatment. Another 19-29% use between six to ten years before entering treatment, while one third to one half of admissions each year have used heroin for between 11 and 15 years before entering treatment. Ten percent of admissions for heroin during the first six months of FY 1984/85 began thelr use in 1980 or later. Three of every four heroin admissions during FY 1983/84 to Detroit/Wayne County programs |ive in the city of Detroit. However, in FY 1984/85 thus far, 56% of statewide heroin admissions are Detroit residents while another 23% are "out=-county Wayne" residents. Almost half (45%) of the Detroit/Wayne County heroin admissions reported that public assistance Is their main Income source in both FY 1983/84 and thus far In FY 1984/85. Just under half (47-49%) of heroin admissions reported no secondary drug use; this compares to 52% last year. Alcohol (33%) was the second most common secondary drug while cocaine (27%) was the second most frequently reported secondary drug. Other opiates were next at 25%. This Is a reversal between cocaine and other oplates as compared to last year. 11-50 Thus far in FY 1984/85, the vast majority of heroin admissions (84%) of those using heroin at admission reported dally use. Another 3% reported almost everyday use patterns while two percent reported a "weekends only" use pattern. The patterns are almost the same as in FY 1983/84 except that the "almost daily" and "weekends only" users declined somewhat while "once per week" and "once per month" patterns Increased slightly. Cocaine Cocaine continues to be Increasing across all indicators regarding the Detrolt/Wayne County area, as well as In Michigan as a whole. The Detroit Police Narcotics Unit made 225 arrests for cocalne during 1984, this represents a 26% increase in cocaine arrests over 1983. Thus far In 1985 (through March) Detrolt police have made 84 arrests for cocalne; this Is a 27% Increase over the same time period in 1984, Cocaine was the second most frequent drug In total arrests by Detroit Narcotics officers during both 1984 and thus far Into 1985. Previously cocaine ranked third after heroin and marijuana. Larger amounts are more frequently encountered. The Detroit Narcotics confiscated over 17 pounds of cocaine during 1984 as compared to over six pounds during 1983; this represents almost a tripling In one year. Seizures in 1985 thus far are very close to amounts seized during 1984, Data from the Drug Abuse Warning Network (DAWN) in terms of emergency room mentions of cocaine are also showing an Increase. During 1982 there were an average of 56 cocaine mentions each quarter; during 1983 there were 120 mentions. This Is an average Increase of 114%, During 1984 there were an average of 146 cocalne mentions per quarter; this Is a 228 Increase over 1983. Over the entire three year period cocaine mentions almost tripled on an average quarterly basis. During 1984 Michigan State Police Narcotics officers arrested 700 persons on cocaine charges (at least 90% for dellvery/sales). This level Is nearly Identical to 1983 activity. Through March of 1985 State Folice have made 168 cocalne arrests (this is at the same rate as last year). Virtually all reports note that 1he cocaine Is readily available In the Detrcit/Wayne County area and it Is of high purity (80-90f). Similar reports suggest increased avallability throughout the state. Admissions to “treatment for primary substance abuse problems with cocaine are increasing sharply In Detroit/Wayne County as well as In Michigan as a whole. For the state as a whole, the number of admissions in FY 1982/83 was 446; thls compares to 79¢ in FY 1983/84. Thus far in FY 1984/85 there have been 830 cocaine admissions. This trend appears to be Increasing by doubling each year. Fer Detroit/Wayne County, the number of cocalne admissions In FY 1982/83 was 187 versus 473 in FY 1983/84. In Detroit/Wayne County there have been 478 cocalne admissions through six mcnths of FY 1984/85; this represents more than twice as many cocaine admissions over the same period in the prior year. The Detroit/Wayne County area accounted for 60% of statewide cocaine admissions In FY 1983/84. While thus far in FY 1984/85 this proportion is 58%. In terms of frequency of use at admission, during both FY 1983/84 and thus far in FY 1984/85 over half (58%) of the Detroit/Wayne County admissicns who used cocaine In 11-51 the prior 30 days reported dally use patterns. On a statewide basis 44% were dally users. These are proportional Increases In dally users In FY 1984/85 vs. FY 1983/84. In Detroit/Wayne County 10% used on a four to six days per week basis while statewide thls use pattern was reported by 12% of cocalne users. These are decreases over FY 1983/84 (18%). In Detroit/Wayne County 11% of cocalne admissions reported a "weekends only" use pattern while statewide this group was 16% of cocalne admissions. These are also decreases over FY 1983/84 data. Cocalne admissions continue to be largely concentrated In the 21-35 year old age group In both Detrcit/Wayne County and Michigan. The 21-25 year old group made up 25% of Detroit/Wayne County admissions while statewide this age group made up 24% of cocalne admissions thus far in FY 1984/85. The 26-29 year old group represented 25% in Detroit/Wayne County and 29% statewide. The 30-35 age group represented 33% of Detroit/Wayne County admissions and 30% of statewide admissions. The proportions for this older group were 26% and 23% respectively In FY 1983/84, Males made up the majority of cocaine admissions; 73% In Detrolt/Wayne County and 75% statewide. In terms of rece, cocalne admissions during FY 1984/85 in Detrolt/Wayne County were 66% lacks (63% In FY 1983/84) and 33% Whites (34% In FY 1983/84) with the remainder mostly Hispanics. There have been no American Indian admissions for cocalne. On a Fision ae basis 43% were Whites (51% In FY 1983/84), while 55% were lacks (47% In ~ FY 1983/84). The proportion of Detrolt/Wayne County cocaine admissions who were employed ful l= time was 23% while statewide thls group was 34% of cocaine admissions. These are slight Increases over last year. The unemployed In the work force group represented 71% of Detroit/Wayne County cocaine admissions while statewide the unemployed but able to work made up 52% of the cocaine admissions. Public assistance wes reported as the major source of Income by 32§ of Detroit/Wayne County cocaine admissions during FY 1984/85 thus far while statewide this source was reported by 23%. These are Increases of four and two percent respectively over last year's data. Over one In every three cocalne admissions (36%) in Detroit/Wayne County reported they dlid not use any secondary drugs; Just under one In three (31%) of statewide admissions reported having no secondary drug use. These are nearly five percent Increases over last year. Alcohol was the most common secondary drug (32%) for Detroit/Wayne County admissions In FY 1983/84; In FY 1984/85 thus far alcohol Is reported 40% of the time to be the secondary drug. Marijuana was the second most common secondary drug; 28% for Detrolt/Wayne County cocaine admissions and 30% for statewide cocaine admissions. Heroin follows with 208 of the secondary drug reported in Detroit/Wayne County and 14% statewide. Another Indicator of the Increase In cocaine Is its mention as a secondary drug. For Detroit/Wayne County admissions thus far In FY 1984/85 cocaine was reported as the secondary drug In 493 admissions; almost half of these reports of cocaine as secondary Involved heroin as the primary drug while another 43% of the reports of cocalne as secondary drug Involved primary alcohol problems. On a statewide basis thus far In FY 1984/85 cocaine was reported as secondary drug in 866 admissions; almost half (49%) of these reports of cocalne as secondary Involved alcohol as the 1X-52 primary drug while almost another 36% Involved heroin as the primary drug. Overall, reports of cocaine as a secondary drug are up by 36% in Detroit/Wayne County and 43% statewide over last fiscal year. In terms of age of first use for cocalne admissions thus far In FY 1984/85, the most common age range reported was between 21-25 years (28% for Detrolt/Wayne County and 29% statewide). The age perlod between 26-35 years was next most frequently reported (26% for Detrolt/Wayne County and 24% statewide) while first use of cocalne was reported occurring between 14 and 17 years of age by 19% of Detroit/Wayne County admissions and 17% statewlde. One factor regarding year of first use of cocaine and subsequent admission to treatment which has been consistent over the past three and one half years Is that use occurs for about five years or less before entry Into treatment for at least 50% of the admissions. About another 25-30% use for between six and ten years before entering treatment. This pattern is quite similar to that for other oplates but very different from that for heroin admissions. Also confirming the Increases In other cocalne Indicators are urine tests conducted on current and prospective treatment admissions In the city of Detroit. The percentage of tests Indicating positive cocaine use was 7.3% in December, 1982; thls rose to 13.5% In December, 1983 and to 25.8% by December, 1984. During May 1985 30.1% of all urine tests were positive for cocaine. Among persons seek ing treatment through the Detroit Health Department's Central Diagnostic and Referral Center, 37.6% tested positive for cocaine while 87.6% tested positive for heroin/morphine during May, 1985, This data confirms the projections made In the last report wherein this percentage was expected to double on an annual basis. This trend Is very similar to that of cocalne admissions which have doubled each year over the past two years. Cocalne Is reportedly commonly packaged In "rocks" using heat-sealing plastic materials to separate each item. These packages cost $25 In the Detroit area and contaln about one quarter of a gram. Other Oplates There are mixed Indications that abuse of opiates other than heroin Is Increasing In the Detrolt/Wayne County area. These types of drug are manufactured synthetically; the most common drugs Include Demerol, Dilaudid and codelne. During 1984 the Detrolt Narcotics Unit made 32 arrests for Dilaudid; this Is almost the same level as In 1983 (33 dllaudld arrests). Codeine users are also Increasing; there were 159 arrests In 1984 as compared to 173 In 1983, Codeine users were the fourth most common drug arrests by Detroit Narcotics Unit during 1984, The Detroit police seized 32% more codeine (7851 tablets) In 1984 than in 1983. Through March of 1985, Detroit Narcotics police have made 51 codelne arrests (vs. 41 In the same period In 1984) and seized 1664 tablets (vs. 2723 In 1984). There have also been six Dilaudid arrests (vs. 16 In 1984). Also, thus far In 1985 selzure of 930 Demerol tablets were reported vs. none In 1984, Data from the DAWN system shows a relatively stable trend In quarterly average Dilaudid mentions since 1982; during the most recent period there were 21.5 mentions I1-53 per quarter on the average. Average quarterly mentions of codeine are also essentially stable, except that In 1983 and 1984 there were about 15 vs. 10 per quarter In 1982, Michigan now ranks number two In per capita distribution of Dilaudid and number two per capita for codeine products based on DEA's latest ARCOs data (third quarter, calendar year 1984), Michigan previously ranked number one for Dilaudid prescriptions per capita. The State Board of Medicine (as well as the State Board of Osteopathy) have recently implemented new rules severely restricting the prescription of methamphetamines. Law enforcement officials feel that this will result In drastic reductions of Desoxyn and Preludin in the illegal market. Pentazocine (Talwin) and tripelennamine (pyribenzamine) continue to decline as noted in previous reports for Detroit/Wayne County. However, admissions are double that of last year thus far in FY 1984/85, Detroit Narcotic records show that 13 Talwin arrests occurred during 1984 as compared to 52 during 1983. There have been no arrests for Talwin through March of 1985. Seizures of Talwin are also down; there were 1724 in 1984 vs. 2012 during 1983. Through March of 1985 a total of 98 talwin tablets have been seized. The DAWN system also reflects the decline in talwin and pyribenzamine; the quarterly average talwin mentions were 66 during 1982 and 1983. The 1984 level of eight talwin mentions is about one-quarter of that In the prior two years. Pyribenzamine mentions are down even further; the 1984 data shows a quarterly average of only two such mentions. During FY 1983/84 there were 26 admissions statewide with a primary drug problem of "T's and Blues"; 11 of these cases were In Detroit/Wayne County. There were also 36 mentions of "T's and Blues" as the secondary drug during this period. Through the first six months of FY 1984/85 there have been 26 admissions statewide with five In Detroit/Wayne County. This is a "doubling" in admissions trends, and It is believed to be largely due to depletion of "supplies" of the "old version of Talwin™ (i.e. not containing naltrexone) by long-term users. In terms of treatment admissions, the number of admissions in Detroit/Wayne County for other opiates (N=693) was increasing by quarter during FY 1983/84. This appears not to be changing. During the October thru December 1983 quarter there were 123 admissions; during the January thru March, 1984 quarter were 142 such admissions (15% Increase over prior quarter) while In the April thru June, 1984 quarter there were 158 such admissions (an 11% increase over the prior quarter). The figures for the last quarter continued this trend. However, through March of 1985 (six months of FY 1984/85) there have been 259 admissions for other opiates in Detroit/Wayne County and 463 such admissions statewide. At this rate, annual admissions for other opiates will be down by about 25f compared to FY 1983/84. In terms of age, 26-35 year olds represented 708 of all admissions for other opiates, over one in ten (12%) were between 21-25 years of age while three percent were less than age 21 thus far in FY 1984/85. I1-54 Over six of every ten other opiate admissions were whites while 34% were blacks. Just over half (53%) were males. About four of every ten (41%) reported that thelr major Income source was public assistance. Almost half (46%) of these admissions were to methadone maintenance programs while one In four (27%) entered residential treatment. Almost half (41%) reported no secondary drug usage. For FY 1983/84 admissions, heroin was the most common secondary drug used (31%) followed by alcohol (21%); however, during the first six months of FY 1985/86 alcohol Is the most common secondary drug (33%) followed by heroin (178). Almost eight of every ten users (79%) reported daily use of other opiates at admission. Amphetamines Prior reports have noted that Michigan ranks number one in per capita distribution of prescription methamphetamine (pDesoxyn). The DEA reports that although Michigan has only four percent of the United States population, It accounted for over 36% of the nation's total methamphetamine distribution In 1983 and earlier. However, by the third quarter of calendar year 1984, Michigan accounted for 24% of the national total. This reduction Is due In part to Increased awareness and more law enforcement and regulatory activity. Michigan now ranks number two In methylphenidate (Ritalin) distribution. I+ Is believed that a substantial amount of these drugs are diverted to other areas of the United States and possibly even out of the country. Police arrests and seizures of amphetamines are relatively small and appear to be decreasing somewhat. An exception In selzures Is reported by the Michigan State Police Narcotics Unit which has seized over 140,000 methamphetamine dose units In 1984 versus just under 1500 In 1983. A methamphetamine lab was seized In the Kalamazoo area by the Michigan State Police. The DAWN data also shows a relatively low level of methamphetamine and amphetamine mentions; the range over quarters In the last three years Is zero to twenty mentions with a steady decreasing trend over time. There were 114 admissions for amphetamine abuse in Detroit/Wayne County In FY 1983/84; this is about one third of statewide admissions (N=367). Six of ten (58%) were males while over one In four were between 21-25 years of age. Almost seven of ten are between 21 and 35 years of age. Just under one In six (158) reported first use between ages 14 and 17 while another half (48%) reported first use between ages 18-25 years. Over half (528) entered outpatient treatment while 19% entered residential treatment. Two of three (65%) are whites while 23% are blacks. Compared to last year's admissions data, amphetamine admissions now Involve more blacks (23% in FY 1983/84) and fewer admissions to residential treatment (41%). In addition, recent admissions more often start use at older ages than previous admissions did. Other Drugs Although there are a wide variety of other drugs being abused In Detrolt/Wayne County, there Is not enough space to describe trends for all these drugs In much detall here. However, some statements may be made regarding trends In certain drugs over the past several months. 11-55 As noted In the last report, Quaaludes continue to decline; police data as well as DAWN and treatment admissions date suggest there are minimal levels of use and availability of this drug. While val ium continues to be the fourth most common drug mentioned in DAWN, overall mentions have been declining since 1982 at a rate of almost two per month (the quarterly average mentions are now about 120). Mari juana continues to be reflected at relatively stable levels in police reports as well as In other Indicators. Among the 3051 statewide mar! juana admissions in FY 1983/84, 761 (25f) were In Detroit/Wayne County. Thus far In FY 1984/85 there have been 354 marl juana admissions in Detroit/Wayne County. Males represent three of four marijuana admissions and over four of every ten are between 14-17 years old. First use of marl juana was reported at occurring between 11-13 years of age by 37% while this took place between 14-17 years of age by 44%. Almost all (81%) entered outpatient treatment. Seven of every ten were whites while 27% were blacks. Detroit Narcotics Police report marijuana Is the second most common drug used by persons arrested since 1980. Data from the DAWN system shows a 1984 quarterly average of 60 marijuana mentions in the prior year (1983) there were an average of 188 mentions per quarter. There were 62 PCP admissions during FY 1983/84 in Detroit/Wayne County while the statewide total was 93. Thus far during FY 1984/85 (six months) there have been 40 PCP admissions statewide with 28 of these In Detroit/Wayne County. Among this group almost two-thirds were under age 25; 21-25 year olds represented 39% of PCP admissions In Detroit/Wayne County. Another 18% were between 26-29 years old. About one third reported thelr first use of PCP took place between age 14 and 17. About two-thirds entered outpatient drug free treatment programs. Almost all (89%) were whites while 10% were blacks. Michigan State Police, In cooperation with federal and local agencies, located two PCP labs In Western Michigan (a third was in Chicago) which reportedly were manufacturing up to 2.75 million dosage units per month. Since this action PCP avallabllity has been greatly diminished. There were 104 admissions for tranquilizers in Detroit/Wayne County and 242 statewide In FY 1983/84, Through the first six months of FY 1984/85 there have been 101 admissions statewide with 36 of these occurring in Detroit/Wayne County. Among this group, almost two thirds are males (opposite for statewide admissions) and almost half (48%) are between age 30 and 44, The most frequent age of first use Is 26-35 (28%). Almost one In three are blacks while most of the remainder are whites. Almost half (53 admissions) of the 130 statewide admissions for hal lucinogens during FY 1983/84 occurred in Detroit/Wayne County. Thus far in FY 1984/85 there have been 60 such admissions statewide with 22 in Detroit/Wayne County. Males accounted for 82% of these admissions. The 18-20 year old group represented 23% of these admissions while the 14-17 year olds and 26-29 year olds each made up another 23%. II-56 Almost all (82%) reported their first use was between 11 and 13 years old while another 30% reported first use was before 18 years of age. Seventy-sevén percent are whites. In terms of barbiturates, there were 109 admissions statewide In FY 1983/84 with 47 of these occurring In Detroit/Wayne County. Thus far In FY 1984/85 (six months) there have been 12 such admissions In Detroit/Wayne County and 40 statewide. Among the statewide admissions, 75% are white and half are males. Over half are In the 30-44 years old group. Half of these cases began use before the age of 21 years; one quarter began between 26 and 35 years of age. Other Comments There has been recent discussion In the court system in Detroit regarding processing of cases Involving "small amounts" of heroin. It is felt that these cases tle up the courts and often result In no sanction or Jail time. Legislation may be proposed to have cases involving "two packets" or less of heroin sent to traffic court (as Is currently done with cases involving two ounces or less of marijuana). There are some reports that heroin from the Middle East (which enters the United States through Detroit) Is taken to Miaml and exchanged for cocaine because of the "wider market" for cocaine. A new combination reportedly popular among some populations in the Detroit area Is soma and codeine, taken orally or injected. There are reports that some doctors are operating "on the street" by writing prescriptions to those who "wait In |ine" in certain areas of Detroit. There are also other "operations" where an Individual would receive a prescription but never actually see or recelve any paper (a "runner" would fill the prescription at an unknown location and then give the drugs to the buyer). 11-57 8G9~II TABLE 1 Narcotic Addiction Deaths (Source: Wayne County Medical Examiner's Office: Dr. Montforte, 1985) Year Quarter 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985% 1st Quarter 56 79 51 23 28 20 34 26 31 40 40 42 2nd Quarter 55 79 55 23 13 20 36 27 63 21 40 45 3rd Quarter 46 124 57 29 20 20 54 38 48 39 34 4th Quarter 65 59 43 20 12 27 34 50 50 36 55 - Total 222 341 206 95 73 87 158 141 192 136 169 ¥Through May 1985, OSAS/EVAL 6/85 65-11 TABLE 2 Heroin Price and Purity (Source: Domestic Monitor Program, Drug Enforcement Administration) 1981 Jan Apr Jul Oct Mar Jun Sep Dec Number of samples 20 26 30 29 Number of samples (no Heroin) 2 - 3 8 Average purity 4.8% 3.5% 4.9% 6.2% Purity range .3% .5% .4% .2% thru thru thru thru 23.0% 29.1% 53.2% 47.5% Average price per sample $213 $135 $129 $125 Average price per mg. (if pure) $11.80 $5.74 $4.11 $4.02 ¥Began reporting Semi-annually with 1984, 1982 Jan Apr Jul Oct Mar Jun Sep Dec 27 30 33 25 2.82 3.73 3.2% 4.3% 39 1% .6% 3% thru thru thru thru 39.24 12.0% 13.0% 31.1% $82 $81 $98 $100 $3.06 $3.05 $3.32 $1.42 1083 Jan Apr Jul Oct Mar Jun Sep Dec 19 19 22 26 4 - 3 2 6.1% 4.5% 3.5% 2.6% .4% .9% 1.1% .4% thru thru thru thru 31.8% 10.8% 30.0% 22.8% $106 $113 $97 $125 $1.97 $2.84 $3.36 $4.24 Jan 1084% Jul Jun Dec 51 2.3% 01% thru 44.9% $102 $2.90 OSA 6/8 37 2.5% 01% thru 15.9% $101 $3.36 S/EVAL 5 09-11 TABLE 3 Type of Drug Involved in Detroit Court Cases (Source: City of Detroit Police Narcotics Unit) Heroin 12 55% 135 54% 1565 57% 1310 57% 866 52% 17° 46% Methadone 1 <1 20 1 45 2 17 1 5 <1 ¥ <1 Marijuana (sale or distribution) 4 19 246 10 285 10 217 S 199 12 43 1" Amphetamines 33 1 36 1 56 2 n 3 18 1 0 - Barbiturates 2 1 3 2 35 1 18 1 5 <1 1 <1 Cocaine 152 6 89 4 149 5 179 8 225 14 84 2 Codeine 19 1 47 2 97 4 173 7 159 10 51 13 Talwin 499 20 245 9 52 2 13 1 0 - Dilaudid 8 <1 7 <1 21 1 33 1 32 2 6 2 LD 34 1 15 1 19 1 5 1 ° 1 4 1 Morphine 1 <1 0 - 0 - 0 - 0 - 0 - FCP 3 1 17 1 16 1 15 1 16 1 5 1 Quaalude c - C - Cc - 0 - 0 - 0 - Val lum 12 5 62 2 81 3 34 1 16 1 3 1 Other Drugs 69 3 24 1 78 3 137 6 66 4 10 3 Other Charges (drug involved) 8 46 35 3 24 0 Total 241 95% 2503 9%t Ziz1 9% 312 9% 1653 98% 387 99% ¥Through March 31, 1985. OSAS/EVAL 6/85 19-11 TABLE 4 Drug Abuse Mentions - Reporting Emergency Rooms Detrolit/Wayne County Area January 1982 - December 1984 Source: DAWN (NIDA) 1982 1983 1984 Jan Apr Jul Oct Jan r Jul Oct Jan pr Jul Oct Drug Mentioned Mar Jun Sep Dec Mar Jun Sep Dec Mar Jun Sep Dec Heroin 334 471 642 638 856 803 866 694 706 593 643 528 Mari juana 72 85 84 115 223 253 221 54 91 52 42 53 Cocaine 39 52 63 71 82 133 145 119 165 141 127 152 Dilaudid 23 24 35 27 23 39 38 29 30 33 14 11 PCP 19 28 25 26 31 40 22 22 28 22 16 25 Demerol 27 35 23 26 28 30 17 12 18 14 10 3 Codeine 11 12 9 8 14 16 14 19 26 14 10 12 Val lum 164 153 185 185 160 141 109 129 153 112 101 108 Talwin 67 50 75 70 59 44 29 18 12 7 8 5 Alcohol=-in-Combination 268 261 328 325 321 319 294 272 308 234 205 218 Total Mentions 2153 2283 2665 2636 3113. 3059 . 3019 2545 3013. 2528 2530 241 Top five drugs mentioned, their ranking, and percentage of the total. 1982 1983 1. Heroin 20 1. Heroin 26 2. Alcohol-in-Combination 12 2. Alcohol-in-Combination 10 3. Valium 7 3. Marl juana 7 4. Magi juana 4 4. Valium 5 5. Talwin 3 5. Cocaine 4 Jan-Jun Jul-Dec 1984 1984 1. Heroin 23 1. Herol 23 2. Alcohol-in-Combination 9 2. Alcohol-in-Combination 9 3, Marijuana 5 3. Cocaine 6 4, Valium 5 4. Valium 4 5. Cocaine 2 5. Mari juana 2 OSAS/EVAL 6/85 Z9~11 TABLE 5 Treatment Admissions by Primary Drug (Source: Office of Substance Abuse Services) Detroit/Wayne County ad Toe 7 Ree of Te oF Faroe of A Td NE aT PrimryDrg _ Amistions Admissions Amiseians Amissions Bion: Aon Asis Aeon None 77 <1% g3 1% 113 ea 108 1% 25 <19 Alcohol 7875 47 8571 53 10548 61 11114 60 5286 61 Amphetamines 277 1 158 1 105 1 114 1 48 1 Barb iturates 261 2 152 1 60 <1 47 <1 12 <1 Cocaine 181 1 124 1 187 1 473 3 478 5 Hal lucinogens 141 1 115 1 4z <1 53 <1 22 <1 Heroin 4917 30 4417 Vij 4115 24 4221 23 1737 2 Inhalants 15 <1 12 <1 12 <1 10 <1 1 <1 Mari juana/Hashish 1220 3 1065 7 820 Lo 761 4 357 4 Methadone (Non=Rx) 62 <1 41 <1 65 <1 83 <1 36 <1 Other Sedatives/ Hypnot ics 79 ee 56 <1 24 <1 13 <1 6 <1 OHEr rar 505 3 300 2 438 3 610 3 223 3 Over=the-Counter 19 <1 25 <1 5 <1 9 <1 2 <1 Tranquil izers 210 2 285 2 128 1 108 1 36 <1 FCP 113 1 103 1 72 <1 62 <1 30 <1 Multi-Drug 43 <1 65 <1 64 <1 93 1 52 1 Significant Other Family) 173 1 264 2 402 2 431 2 77 4 Other 68 <1 52 <1 3 <1 25 <1 11 <1 Unknown 265 2 70 <1 15 <1 15 <1 4 <1 Not Reported 80 <1 154 1 38 <1 31 <1 1 <1 Total 16600 7) 4 16213 98% 17202 97% 18381 98% 8704 98? *Six months (October 1, 1984 - March 31, 1985). OSAS/EVAL 6/85 £9=-11 TABLE 6 Admissions by Primary Drug Type Statewide vs. Detroit/Wayne County #¥Six months (October 1, 1984 - March 31, 1985) 8704 100% (Source: Office of Substance Abuse Services) s EB BelER IIa oR Detrotiivayng oo Primary Drug u ercen fuss erc State Totals Alcohol 32246 69% 10548 61% 33% Heroin 4943 11 4115 24 83 Other Opiates and ; Synthetics 1182 3 503 3 43 All Others (Various) 8520 ‘18 2126 12 25 Total 46891 101% 17292 100% 37% FY 1983/84 FY 1983/84 Detroit/Wayne Co. Primary Drug I 51008 Pelzely{iayns- Co. AUnlsglovs , 2g,3 Dersenl.S Alcohol 34660 74% 11114 60% 32% Heroin 4896 11 4221 23 84 Other Opiates and Synthetics 1149 2 693 4 60 All Other (Various) 6035 13 2353 13 39 Total 46840 100% 18381 100% 39% FY 1984/85% FY 1984/85% Detroit/Wayne Co. de Adm sglong Detroit/Wa pe.Co. Agnlssions as a Percent of Alcohol 17439 70% 5286 61% 30% Heroin 2087 8 1737 20 83 Other Opiates and : Synthetics 390 2 254 3 65 All Others (Various) 5149 21 1427 16 28 i Total 25065 101% 35% 9943/EVAL yo-11 TABLE 7 Opiate Admissions to Treatment (Source: Office of Substance Abuse Services) Detroit/Wayne County Year Quarter 1978/79 1979/80 1080/81 1981/82 1982/83 1983/84 1984/85% 1st Quarter 1559 1339 11.75 1331 1165 986 2nd Quarter 1244 1246 1455 Y 175 1110 1204 1010 3rd Quarter 1119 1.573 1451 1161 1160 1247 4th Quarter 1484 1561 1239 1181 1183 1235 Total 3847 5939 5484 4692 4784 4851 1996 ¥Six months (October 1, 1984 - March 31, 1985) OSAS/EVAL 6/85 99-11 " n 1a Id Number of Admissions i .] a ion sly ron] TABLE 8 Detroit/Wayne County Year of First Use - Heroin Admissions E 1975 Year of First Use oe _ = ra = Ly SG SEG (six months) OSAS/EVAL 6/85 99-11 Number of Admissions 5 Zo i i £ £ z T ; we gn" TE 3 $5 3 ® = ER ESSE £E = mmm =__E po Key: tnpLt 7 Year of First Use - Cocaine Admissions Detroit/Wayne County i= +! SBE = - soit 5 1965 Admission Year ri. Fi “SE od uy i te I . wl eres iii ri HH : 0 hy Ct fedned 1 SH Sl 3 § 3 WS % i § i : i Tr : 3 = ; i seis x Fl, TH oadP5E 0 85e8 s:2i 22 tag, seefies 1 + a : 22 23i 5 foesd i i: t 3: # HE a oul r st PITT = n 3 i re hed 2 : = Frade + » se, 23 « Ses 7, A ast Fi eae afer = Y ! Ban Eb gg 1975 Year of First Use 82/782 p-83/84 ee SBD (six months) OSAS/EVAL L9-II 5 2, 1 P 3 £ ES 2 = i f EE 13 ] 4 A i i s= nl nd Number of Admissions I PIM. TV Year of First Use - Other Opiate Admissicns Detroit/Wayne County £ BB. .B gE &. oF 1970 1975 J, fo shi di, Hr Fiflafe ini + ped I fils 2 gone ERE “a1 2a: a3 28 t LE sara Year of First Use 1d SOS caf Foe gross oF fl ut pe TF vine Ral of . F (six months) OSAS/EVAL 6/85 DRUG ABUSE TRENDS IN MIAMI - JUNE, 1985 James N. Hall Up Front Drug Information Center Cocaine remains the Miami drug headline of 1985 to such an extent that the observer may be snowblinded from seeing other developing issues. Early indicators of increased heroin use among middle and upper socio-economic groups faded with the passing of the winter season. Community attitudes favoring alcohol sobriety were dimmed by evidence that cocaine use promotes alcohol consumption and addiction. Media exploration of ‘designer drugs’ launched a national demand for what previously was a relatively unknown substance, MDMA (called ADAM in Miami but nationally known as ECSTASY). Marijuana use remains stable but price of and complications from more potent domeatic varieties are increasing. Local corporations more and more are turning to urinalysis for pre-employment and on the job testing. Cocaine A summary of cocaine indicators compiled for the Florida Cocaine Task Force by the American Medical Association reveal the following state trends: Availability ......Up PUrityevsrsessnnsens Up Markedly Price.ssesvsceas...Down Intensity of Use...Up Cagsualties.........Up Markedly Each indicator has various consequences. With prices relatively low and availability high, less sophisticated younger users are introduced to cocaine. In Miami, junior high age students have access to cocaine if they desire to have it. Increased purity of street samples are reflected in rising Emergency Room visits and accidental deaths related to cocaine. Intensity of use reflects increased occurrence of freebase amoking and intravenous use of cocaine. '"Speedballing' now accounts for a third of all cocaine related ER mentions of the drug. Patterns indicated both an increasing number of users seeking a greater jolt than intranasal snorting provides them as well as growing availability of processed freebase and more pure street cocaine for injection. II-68 Although data from local treatment programe is not available for thie report, an informal survey revealed treatment for cocaine as the primary drug of abuse ranged from seventy-five to eighty-six percent (75% - 86%) of all admissions. Cocaine All All Six Months Accidental 1983 1984 1985(Jan.-June) Overdose Deaths 25 24 7 The number of accidental overdose deaths in the first six months of 1985 appears to be on a decline. However caution is noted in that several cases are still to be classified and it is believed that the number of cocaine related overdose deaths will be increased. Two new categories of cocaine related mortalities have been detected by the Dade County Medical Examiners office. The first is a cocaine-induced psychosis and sudden death syndrome to be reported by Dr. Charles V. Wetli in the July 1985 issue of The Journal of Forensic Science. The study identifies seven cases in which victims using varying dose levels experienced intense paranoia followed by violent and bizarre behavior necessitating forcible restraint. The victim frequently exhibited hyperthermia and unexpected strength. Fatal respiratory collapse occurred suddenly within a few minutes to an hour after the victim was restrained. Five of the deaths occurred in police custody. Rescue and emergency room personnel should be aware that excited delirium may be the result of a potentially fatal cocaine intoxication requiring immediate transport to a medical facility, continuous monitoring, administration of appropriate cocaine antagonists, and respiratory support. Other previously uncounted cocaine related deaths have resulted from use of the drug by those with a preexisting cardiac condi- tion exacerbated by cocaine stimulant properties. Such deaths have been reported as death by heart attack or other condition rather than as drug related. Changing trafficking patterns have seen the importation of coca paste (cocaine sulfate) and processed freebase cocaine into Miami. These forms of cocaine imports reflect the lack of processing chemicals (Ether) in South America and attempts at avoiding detection by doge trained to amell cocaine hydrochlor- ide. The Miami Herald reports processed freebase cocaine is stored in the Bahamas for shipment to the United States. Freebase abuse is already taking its toll on the out-islands as a spill-over effect from trafficking activities. Cocaine sulfate is processed in clandestine laboratories through out Dade County. These labs, often found in residential neighborhoods, present a new form of violence from the cocaine trade in that they are most prone to explosion from the volatile chemicals used. II-69 Incidents of smoking cocaine sulfate also known as paste, base or basuco are relatively unknown except for some use by South Americans directly involved in processing and trafficking. However if the price of cocaine sulfate were to fall sharply below the cost of processed cocaine hydrochloride, use could spread, particularly among younger groupe, like a firestorm across the Everglades. A key prevention strategy should include warnings about lead and petroleum contaminants found in cocaine sulfate smoke as well as the totally compulsive nature of its use. The presence of certain analogs in street cocaine samples may indicate new source plants and areas of production in the Amazon basin. Continued study of these chemical traces could reveal more about the origins and patterns of traffic and production. The creation of a Florida Cocaine Task Force in late 1984 has resulted in a strategy to combat the widespread effects of cocaine abuse on the state. The Task Force will release its report in September and is expected to offer a citizen offensive incorporating the theme, "Cocaine is Hurting You!, Cocaine is Hurting U.S." The report will demonstrate a significant relationship between cocaine use and criminal activity. It will identify the need for early intervention and treatment alterna- tives for young users and offenders. Heroin January of 1985 brought signs of increased heroin problems for the Miami area. Methadone programs reported declining numbers of clients which is generally considered a sign of increasing heroin street availability. Three reported heroin related deaths in one weekend represented one third of the total for 1984. Private hospital treatment programs reported an increase in clients for heroin treatment from middle and upper socio-economic groups. New users report introduction to heroin through cocaine use. Either by combining the drugs in a IV "speedball” or using heroin by intranasal snorting. Several heroin addicts reported they mistakenly believed they could avoid addiction by snorting the drug rather than injecting it. Synthetic heroin is reported in the area by users and is attributed as the cause of at least one South Florida (Broward County) death in 1985. MDMA Media coverage of the scheduling of MDMA as a controlled substance created an overnight street demand for the drug called, ADAM or "Ecstasy." It is anticipated that such a demand will bring adulterated sources and deceptions such as offering PCP or LSD as MDMA to the illicit market. 11-70 Marijuana Marijuana use appears stable in Miami although the availability of imported cannabis is reported on the decline. Increasing amounts of domestic marijuana have raised the street price of the drug. Reporte from northern Florida treatment programs indicate an increase in the number and age of clients admitted for marijuana abuse. It be possible that these incidents could be related to the higher potency of domestic varieties of marijuana which have been in greater supply over the past few years in northern and central Florida. I-71 AVAILABILITY PURITY PRICE PATTERNS OF USE USER POPULATION MORBIDITY MORTALITY TREATMENT IMPACT ENFORCEMENT IMPACT FLORIDA COCAINE TASK FORCE SUMMARY OF FINDINGS FEBRUARY, 1985 National--11 1bs. seized in 1960; 25,000 1bs. seized in 1984. Estimated 54 to 71 metric tons entered US in 1983. Florida---Major point of entry for illegal shipments to US. Higher per capita consumption of pharmaceutical cocaine than U.S. average. Increased product purity reported by all sources. National--Prices generally declining, with regional variations. Florida---Prices dropped markedly in 1984, with $50/gram street ; price reported in Miami in mid-1984. More intensive forms of use (i.e., freebasing, intravenous) up sharply. Speedballing (combining heroin and cocaine use) now accounts for a third of all cocaine-related ER mentidns. National--Estimates from 1982 NIDA National Survey on Drug Abuse: Ever used = 22,000,000 Used in past year = 12,000,000 Use currently = 4,200,000 In 1982, 28.37% of young adults (18-25 years old) reported that they had used cocaine at least once. Cocaine-related emergency room episodes as a percentage of all drug-related emergency room episodes reported through DAWN: 1981 1982 1983 National--Total DAWN Reports 3.947% 5.15% 6.637 Florida---Miami DAWN Reports 5.60% 8.60% 12.51% Cocaine-related deaths reported by medical examiners ag a per- centage of all drug-related deaths reported through DAWN: 1981 1982 ~~ 1933 National--Total DAWN Reports 6.587% 6.712 10.55% Florida---Miami DAWN Reports 26.23% 22.83% 30.21% Treatment program admissions for cocaine as the primary drug of abuse, as reported through CODAP (note: Figures double when cocaine is reported as the primary or secondary drug of abuse): ; 1977 1981. 1983 National--Total CODAP Reports 1.3 2 5.82 9.07 Florida---State CODAP Reports 3.9% 13.3% 19.2 % 1982 1983 Florida---Arrests for sale of cocaine 1,546 2,146 Arrests for possession of cocaine 3,100 4,408 I-72 DRUG USE INDICATORS IN THE TWIN CITIES METROPOLITAN AREA JUNE, 1985 Bruce W. Hutchinson, M.A. Research Coordinator Chemical Dependency Program Division Department of Human Services Space Center 444 Lafayette Road St. Paul, Minnesota 55101 For purposes of this report, the Twin Cities metropolitan area was defined as the five county area consisting of the counties of Anoka, Dakota, Hennepin, Ramsey and Washington. This area contained approximately 47 percent of the total state population as of the 1980 Census. The cities of Minneapolis (located in Hennepin County) and St. Paul (located in Ramsey County) contained approximately 16 percent of the total state population and approximately 34 percent of the five county population. : Indicator data sources examined included the following: 1. Hospital emergency room drug abuse mentions as reported to the Drug Abuse Warning Network (DAWN); y 2. Detoxification episodes involving drugs other than alcohol at detoxification facilities serving the five county Twin Cities metropolitan area; 3. Treatment admissions to five publicly~funded drug abuse programs serving Minnesota residents (primarily from the counties of Hennepin and Ramsey); 4. Treatment admissions from the five county Twin Cities metropolitan area to six state hospital chemical dependency programs; 5. Treatment admissions (Minnesota residents ~ primarily metropolitan) to seven hospital-based chemical dependency programs located in the Twin Cities metropolitan area; Drug overdose deaths as reported by the Hennepin County Medical Examiner; Qualitative and quantitative analysis data on drugs seized by law enforcement agencies in Hennepin County as reported by the Minneapolis Health Department Laboratory; 8. Initial contact questionnaires filled out on methadone maintenance waiting list clients at the Hennepin County and VA methadone programs; 9. Responses to an informal telephone survey of program directors and/or intake staff from fifteen Twin Cities metropolitan area treatment programs; and 10. Informal interviews with the heads of the Narcotics Divisions of the Minneapolis and St. Paul Police Departments. ~N Oo The indicators examined in this report are not uniform in their geographic coverage. DAWN, detoxification episodes and treatment admissions involved, for the most part, residents of the five county area. Law enforcement and mortality data are limited primarily to Hennepin County. Telephone interviews with treatment program staff were limited primarily to programs located in the counties of Hennepin and Ramsey. Taken together, it is felt that the indicators examined in this report adequately represent drug use/drug availability patterns found throughout the five county Twin Cities metropolitan area. 11-73 DAWN data presented in this report provide coverage of the five county Twin Cities metropolitan area. The majority of drug abuse mentions reported occurred in the counties of Hennepin and Ramsey and were handled at facilities located in Minneapolis and St. Paul. Of 15 facilities expected to report on the DAWN system, 14 facilities satisfied the selection criteria necessary to be included in the most recent figures released by the National Institute on Drug Abuse. The vast majority (approximately 90 percent) of all detoxification episodes which occur in Minnesota involve alcohol as the primary drug, Data on non-alcohol detoxification episodes presented in this report were gathered from facilities located in the counties of Hennepin, Ramsey and Dakota. These facilities provide good coverage of the Twin Cities metropolitan area, particularly the cities of Minneapolis and St. Paul. Data from the facilities located in Ramsey and Dakota counties were obtained from a management information system operated by staff from the Chemical Dependency Program Division, Department of Human Services. Data from the facilities located in Hennepin County were obtained from a management information system operated by county staff. In August, 1984, all but one of the Hennepin County facilities began reporting on the Drug and Alcohol Abuse Normative Evaluation System (DAANES), which is maintained and operated by Chemical Dependency Program Division staff. Data from DAANES for these facilities were not presented in this report. Data presented cover the time period from January, 1979 to June, 1984. The five publicly-funded drug abuse treatment programs from which data were available included two drug-free residential programs, two drug-free outpatient programs and one methadone program. Four of these programs are located in Hennepin County and one is located in Ramsey County. Clients served typically resided in either Hennepin County or Ramsey County. All five of the programs were consistent reporters on the CODAP system, with admissions data available from 1979 through the third quarter of 1983. The CODAP system was phased out by the end of September, 1983, at which time these programs began reporting on DAANES. Trends in admissions data for these - programs combined old CODAP data with the new DAANES data. Several caveats exist, however, which suggest caution in interpreting sudden upward trends which occurred when DAANES data were introduced into the series. First, the concept of "primary drug" was not included in DAANES. Rather, a client was simply asked to identify substances used and use frequency in the six months prior to admission from a list of commonly abused substances. This made it easier for a client to endorse use than attempting to recall use of specific substances without benefit of a list. Second, the CODAP drug matrix limited responses to four substances, while DAANES permitted positive (did use) responses for up to ten substances. Third, pre-admission client recall of use patterns was limited to one month on the CODAP system and to six months on DAANES. Chemical dependency treatment programs currently are operational in six state hospitals throughout the State of Minnesota. Since July, 1983 these programs have been reporting on DAANES. Although data for only three six month time periods were available as of this writing, the data were presented in order to illustrate the utilization of this treatment environment by individuals experiencing problems with drugs other than alcohol. The time period covered was from July, 1983 through December, 1984. Data presented are for admissions to any state hospital in Minnesota from the Twin Cities metropolitan area. Of special interest is the fact that one state hospital program has provided and continues to provide opiate detoxification services and drug-free residential treatment to opiate addicts. The use of treatment data as an indicator of the magnitude and severity of the drug abuse problem was significantly enhanced during this reporting period by the acquisition of data on over 3,600 Minnesotans admitted to treatment in seven hospital-based chemical dependency treatment programs (four inpatient-three outpatient) I-74 located in the Twin Cities metropolitan area. Since these data covered the time period from July, 1981 through December, 1983 they do not necessarily reflect current trends in the abuse of selected substances. The data are, however, invaluable as an aid to assessing the continuum of care available to and/or accessed by drug abusers in the Twin Cities metropolitan area. The hospital-based treatment data were provided by Dr. Norman Hoffman, Director of the Collaborative Alcohol Treatment Outcome Registry (CATOR). CATOR is a computerized patient registry designed for the routine documentation of patient characteristics and post-treatment follow-up. A consistently reporting group of programs was chosen from the CATOR data base, from which all Minnesota resident admissions were selected for analysis. Monthly reports are received at the Chemical Dependency Program Division from the Hennepin County Medical Examiner's Office which contain information on deaths involving alcohol and/or other drugs. For purposes of analysis and conceptual clarity, only those deaths where drugs and/or alcohol were certified as the cause of death were included in this report. This excluded those deaths where drugs and/or alcohol may be mentioned under "Other Significant Conditions." In the absence of data on county of residence of the deceased, it is assumed that the majority of deaths reported involve Hennepin County residents. Law enforcement agencies in Hennepin County utilize the Minneapolis Health Department Laboratory for qualitative and quantitative analysis of drugs obtained through seizures and, infrequently, informant buys. The Minneapolis Police Department and the Hennepin County Sheriff's Department are the most frequent users of this service. In the latter part of 1983, the two methadone programs in the Twin Cities metropolitan area began keeping waiting lists of those persons desiring methadone maintenance. This waiting 1ist phenomenon sparked an ongoing debate as to the extent of the opiate abuse problem, the characteristics of those applying for maintenance, alternatives to methadone maintenance, methadone maintenance program goals and a host of related issues. In an attempt to address some of these issues, data were collected from those applying for a spot on the waiting list at either the VA program or the Hennepin County program. Data from the Hennepin County waiting list basically cover calendar year 1984, while data from the VA waiting list cover the period from July, 1983 through the end of 1984. Program directors and/or intake personnel of fifteen residential programs in the Twin Cities metropolitan area were interviewed via the telephone concerning trends over the past two years in the characteristics, drug use patterns and associated problems of their treatment admissions. Of particular interest were adolescent drug use patterns and the prevalence of cocaine use/abuse. Interviews were also conducted with the heads of the Narcotics Divisions of the Minneapolis and St. Paul Police Departments and with an agent from the Minneapolis DEA office concerning trends in drug trafficking, drug availability, drug prices and related enforcement activity. In the sections which follow, relevant information from the sources enumerated and described above were used to describe a variety of trends (e.g., use patterns, treatment admissions, law enforcement activity, etc,) for selected substances of abuse in the Twin Cities metropolitan area. 1-75 OPIATES Waiting lists were established in late 1983 at both of the methadone clinics serving opiate addicts in the Twin Cities metropolitan area. These waiting lists have resulted in numerous questions as to the extent of the opiate abuse problem, the adequacy of the continuum of care for opiate addicts, the types of persons presenting for methadone maintenance and even the wisdom of keeping waiting lists. Sociodemo- graphic and use history data were collected from waiting list clients in 1983 and 1984 at the program operated by Hennepin County (Table 1) and at the program operated by the VA (Table 2) in order to address some of the issues raised concerning the waiting list phenomenon. Table 1 shows admissions to the county program prior to 1983 and in 1983, These admissions were compared on selected variables to waiting list clients. The waiting list showed a higher percentage of females than either admission group. The racial composition of the waiting list group showed no appreciable difference from either admission group, with the same holding true for average age (33.2 years in the 1983 admissions group and 33.0 years in the waiting list group). The waiting list group did, however, have a higher percentage of persons in the 25 and under age group and in the 36 to 55 age group than did either admissions group. The average years of use for clients on the waiting list was 14.5 years, compared to 12.6 years for 1983 admissions and 11.6 years for pre-1983 admissions. No appreciable differences were noted when comparing the three groups on prior methadone admissions or prior drug-free treatment admissions. Data in Table 1 indicate that the waiting list client did not differ appreciably from the previously admitted client. Although a few of the younger waiting list clients reported a short abuse history, the vast majority reported a use history of at least 9 years (75.8 percent). For the most part, clients on the waiting list began their opiate use in the late 1960's - early 1970's, which is consistent with what has been reported by previous admissions . 77.4 percent of the waiting list clients indicated that they had not sought other treatment prior to applying for methadone maintenance, and 66.1 percent indicated they would not accept a referral to another modality. Leading reasons given by waiting list clients for preferring methadone maintenance were "abstinence-based treatment doesn't work" (50.8 percent) and "past success with methadone" (39.0 percent). When asked why methadone maintenance was necessary now, 39.3 percent of the waiting list clients indicated money problems, while 23.2 percent mentioned a pressing criminal justice problem. As of this writing, data on the final disposition of those on the waiting list for the Hennepin County program were not available. As a result of the waiting 1ist, 100 slots have been added since April, 1983, bringing the total available slots to 230. Plans are to designate 200 slots for maintenance and 30 slots for detoxification with options (e.g., drug- free outpatient counseling, acupuncture), There is currently a 3 to 4 month wait for persons on the waiting list. Table 2 shows a comparison on selected variables between admissions to the VA methadone program from 1979 to 1983 and clients placed on the waiting list during late 1983 and 1984. Of the 45 clients on the waiting 1ist, 25 had been admitted to the program at the time data collection had ended, with an average wait of approximately 4 months, A higher proportion of waiting 1ist clients were White compared to the admissions group (81,6 percent versus 71.7 percent), while the opposite was true for Blacks (15.8 percent versus 28.3 percent), The average age of the waiting Tist clients was approximately 4 years greater than that of the admissions group (36.1 years versus 31.9 years). On average, the waiting list clients reported 3.3 years more opiate use than did the admissions group, and slightly more prior methadone maintenance experience (1.9 admissions versus 1.5 admissions). However, the waiting list group did report approximately 1 fewer drug-free treatment admission than did the admissions group (2.4 versus 3.3). Fully 100 percent of those on the waiting list who responded indicated they would not consider an alternative placement, 11-76 When asked to list the reasons why they wanted methadone maintenance now, 66.7 percent of the waiting list clients responding indicated a criminal justice-related problem, 27.3 percent indicated general habit maintenance problems and 18.2 percent indicated money problems, The leading reasons for not considering an alternative to methadone maintenance weré prior failures in drug-free treatment (45.5 percent) and a need to work and support a family (18.2 percent), Data on the waiting list clients from both methadone maintenance programs indicated no drastic changes in the opiate abusing population compared to prior admissions, The majority of the waiting list clients have had some prior treatment and criminal justice system experience, began using opiates in roughly the same time period as earlier admissions to methadone maintenance programs and are seeking methadone maintenance for economic and/or criminal justice-~related reasons. Other indicators examined in this report showed some upward movement, Opiate related detoxification admissions in Hennepin County facilities increased from the first six months of 1979 to the first six months of 1984 (Figure 1B), Although the increase was not large, a peak was reached in the second six months of 1983, which roughly coincided with the establishment of waiting Tists at the two methadone programs. Figure 2B shows a similar trend at detoxification facilities located in the counties of Ramsey and Dakota, Again, although the overall increase was small, a peak occurred during the second six months of 1983. Because of the switch of management information systems (CODAP to DAANES), the primary drug concept was abandoned in an effort to combine data from the two systems. This resulted in a 1979 through 1984 data series in which reported use frequency (abstainers versus daily users) was tracked across 12 six month time periods for all admissions to the five Twin Cities metropolitan area drug treatment programs. As mentioned previously, because of the manner in which clients were asked about drug use on DAANES, it is difficult to assess changes in either the abstainer or daily user categories between the first six months and the last six months of 1983 (when the programs switched to DAANES). Figure 3C does show a decline in the percentage of admissions abstaining from heroin prior to admission, accompanied by an increase in the percentage of daily users, These changes began in the last six months of 1983 and continued through the end of 1984, The percentage of daily heroin users admitted during the last half of 1984 (8,4 percent) was far below the same percentage found in the first six months of 1979 (32.8 percent). This is felt to reflect a fairly steadily diminishing supply of heroin in the Twin Cities metropolitan area coupled with a tendency toward reliance on the synthetic opiates (particularly Dilaudid) in the addict population. Figure 3D shows the abstainers/daily users trend in synthetic narcotic use at admission, Very little movement was seen in either the abstainer or daily user category, which is thought to reflect a somewhat more stable Dilaudid supply than has been true with heroin, Figures 4C and 4D show the percentage of abstainers and daily users of opiates and analgesics among admissions to seven hospital-based chemical dependency programs in the Twin Cities metropolitan area. Both drug types show 1ittle if any movement in either the abstainer or daily user categories over the five six month time periods for which data were available. The percentage of admissions reporting daily use of either drug type was consistently in the area of 2 percent, while the percentage abstaining was consistently above 90 percent. Drug use data on admissions to Minnesota's six state hospital chemical dependency programs were available for three six month time periods (July, 1983 through December, 1984) from DAANES. Figures 5C and 5D show upward movement in the percentage of admissions reporting daily use of heroin and synthetic narcotics. The 13-77 percentage of daily heroin users rose from 2.2 percent in the last six months of 1983 to 4.0 percent in the last six months of 1984, The comparable figures for daily synthetic narcotic users were 4.3 percent and 5,9 percent, respectively, Although clearly too early to label a trend, this upward movement T1ikely reflects an increase in utilization of the opiate detoxification~treatment program at one of the state hospitals. This increase is thought to be related to the current lack of methadone slots in the Twin Cities metropolitan area. Figures 6C and 6D indicate that the opiate addict in the Twin Cities metropolitan area has received services (recently) in publicly funded programs (primarily methadone). To the extent that the seven hospital-based programs represent the private sector in Minnesota's chemical dependency treatment system, it does not appear that the private sector currently plays a significant role in the treatment of opiate addicts. Table 3 shows that the hospital-based programs have tended to see a substantially different population than have the publicly funded programs, The hospital-based programs have admitted the highest percentage of women of the three treatment environments (27.0 percent versus 18,8 percent in the drug treatment programs and 13,6 percent in the state hospital treatment programs), the highest percentage of Whites (94.8 percent versus 79.7 percent and 83,3 percent, respectively), the highest percentage of those over 35 years of age (48.4 percent versus 10.3 percent and 35.6 percent, respectively), the lowest percentage of those with mulitple prior treatment experiences (12.6 percent versus 49,0 percent and 59.3 percent, respectively), the highest percentage with a job (60.2 percent versus 20.2 percent and 34.3 percent, respectively), the Towest percentage with less than a high school education (25.8 percent versus 39.2 percent and 32.0 percent, respectively), the lowest percentage unmarried (29.0 percent versus 63.3 percent and 48.9 percent, respectively) and the lowest percentage with prior arrests (34.3 percent versus 64.2 percent and 42.3 percent, respectively). These demographic characteristics do not reflect those of persons traditionally thought to be primary abusers of drugs other than alcohol in the Twin Cities metropolitan area (particularly opiate addicts). Program directors and/or intake staff at fifteen residential facilities in the Twin Cities metropolitan area indicated that reported opiate use among admissions over the past two years has not been increasing. Recently, however, two hospital-based programs and one physician have formally requested permission to dispense methadone for purposes of detoxification, This appears to be a by-product of the waiting lists at the two methadone programs. There were seven narcotic-related deaths reported by the Hennepin County Medical Examiner in 1984 (Figure 7A). Of those seven deaths, two were accidental, one was unknown and four were suicides. The non-suicide cases involved codeine, propoxyphene and an unknown opiate. In the first four months of 1985 there have been two narcotic- related deaths, one of which was classified as a suicide. The non-suicide case involved methadone and alcohol. There is no indication in the medical examiner reports that the availability or quality of opiates has changed dramatically in the Twin Cities metropolitan area. DAWN opiate mentions (Figure 8B) have shown sporadic upward movement from the fourth quarter of 1981 through the fourth quarter of 1984, with a peak occurring in the third quarter of 1984, Since these emergency room episodes generally involve an acute overdose situation, the peaks in Figure 8B may reflect the sporadic availability of relatively high quality white heroin in the Twin Cities metropolitan area. I1-78 In a prior CEWG report (June, 1984) it was noted that a significant heroin case was made by federal, state and local authorities involving individuals of Lebanese extraction. Although the heroin was destined for other markets, it is possible that some became available to Twin Cities addicts. Since the aforementioned case, two more significant heroin cases have been made in Minnesota. The first, in St. Paul, involved two elderly members of an Hispanic family and low grade Mexican brown heroin. Police speculate that Mexican heroin has been transported for a number of years from Chicago to Milwaukee to St. Paul. Those arrested were thought to be major suppliers to St. Paul's addict population. A much larger operation recently netted six arrests in Minnesota and twenty more in other states, including Iowa and Wisconsin, An Iowa man and his Nepalese wife (daughter of a Nepal district judge) were arrested at their lake cabin in northeastern Minnesota. During the nine month investigation, one and one-half pounds of heroin were seized or purchased. In Dakota County several purchases were made during the investigation. One involved one-quarter pound for $45,000 and one involved 300 grams for $60,000. Interestingly, law enforcement officials indicated that the suppliers had better luck arranging sales to undercover police than to actual dealers. This may indicate a lack of an adequate structure to move the heroin from the wholesale to the retail level. Law enforcement heroin seizures reported by Hennepin County law enforcement agencies during the last six months of 1984 and the first four months of 1985 indicated the limited availability of white heroin in small amounts (% to % gram) ranging from 16 percent to 27 percent pure. Mexican brown heroin is still reportedly available, although the arrests in St. Paul mentioned previously may impact availability. Four milligram pilaudid remains the most popular opiate among addicts in the Twin Cities metropolitan area. Law enforcement sources reported the price to be between $40 and $50 for a four milligram tablet. Table 4 shows that Minneapolis Police Department activity related to ilaudid peaked in 1983 and dropped significantly in 1984 (from 15 arrests to 6 arrests for the sale of pilaudid). Also of note has been the dramatic decline of arrests for forged prescriptions (from 51 in 1978 to 6 in 1984). This decline is thought to be largely the result of pharmacies in the Twin Cities metropolitan area removing narcotics from their shelves and better communication between medical service providers and area pharmacists concerning prescriptions. Table 4 also shows a dramatic increase in arrests for possession of injection equipment, which may indicate an increase in the prevalence of narcotic use. Equally plausible, however, are possible increases in the prevalence of the intravenous use of cocaine and methamphetamine in the Twin Cities metropolitan area. The St. Paul police have indicated a continuing problem with the importing by mail of opium in the Indochinese refugee community (primarily the Hmong). Ceremonial clothes have been impregnated with opium and sent through the mail to the older generation opium users who brought their habits with them to the United States. The number of cases made over the last five years is relatively small (approximately 20). Apparently the shippers are now using bogus names on the packages in order to avoid problems for the end user upon a set-up delivery. It has been recently learned that a self-help group has formed involving nurse anesthetists from Twin Cities metropolitan area hospitals. Of primary concern to group members has been the use of fentanyl. Little is known at this point concerning the magnitude or severity of the problem. 1-79 COCAINE Cocaine retains its position as the media darling of the Twin Cities drug scene. Empirical and anecdotal data from all sources have indicated cocaine use and its consequences consistently moving in an upward direction. No cocaine-specific data were available from Hennepin County detoxification facilities. Figure 2D, however, indicates that cocaine related detoxification admissions have increased in facilities located in the counties of Ramsey and Dakota, Treatment data for cocaine users have underestimated the impact cocaine has had and continues to have on drug abuse in the Twin Cities metropolitan area, Data presented in this report on cocaine use among treatment admissions reflect only those who abstained from use or used daily prior to admission. Anecdotal data from the service provider community indicated that the daily cocaine user is a relatively rare phenomenon. Most cocaine users are appropriately classified as polydrug users, using cocaine, in combination with alcohol and/or marijuana. Figure 3E shows a very slight movement upward in the percentage of admissions in the five drug abuse treatment programs reporting daily cocaine use prior to admission, The upward trend is likely explained by the change in information systems reported earlier. The same could be said for the decline in abstainers, although the decline seems to have continued past the date of system change. More revealing for this treatment group was the fact that in the first six months of 1979, 17,9 percent of admissions reported some cocaine use prior to admission. In the last six months of 1984, that figure was 42.9 percent. Admissions to the hospital-based programs in the Twin Cities metropolitan area have reported very little change in patterns of cocaine consumption from the last six months of 1981 through the last six months of 1983 (Figure 4E). Less than 2 percent of all admissions reported daily cocaine use in the last six months of 1983, The percentage of admissions reporting some cocaine use did increase-over the thirty month period from 17,5 percent to 20.4 percent, Interviews with metropolitan area service providers indicated that cocaine use has noticeably increased among treatment admissions over the past two years. If data for 1984 and 1985 were available, it would likely reflect a higher proportion of cocaine use and daily use among admissions to treatment in the area's non-public programs. One hospital-based program reported that cocaine as a drug of choice was up over 50 percent among treatment admissions in the past year. Another service provider reported seeing high rates of sexual dysfunction among cocaine users. The same provider also indicated a high rate of referrals to halfway houses for cocaine users after treatment, The majority of program staff interviewed indicated that cocaine was no longer the exclusive domain of the street drug users and the economically elite. Rather, cocaine use has made significant inroads into the drug using habits of the middle class (both blue collar and white collar). Service providers dealing primarily with adolescent populations reported seeing increases in experimental cocaine use but relatively little sustained use among Minnesota youth. A common observation was that youth from out-of-state (primarily California, New York and New Jersey) were more likely than Minnesota youth to have extensive experience with cocaine and other "exotic" drugs. Admissions to Minnesota's state hospital chemical dependency programs from the Twin Cities metropolitan area have reported daily cocaine use in slightly increasing numbers from the last six months of 1983 through the last six months of 1984 (Figure 5E). The percentage has increased from 1.9 percent to 3,4 percent. The percentage of abstainers has declined from 80.9 percent to 76.5 percent of all admissions, which indicates that cocaine use on less than a daily basis has also increased among this population. Daily cocaine use was found to be more prevalent among admissions to the five metropolitan area drug treatment programs than was found among admissions to the II-80 other two treatment environments (Figure 6E). This may be due, in part, to the time periods for which admissions data were available. However, when looking at total admissions to the three treatment environments, the percentage of abstainers was remarkably similar (approximately 80 percent). All indications are that the percentage of abstainers from cocaine in the treatment population will continue to drop in the near future. Hospital emergency room episodes involving cocaine have increased somewhat from 13 in the fourth quarter of 1981 to 22 in the fourth quarter of 1984 (an increase of over 69 percent). Coupled with the finding that detoxification admissions have shown an increase indicates that cocaine related morbidity has increased in the Twin Cities metropolitan area (Figure-8D). In July, 1984 the Hennepin County Medical Examiner reported the first cocaine related death since April, 1983. The death was classified as cocaine poisoning due to intravenous cocaine injection. Law enforcement personnel indicated that street level cocaine prices dropped and purity increased as Cubans attempted to corner the street cocaine trade in Minneapolis and St. Paul, A recent crackdown netted a number of Cubans from the Mariel boatlift accused of possession and/or sale of cocaine. It is not anticipated that this action will have any lasting impact on availability since more Cubans are reputedly moving into what is perceived to be an attractive market with less competition than is found in other areas. Current prices reportedly vary from $100 to $140 per gram and $2,300 to $2,500 per ounce, Ounce purity levels vary from 20 to 60 percent depending upon the sophistication of both buyer and seller. Arrests by the Minneapolis Police Department for both possession and sale of cocaine have shown large increases from 1978 to 1984 (Table 4). Similarly, seizures made by law enforcement agencies in Hennepin County were at their highest level during the last six months of 1984 (both in terms of quantity seized and number of cases) of any six month period for which data were collected (beginning in January, 1980). There were 6,78 pounds of cocaine seized in 108 separate cases, Although the amount seized varies considerably, the number of cocaine cases has increased steadily since the second six months of 1980, STIMULANTS Stimulant admissions have increased in Hennepin County detoxification facilities (Figure 1C) and decreased in Ramsey and Dakota County facilities (Figure 2C). The increase in Hennepin County stimulant detoxification admissions may well have been caused by cocaine related admissions which were included in the stimulant category. Admissions to the five metropolitan area drug programs have been reporting daily stimulant use in higher proportions and abstaining from stimulant use in Tower proportions beginning during the last six months of 1983 (Figure 3G). Again, these changes may be attributable in part to a switch in information systems, However, the changes have continued since the new information system was implemented, The percentage of admissions to the seven hospital-based programs reporting daily stimulant use remained relatively unchanged from the last six months of 1981 through the last six months of 1983 (Figure 4F). The percentage of admissions reporting no use, however, increased slightly over the same time period (78,1 percent versus 82.3 percent). The interviews conducted with residential program staff in the 15 metro- politan area facilities yielded some conflicting information on stimulants, particularly for the adolescent treatment population, Staff at one adolescent program indicated that methamphetamine was a popular drug and indicated a relationship between the drug and increased needle use. The actual number of documented cases was small, II-38]1 and the majority involved clients from other states, Staff at another program reported that stimulants were the most commonly abused substances reported by adolescents after alcohol and marijuana. Still another seryice provider dealing “with adolescents reported hearing less talk about "speed" in group counseling sessions over the past two years. Figure 5G shows little movement in the percentage of admissions to state hospital treatment programs reporting no use of daily use of stimulants prior to admission, A rather consistent picture of the use of stimulants across the three treatment environments emerges in Figure 6G. Over the time periods covered by the data, the percentage of admissions reporting no stimulant use prior to admission in all three treatment environments was approximately 80 percent. This is very similar to the finding for cocaine use (Figure 6E). This may indicate similar patterns of use for stimulants and cocaine, although it is not known to what extent (if any) the two user groups overlap. DAWN stimulant mentions (Figure 8C) exhibited an overall downward trend from the fourth quarter of 1981 through the fourth quarter of 1984, although two noticeable peaks did occur during the second quarter of 1983 and the first quarter of 1984. Table 4 shows that enforcement activity related to stimulants by the Minneapolis Police Department peaked in 1980. However, methamphetamine seizures by law enforcement agencies in Hennepin County increased dramatically in the last six months of 1984 with very Tittle slack seen in the first four months of 1985. Law enforce- ment seized 1,400 grams of methamphetamine in 38 seizures during the last six months of 1984. Although the amount seized through April, 1985 has not kept pace with the amount seized in the previous period, methamphetamine has been involved in 19 seizures. "Bikers" are perceived as being the single group most heavily involved in the methamphetamine business in Minnesota. OTHER DRUGS Marijuana continues to be the most widely used of all {illicit drugs by drug users in the Twin Cities metropolitan area and throughout the State of Minnesota. Marijuana is the most frequently mentioned drug other than alcohol by admissions to detoxification facilities located in the counties of Hennepin, Ramsey and Dakota. Marijuana detoxification admissions showed a dramatic increase for Hennepin County facilities, which coincided with the inclusion of an adolescent detoxification facility in the reporting system. Controlling for the addition of the adolescent facility yielded a much less dramatic increase, with some cyclical activity in evidence (high from January through June and low from July through December). The trend line for marijuana detoxification admissions to facilities in the counties of Ramsey and Dakota (Figure 2A) was nearly flat. The cyclical patterns noted for Hennepin County admissions (Figure 1A) were less in evidence for these facilities. Daily marijuana use was reported by a higher percentage of admissions to all three treatment environments than daily use of any drug except alcohol (Figures 3B, 4B and 5B). Trends in daily use appear to be moving upward as reflected by treatment admissions. Hospital emergency room episodes involving marijuana have declined from the fourth quarter of 1981 through the fourth quarter of 1984 (Figure 8A). This decline may have been caused, in part, by the lack of participation of several key suburban hospitals in Project DAWN, Interviews with adolescent service providers all indicated that marijuana was the number two drug of choice of Minnesota treatment admissions. Clinicians in several programs indicated that kids have been paying higher prices and smoking more potent marijuana, Law enforcement officials reported prices for Colombian and domestic marijuana to be in the $50 to $100 range depending on quality and/or buyer sophistication, with the more exotic and potent forms of I-82 marijuana priced significantly higher, Adolescent and adult marijuana users appear to be inclined to purchase marijuana in Tess than ounce quantities as a result of the high prices. Several adolescent service providers indicated that the incidence of prostitution, particularly among males, was up in part as a result of higher drug prices. Staff from several adolescent treatment programs in the Twin Cities metropolitan area indicated an upswing in the number of admissions reporting the use of LSD as a secondary drug. Detoxification, treatment and DAWN data revealed no recent increases in episodes related to LSD. Law enforcement seizures and reports indicated that LSD is available in the Twin Cities at approximately $5 per hit. The number of LSD seizures and the quantity seized (12 seizures, 1900 dosage units) by law enforcement agencies in Hennepin County was up during the Tast six months of 1984. The first four months of 1985 have yielded 2 LSD seizures and 268 dosage units. Adolescent program staff at two facilities geared toward long-term care reported that LSD use among treatment admissions has tended to post date stressful, abusive situations in the home. The abuse of inhalants (particularly by adolescent American Indians) remains a problem noted both in detoxification facilities (Figure 1F) and by adolescent treatment program staff in the Twin Cities metropolitan area. Several staff at different facilities indicated that economic considerations have made inhalants (e.g., gasoline, aerosols, white-out, etc.) more attractive to adolescents from a variety of socio-economic backgrounds. As evidenced by data presented in Figure 7C, tricyclic antidepressants continue to be involved in a high number of deaths as reported by the Hennepin County Medical Examiner. Close to 100 percent of these deaths have been determined to be suicides. During the first four months of 1985, 6 deaths have been attributed directly to tricyclic antidepressants. Five deaths have been attributed directly to alcohol during this same time period. Deaths due to tricyclic antidepressants have shown no signs of abating during the most recent reporting period. SUMMARY Both methadone maintenance programs serving the Twin Cities metropolitan area currently have waiting lists and 3 to 4 month waits prior to admission. The waiting lists at both programs appear to be populated by addicts with similar characteristics to previous methadone maintenance clients, Economics and pressing criminal justice matters seem to be the primary reasons for seeking methadone maintenance. The current demand for methadone maintenance appears to be unrelated to issues of drug quality and/or availability. Cocaine appears to be gaining in popularity among Twin Cities drug users as reflected by all of the indicators examined in this report. The use of cocaine rarely occurs over extended periods of time among Minnesota adolescents, primarily for economic reasons. Most treatment admissions to Twin Cities metropolitan area programs who report regular use of cocaine also report other drug use (usually alcohol and/or marijuana). A common theme noted in interviews with staff at adolescent treatment programs in the Twin Cities metropolitan area was the report of an increase in the incidence of reported physical (often sexual) abuse among treatment admissions. In many instances, the abuse has tended to precede the escapist and self-destructive use of chemicals. This pattern of chemical abuse represents a departure from abuse patterns character- ized by extensive experimentation. I1-83 Sex: Race: Age: TABLE 1 Sociodemographic characteristics of Hennepin County methadone Male Female White Hispanic Black Indian Asian/Other 25 & Under 26-35 36-55 Over 55 Average Age Average Years of Use Average Prior Methadone Admissions Average Prior CD Treatment Admissions admissions and waiting list clients. Pre-1983 (N=446) 69.5 NW o wn OHNO OFNDWW PHPNLWOM NO PW nN se nN O) = w — oo 11.6 0.7 2.2 Admissions 1983 (N=60) 66.7 33.3 nN = ow OMUIOoo Tae iE OCONW OwoOoN w w ry 12.6 0.8 2.9 11-84 Waiting List 1983-1984 (N=62) 61.3 38.7 ~ — nN O1 = ONO» OR0O0YWW . eo oo eo op M oo NO w w o — DH on 14 3.0 TABLE 2 Sociodemographic characteristics of VA methadone admissions and waiting list clients. Admissions Waiting List 1979-1983 1983-1984 (N=111) (N=45) Race: White 1.7 81.6 Black 28.3 15.8 Hispanic 0.0 2.6 Age: 25 & Under 5.3 0.0 26-35 72.6 53.1 36-55 22. 43.8 Over 55 0.0 31 Average Age 31.9 36.1 Average Years of Use 10.9 14.2 Average Prior Methadone Admissions 1.5 1.9 Average Prior CD Treatment Admissions 3.3 2.4 II-85 TABLE 3 Sociodemographic characteristics of admissions to three treatment environments. 1/79-12/84 7/81-12/83 7/83-12/84 Drug Private/ State Treatment Community Hospital Programs Hospital Programs Programs (N=4,281) (N=3,670) (N=2,824) Sex: Male 81.2 73.0 86.4 Female 18.8 27.0 13.6 Race: White 79.7 94.8 83.3 Hispanic 2.2 0.8 2.1 Black 12.0 2.6 8.5 Indian 5.3 1.6 5.5 Asian/Other “ed 0.1 0.3 Age: 25 & Under 50.4 24.7 30.7 26-35 39.3 25.9 33.7 36-55 9.9 30.8 28.1 Over 55 0.4 18.6 1.5 Prior : : Treatment: None 27.3 63.5 23.6 One 23.7 23.9 17.1 Two or More 49.0 12.6 59.3 Employment Status: Employed 20.2 60.2 34.3 Unemployed 64.8 18.6 58.2 Retired/Disabled 0.8 12.4 5.2 Homemaker 4.3 4.5 1.4 Student 9.9 4.3 1.2 Education Level: Less Than High School 39.2 25.8 32.0 High School 44.4 66.5 63.6 College 16.4 7.7 4.3 Marital Status: Single 5 63.3 29.0 48.9 Divorced/Separated 23.1 20.3 37.2 Widowed 1.1 5.7 2.7 Married 12.5 45.0 1.3 Prior Arrests: Yes 64.2 34.3 42.3 8 65.7 57.7 No 35. II-86 TABLE 4 Minneapolis Police Department Drug Arrests Sale of Heroin Possession of Heroin Sale of Dilaudid Possession of Barbiturates Sale of Cocaine Possession of Cocaine Sale of Amphetamines Possession of Amphetamines Sale of PCP Sale of LSD Possession of Injection Equipment Uttering Forged Prescription 1978-1984 1978 1979 1980 ‘1981 1982 1983 1984 11 2 8 7a10 "6° 5 95.8 Ted ad 3 3 2 $08 0 BE 6 2-9 9 6. 0A 5 17.31 19.721 24 88 34 24. 25. Ml CHAM 4 "1 RE Bay 71 £5.18 |i, 6 Ap. TB. 4 g dy 8+ ym gua £1 Ww.7 8 5 3 23° 16 27 26. 42 43 63 51° 30-20 M28 Wb IT-87 NUMBER OF ADMISSIONS NUMBER UF ADMISSICNS MGURE IA. MARIJUANA DCTOXIAC ATION ADMISSIONS HENNEPIN COUNTY FACILITICS 2204 20 + 150 160 + 140 1204 106 50 40 204 . 12 12 (80 o\ = oa we is SoS Ses ~ Tae EL Co HH ' Ean ” 3 FIGURE 1C. STIMULANT DETOXIFICATION ADMISSIONS HENNEPIN COUNTY FACILITIES 3G 20- nme Bo RIED A TE CT TT TT PT pw Ta Tan Ta We Ma et NGURE 18. OPIATE. DCTOXIFICATION ADMISSIONS HENNEPIN COUNTY FACILITIES, 254 20 NUMBER OI" ADMISSIONS 7 80 80 > «& SL BL (8 65 Gh ; Se RE To wr EN Wg Rr a ARS ov TIME Wl FIGURE 1D. : DEPRESSANT DETOXIFICATION ADMISSIONS HENNEPIN COUNTY FACILITIES 39+ 20+ 2454 20+ NUMBER OF ADMISSIONS — F-—— oF 47! PAY ‘ oN wT wT oe aff as Sa ES on i an (CC aT Woe Ty Pa Pt Pye hme pe rion i iy TTY WG NUMBER Of ADMISSIONS © NGURE. IE. HALLUCINOGEN DCTOXINCANON ADMISSIONS, HENNEPIN COUNTY FACILITIES PT 80 20 a 85 (oh oo 0 gr 5 Tne 5 © oR pS SEs Pp A) WV 9 on Ce? Wy ne To FIGURE 1G. 68-11 NUMBER Cf ADMISSIONS OTHER DRUG DETOXIFICATION ADMISSIONS HENNEPIN COUNTY FACILITIES 1 Tv ve wn T_T » > of or a eI ott BR AT wt oR it © ane *¥ Se Ma " me pone 0. se NUMBER OF ADMISSIONS 60- 0+ 40- 30 20 MGURL. TF. INHALANT DLTOXIFICATION ADMISSIONS HENNEPIN COUNTY FACILITIES oy \ ww ow ge wo 0 a®' 8 TT SS BD Oh ne Oo ® WRC Wy G2 WN wr AE CaN Ee ws Sd a TIME PCRIOD MGURL 2A. MARWUUANA DETOXIFICATION ADMIS TIONS RAMSCY & DAKOTA COUNTY FACILITIES. 704 NUMBER OF ADMISSIONS oa © NT PE © J NE <3, NA oF oh peo” ep ae NEN AA A = TIME. PCRIOD ip 2 AGURE 2C. STIMULANT DETOXIFICATION ADMISSIONS RAMSEY & DAKOTA COUNTY FACILITIES 204 16- 16 2 ud oS 2 12 4 2 al Zz I+ 0 wt oN WwW Te] To PR - os a JERE » vo i IE ys Cin CR TIME PERICD NUMBER OF ADMISSIONS NUMBER CFF ADMISSIONS 1 MGURC 28. OPIATE DCTOXIFICATION ADMISSIONS RAMSLY & DAKOTA COUNTY FACILITIES ae T v wo © To es AA AE an 5 Cs Sm 3» 20 1h AR y \ M7 ho yb | NN WY TIME PERIOD FIGURE 2D. COCAINE. DETOXIFICATION ADMISSIONS RAMSEY & DAKOTA COUNTY FACILITIES Cr «0 wr ol er Leh (Tam WW 5 oR oy: ne La AF WW Hd es i wl o a TIME PRICD NUMBER OI ADMISSIONS NGURC 2. DCPRESSANT DETOXIFICATION ADMISCIONS RAMSLCY & DAKOTA COUNTY FACILITIES &\ APE PRE 0 0 Wo T(E Bet fg WV Ww Wo Ww oN on aX Ww Wo Ww NUMBER Ci" ADMISSIONS TIME PERICD T6-1II FIGURE 2G. INHALANT DETOXIFICATION ADMISSIONS RAMSLY & DAKOTA COUNTY FACILITIES 12 4 Aas a “+ = ol wh er 5 oN : 2 £0 wh ok Ww Ta WA SA® Ta FR RGSS a ao i X TT RT GT pT TT TT pa ad ER «0 8c 3 ar ET 8° GN eS on Se ANS ORC ol aR Ni WW NUMBER Zi ADMISSIONS NUMBER OFF ADMIS53IONS 3 MGURE 2F. HALLU! INOGEN DETOXIFICATION ADMISTIONT RAMSEY & DAKOTA COUNTY FACILITIES ae ee TIMC PCRIOD FIGURE. 2H. OTHER DRUG DETOXIFICATION ADMISSIONS RAMSEY & DAKOTA COUNTY FACILITIES WwW L y oF Kid LH ~77 pe ‘ A GH Ga JK GY a gt 3» ne AN Te WW Te on Ta RY LEY WN wv’ WN WY WN ba WN ye TIME PERIOD oN NGWRE3A. A Sie ii © Nowe ABS TAINERS VS. DALY ALCOHOL USERS a ABSTAINERS VS. DAILY MARUUANA U' CR"; AMONG ADMISSIONS TO RIVE METROPOLITAN—AREA DRUG; PROGRAMS ; AMONG ADMISSIONS TO AVE. METROPOLITAN—-ARTCA DRUL PROGRAMS, wo 09+ 90+ 90+ 804 80 2 0 Z 70 2 60 a ot 2 so 2 204 I] S & 40+ 3 40+ gi 0 5 $01 20+ 20- 174 Fo ll. fe nl a 0 i : . * ; 3 i ey 2 : : Legend sin ; : Legend 0 ; i : A ABSTAINERS 1 I : ’ AZ TAMERS 2: DAILY USTRS ’ J DAI} ULfPs wt? SA OnE ES Noo 7 ot, 2, po Dh PEL re ens Sony or Te ne 5 wee x Y THE PERIOD : rac poop Bl AE Eee Ree 2 FIGURE. 3D ABSTAINERS VS. DAILY HERON USERS ABSTAINERS VS. DAILY SYNTHETIC. NARCOTIC us ERS. AMONG ADMISSIONS TO hve METROPOLITAN-AREA DRUG PR GRAMS AMONG ADMISSIONS TO AVE METROPOLITAN—AREA DRUG PROGRAMS - | 2a “ hl ven sc 3 “504 2 60+ geo] 2 501 2 so Go 5:9 x oy 2 0 6% a - $04 224 » < 204 0 Tm, . Aon : : 10- en crm ap hTERT ih Legend ST ne Legend 6- IN Aut JIAWNCR | ; o| * NA° TAIHCE” } DAW UgK: © DAW UTE: Ct a tv Cl ER Up ST rw CE Ty Wels NOL RT OMT TO pT Tp RTT pT pe TIME PCRIOD TIME es AMONG ADMISSIONS TO NV PERCENT OF ADMISSIONS we «jell HH I 0 CW “564 49+ 264 - NGURE 3C. ABSTAINERS VS. DAILY COCAINC USERS Sgt ; : gem Bs : : CYT TE eG =D Gm ip OD METROPOLITAN—AREA DRUG PROGRAMS Legend A - ABS TAINERS > DAILY USERS TN 0 ns SP ov TMC PERIOD 41% <1 RS OE 2 wo (CEN 5 Ta © of FIGURE 3G. ABSTANERS VS. DAILY STIMULANT USERS AMONG ADMISSIONS TO FAVE METROPOUTAN—AREA DRUG PROGRAMS . NUMBER OF ADMISSIONS 204 100 1 834 <0 404 30 4 PERGENT OF ADMISSIONS Legend \ AE IAINCR hk i Bt lt a T Y Soh oN WF ne rt WE KARE ce RR .¥ 0 KE LN okt Te Ee as Ww eT Tet oS to” Tf PORIOD MGURL 3r. ABSTAINERS VS. DAILY HALLUCINOCEN USERS AMONG ADMISSIONS TO FIVE METROPOLITAN—AREA DRU' >» PROCRAM’ 100 4 Spt aT rs 70 4 60 +0 40 4 304 ‘PERCENT OF ADMISSIONS 204 od 0 Leqend AT TAMERS | > SAI USER? oe ABSTANERS vs. DALY DEPRESSANT USERS AMONG ADMISS [TAN—AREA ble: PROGRAMS 100 204 804° 704 404 .s0d- 20-4 — Legend NVI *: DAMS 4 ASL TT Nem seg bem te len egyem ty te rr EAT 25 AT eT ncn mee, wn < SRT TE EER a TR a Eg sa Cs JOTI QT TTT > Nd wo NGURE. 4A. ABSTAINERS VS. DAILY ALCOHOL. USERS AMONG ADMISSIONS TO SEVEN METROPOLITAN-ARCA HOSPITAL—-BASED PROGRAMS 100 904 80+ wv Z 104 Qo oi 3 60 + 2 50 o- A) : am —" Z 40 + ~~ ~G -— O 5 so a 20+ 10 a gi Po i : Legend 0- RR ad Te A ABSTAINERS | DAILY USFRS FS 2. 2 5 Sy © PRES gett aS god WV A 3 a a 3 TIME PERIOD 1 0 > MGURE 4C. ABSTAINERS VS. DAILY OPIATE USERS AMONG ADMISSIONS TO SEVEN METROPOLITAN—AREA HOSPITAL—BASED PROGRAMS 100+ Si — Aa 50+ 2 710 Q wv Vv 60 = a < 5p to oO &.40- om 3 Zz 30 + 204 104 do Legend os Ds imo jm fp em Tem = = = =O A ABSTAINERS P_ DALY USERS oN 7 Tr 5 0 > RH gt SR et SO x WV yw Ig TIME PCRIOD NGURC 48. ABSTAINCRS VS. DAILY MARWUANA USERS AMONG ADMISSIONS TO SCYEN METROPOLITAN—ARCA HOSPITAL—BASED PROGRAMS 100] 90- 2 70 £ "1 a 2” sma teil Eo. GS = 401 wi 2 i $0 201 © — Om mm ——— =" 10+ Legend 'B NAS TAINERS > DAILY USERS Sy ol TY BD 5 oC AWW © Oo Sv WW WY 0 all oo TIME PERIOD FIGURE 4D. ABSTAINERS VS. DAILY ANALGESIC USERS AMONG ADMISSIONS TO SEVEN METROPOUTAN—AREA HOSPITAL—BASED PROGRAMS 100- Wi &— 2 tr A —h 80+ 2 704 o a 3 60 a 50+ S 8 40-} 5 so a. 20- 10 Legend of Op ir iB siete ins me Den eit S50 h AGSTAINCRS DAILY USERS A oT oT my PAs ® HL Na oH Ww NY Ww Ww Ww TIME PERIOD MGURE 4E. ABSTAINERS VS. DAILY COCAINE USERS AMONG ADMISSIONS TO SEVEN METROPOLITAN—AREA HOSPITAL—BASED PROGRAMS PERCENT OF ADMISSIONS 90 804 704 60 Legend 0 ASSTAWERS D_ DALY USERS G6-11 bee —-—=——6—— == =—9—-——-0 8 or EY @o .® BE PD A WE TIME PERIOD FIGURE 4G. ABSTAINERS VS. DAILY HALLUCINOGEN USERS AMONG ADMISSIONS TO SEVEN METROPOLITAN—AREA HOSPITAL—BASED PROGRAMS FIGURE 4F. ABSTAINERS VS. DALY STIMULANT USERS AMONG ADMISSIONS TO SEVEN METROPOLITAN—AREA HOSPITAL-BASED PROGRAMS 100 + 70 60 PERCENT OF ADMISSIONS 8 1 G———6 ———9———O0——— 0 «8 or oF ? Mal a ay ae Tr T e® TIME PERIOD FIGURE 4H. ABSTAINERS VS. DALY SEDATIVE USERS AMONG ADMISSIONS TO SEVEN METROPOUTAN—AREA HOSPITAL-BASED PROGRAMS 100 100] 3 90+ A RR ER co 0+ & 2 a i —-A 80 ’ 80 : 70 2 70 0 wv ¢ 60-1 g 60 2 0 2 50+} oO Oo 8 404 & 40 @ = 2 so & s0- 20 20] 10 10 Legend A i di Legend o- 6-———6—-———9———90— —— 0 \ ABSTAINERS o- or 2 Sime m0 ABSTAINCRS > DALY USERS . DARY USERS ov or or 8° °> ov or 8k 18° ®5 a oo © oC oC - » C rr wy # aT Ee” wn TIME PERIOD TIME PERIOD PERCENT OF ADMISSIONS NUMBER OF ADMISSIONS FIGURE SA. ABSTAINERS VS. DAILY ALCOHOL USERS AMONG FIVE—COUNTY METROPOLITAN—AREA ADMISSIONS TO MINNESOTA STATE HOSPITAL CD PROGRAMS 00 | 90 + 80+ 70 60 50+ 6- ih = TS 404 rT 304 20+ 10 A A —A Legend o- a A ABSTAINERS b> DALY USERS JUL-DEC 83 JAN-JUN 84 JUL-DEC 84 a TIME PERIOD = 1 © o FGURE SC. ABSTAINERS VS. DAILY HEROIN USERS AMONG FIVE—COUNTY METROPOLITAN—AREA ADMISSIONS TO MINNESOTA STATE HOSPITAL CD PROGRAMS 100+ 90 4 A 80+ 704 60 50 40 350 20 i Legend Se egen 0 B= cw oe G ® A ABSTAINZRS p_oaur usta JUL-DEC 83 JAN-JUN 84 JUL-DEC 84 TIME PERIOD PERCENT OF ADMISSIONS PERCENT OF ADMISSIONS 30 80+ 70+ 60 50 40 50 20 AGURE 5B. ABSTAINERS VS. DAILY MARUUANA USERS AMONG NVE—COUNTY METROPOUTAN—AREA ADMISSIONS TO MINNESOTA STATE HOSPITAL CD PROGRAMS 100 304 80 704 60 50 40 50 re esmttecine Or — = —— Q — — — — = © Legend bh ABSTAINCRS D DAILY USCRS JUL~DEC 83 JAN-JUN 84 JUL-DEC 84 TIME PERIOD FIGURE SD. ABSTAINERS VS. DAILY SYNTHETIC NARCOTIC USERS AMONG FIVE—COUNTY METROPOLITAN—AREA ADMISSIONS TO MINNESOTA STATE HOSPITAL CD PROGRAMS 0 — — = — ome ri em © Legend h ASSTANCRS ) DAILY USERS JAN-JUN 84 - JUL-DCC 84 TIME PCRIOD JUL-DIC 83 PERCENT OF ADMISSIONS NUMBER OF ADMISSIONS 90 4 ; NGURE SC. ABSTAINERS VS. DALY COCAINE USERS AMONG NVE—COUNTY METROPOLITAN—AREA ADMISSIONS TO MINNESOTA STATE HOSPITAL CD PROGRAMS 80 — 70 +4 80 50 40+ 30+ 20+ 10 = Bn ives nie 0 i a is Legend 9 A ABSTAINERS D DALY USERS JUL~DEC 83 JAN-JUN 84 JUL-DEC 84 TIME PERIOD HH = 1 0 ~ FIGURE SG. 'ABSTAINERS VS. DAILY STIMULANT USERS AMONG FIVE—COUNTY METROPOLITAN—AREA ADMISSIONS TO 3 MINNESOTA STATE HOSPITAL CD PROGRAMS 160 + 90 4 80 a 70 + 60 + S0 +4 40 50 20 10 O = @ == mm © Legend > A ABSTAINCRS > DALY USIRS JUL-DEC 83 JAN=JUN 84 JUL-DEC 84 TIME PERIOD PERCENT OF ADMISSIONS PERCENT OF ADMISSIONS 100 - 90 80 70 50 + 40+ 30+ 20 AGURE SF. ABSTAINERS VS. DAILY HAULUCINOGEN USERS AMONG FIVE—COUNTY MCTROPOUTAN—AREA ADMISSIONS TO MINNESOTA STATE HOSPITAL. CD PROGRAMS 100 + 904 80+ 70+ 60+ 50 40+ 30+] 20+ — Legend a == ow, iw wm © A ABSTAINERS D par USERS JUL-DEC 83 JAN=JUN 84 JUL-DEC 84 TIME PERIOD FIGURE SH. ABSTAINERS VS. DAILY DEPRESSANT USERS AMONG AVE—COUNTY METROPOLITAN—AREA ADMISSIONS TO MINNESOTA STATE HOSPITAL CD PROGRAMS Legend Ga TT RR © h ABSTAINERS )_DAWY USTHS JUL-DEC 83 JAN-JUN 84 © JUL-DCC B84 TIME PCRIOD FIGURE 6B. ABSTAINERS VS. DAILY MARWUANA USERS AMONG ADMISSIONS TO THREE TREATMENT ENVIRONMENTS NGURE 6A. ABSTAINERS VS. DAILY ALCOHOL USERS AMONG ADMISSIONS TO THREE TREATMENT ENVIRONMENTS B22, 55 A722, pps, 4 B22, & 2 gl | ¢ 87/2773, ce BY ; Bl % yf B22 @ 2 Lr g | * 2727 4 W244 er 5-5 % ez J QC le eyo Ue lg Ae Tae le 35-8. RnB B30 RT RB SNOISSIAQY 40 LNIDY3d MENTS 0/7007 FIGURE 6L. IONS TO THREE TREATMENT ENVIRON NN | * ABSTAINERS VS. DAILY COCAINE USERS >>» 122 108 12 130 487 472 138 154 138 104 577 53 143 154 102 m 887 51 147 13 145 105 0 1,117 528 127 128 165 162 1,327 121 124 102 582 427 New York City Heroin Indicators Treatment Admissions with Heroin as Primary Drug of AbuseC 5,490 6,007 6,185 6,678 6,894 6,077 4,863 24,360 19,086* 14,687 13,260 1979 + 1985 Admissions to Prison Detoxificationd 1,671 1,781 1,356 7,23) 2,042 2,102 2,736 2,824 2,15 2,h45 2,778 2,716 2,778 2,930 3,633 4.461 3,989 3,626 3,982 4,136 3,072 3,231 N.A. H.A. Interquartile range, i.e., middle 50 percent of cases. *Estimated due to the artifactual admission of methadone clients because of administrative reorganization. **Although the annual total for 1984 is provided, totals for each quarter are not available. 7,239 9,704 10,954 13,802 15,733 13,955 Purity of Police Exhibits Heroin® M.A. M.A. 2% - 5% 2% - 13% 2% - 14% 2% - 112 3% - 14% 3% - 15% 2% - 17% 3% - 26% 1% - 14% 43 - 27% 5% - 392 Heroin-related indicators in the criminal justice system (i.e., purity of heroin exhibits and admissions to the prison detoxification unit) show trends that are somewhat mixed: : The New York City Police Laboratory analyzed ©,725 exhibits of heroin in 1984 compared to 5,469 exhibits in 1983 -- a 23 percent increase. The purity level continues to be generally high with the interquartile range between three percent and 26 percent in the fourth quarter of 1983, and between four percent and 27 percent in the fourth quarter of 1984. In the first quarter of 1985, the interquartile range of purity was the highest in recent years -- four percent to 39 percent. Admissions of heroin addicts to the Hew York City Department of Corrections detoxification unit at the Riker's Island facility had been increasing steadily during the last few years. Between 1981 and 1982, the number increased 26 percent (from 10,954 to 13,802). Between 198. and 1983, the increase was 14 percent (from 13,802 to 15,733). In 1984, however, the number of admissions decreased 11 percent (from 15,735 to 13,955). Finally, treatment admission data for those reporting heroin as the primary druy of abuse show declines, but treatment utilization rates are at levels that exceed capacity: . Heroin admissions to state-funded treatment programs in New York City have declined steadily since 1982 and continue to decline into 1985. These declining admissions are probably related to the fact that most treatment programs have been operating at capacity or above. State-funded programs of all modalities with a capacity of 30,118 in New York City were operating at 102 percent capacity in March, 1985, State-funded methadone programs, alone, were operating at a capacity of 105 percent with a census of 24,127 clients in March, 1985. Street Studies Update Heroin continues to be readily available throughout the five boroughs of the City, and may be increasing in availability in some areas. In fact, white, brown and beige (or salt and pepper) varieties of heroin are found and may be increasing in availability on the Lower East Side, in Harlem, Brooklyn and the Bronx. In addition, several new brands have been found on the streets, which are increasing in popularity and are now found in several neighborhoods. For instance, "Checkmate," "Smurf," "Dollar Bill" and "Victory" were previously found only on the Lower East Side and are now found at several locations in the Bronx and other locations in Manhattan. According to street sources, there may be an increased demand for heroin as a consequence of using cocaine. Those who freebase cocaine, especially, complain about their highly nervous state that is apparently alleviated by the use of heroin. Those who "speedball" say that the current nigher quality of heroin also improves the interactional effect with cocaine. Copping locations in each borough that used to feature only heroin or cocaine now sell both drugs. I1I-115 In addition to heroin, Dilaudid and "Hits" (i.e., the depressant combination of glutethimide and codeine) appear to be readily available. The four mg. dosage unit of Dilaudid currently sells for $14 in the 14th Street area of Manhattan. Heroin users like to take Dilaudid because of its dependable effect. One user reported, "you get a guaranteed bang for the buck each time." "Hits" continue to be a popular substitute for heroin in many areas of the City. Characteristics of Identified Heroin Users The most notable characteristic of identified heroin abusers had been their increasing age. This trend continues for admissions to treatment and may be stabilizing for decedents. The proportion of heroin admissions to treatment who are 30 years and older continues to increase. In 1977, this group represented 31 percent of heroin admissions; in 1980, 46 percent; in 1983, 59 percent; and in 1984, 61 percent. Decedents had followed a similar trend till 1983. In 1980, 42 percent were 30 years of age and older; in 1981, 50 percent; in 1962, 65 percent were in this age range; in 1983, findings show that 64 percent were 30 years and older. The sexual distribution continues to be predominantly male, but females continue to increase in proportion among identified heroin abusers. In 1980, 22 percent of heroin admissions to treatment were female; in 1981, 25 percent were female; in 1983, 27 percent were female; and in 1984, 29 percent were female. Similarly, among decedents: in 1980, 17 percent were female; in 1982, 20 percent were female; and findings for 1983 show 24 percent female. Among admissions to the Riker's Island detoxification program, women have also become a growing proportion of the total. In 1980, women inmates were 16 percent of program admissions; in 1982, 23 percent; and in 1984, 28 percent of all admissions. As for ethnic distribution, data exist for treatment admissions and for the prison detoxification program. Although blacks have been the modal group, they have been declining in proportion, while Hispanics, especially, have been increasing. Early in 1980, blacks represented 48 percent of heroin admissions, while Hispanics represented 32 percent and whites 20 percent. By 1981, blacks represented 43 percent, whereas Hispanics were 34 percent and whites 22 percent. In 1983, blacks represented 38 percent, Hispanics 35 percent and whites 27 percent. In 1984, the proportion of Hispanics exceeded the proportion of blacks among heroin admissions to treatment -- Hispanics represented 39 percent and blacks 36 percent. Although whites had a growing representation among heroin admissions to treatment, in 1984 they represented 25 percent of this population -- a decline of two percentage points. Similarly, among admissions of adults to the Riker's Island detoxification program in 1983, blacks represented 48 percent, Hispanics 37 percent and whites 15 percent. In 1984, blacks declined to 44 percent, Hispanics increased to 41 percent and whites remained at 15 percent. Interestingly, among adolescent admissions to the Riker's Island program, 65 percent were Hispanics, 20 percent were blacks and 15 percent were whites in 1984. 11-116 As far as regional distribution is concerned, Manhattan continues to be the borough of residence for most drug-dependent decedents and the borough with the highest crude drug-dependent death rate per 100,000 population. For 1983, Manhattan showed a crude rate of 14 drug dependent deaths per 100,000 population compared to a rate of 10 for the Bronx and five for Brooklyn. Also increasing in proportion are decedents who died in New York City but whose residence was outside the City. In 1980, this proportion was seven percent; in 1982, 10 percent; and 1983, 12 percent. Update: Aquired Immune Deficiency Syndrome (AIDS) As of mid-May 1985, 10,282 cases of AIDS have been reported nationally, representing an increase of 3,705 reports in the past seven months. Of the 10,282 cases nationally, 3,700 or 36 percent have been reported in New York City, representing an increase of 1,158 reported cases in the City in the past seven months. In general, the number of reports of AIDS has been increasing in llew York City. In 1983, an average of 78 cases were reported monthly; in the first half of 1984 there was a monthly average of 111 cases; in the second half of 1984 the monthly average, increased to 134 cases; and finally in the first four months of 1985, the monthly average was 171 cases. Of the 3,700 victims reported in Hew York City, 52 percent have expired. of the 3,700 AIDS cases in Hew York City, 33 percent (1,239 cases) involved known intravenous drug users. Although females continue to represent only nine percent of AIDS victims, they represented 18 percent of the intravenous drug users among the AIDS victims. Intravenous drug use is the most prevalent risk factor for females. There is some evidence on the street that intravenous drug users may be changing their needle-sharing behavior. For instance, street drug dealers report that their sales of needles have increased from a year ago. In fact, some dealers are including an extra free needle when they are selling hypodermic needles. In addition, several vendors now sell as a combined package a bag of heroin with a hypodermic needle; the price for the combination is $25 and the brand in Harlem is "Checkmate." Nevertheless, serological studies show that about 60 percent of intravenous drug users have already been infected with the AIDS virus. According to the New York City Commissioner of Health, educational strategies about AIDS are being developed so that substance abusing youth will know the very real consequences of drug use and needle sharing. In summary, some heroin indicator trends are declining (e.g., deaths due to narcotism and admissions to prison detoxification) while other trends show increases (e.g., number and purity of police exhibits and street reports). Interpreting the significance of these differing trends 1s somewhat problematic, especially the decline in deaths due to narcotism on one hand and the increased availability and purity of heroin on the streets on the other hand. Perhaps the fear of AIDS may have reduced the injecting of heroin and therefore the reduced risk of death. Or, perhaps, it is conceivable that the increasing number of deaths due to AIDS among intravenous drug users (293 in II-117 1984 compared to 88 in 1983) accounts for the decline in the deaths due to narcotism. Perhaps, too, the increasing use of cocaine in combination with heroin may decrease the likelihood of deaths from a heroin overdose. In any case, heroin activity continues at relatively high levels and bears close monitoring. Current Trends in Cocaine Activity Indirect indicators and street studies show very high levels of cocaine activity in Hew York City. Indirect Indicator Trends (Table 2) Indirect indicators of cocaine activity show a generally upward trend: Cocaine-involved emergency room reports for the consistent panel of New York SMSA hospitals showed almost no change between 1982 and 1983 (from 2,182 to 2,159). Estimates for the first nine months of 1984 (2,260 episodes), however, are the highest for any comparable period in the past three years, and show a 58 percent increase over the first nine months of 1983 (1,433 episodes). The Hew York City Police Laboratory analyzed the peak number of 12,299 cocaine exhibits in 1984--33 percent more than in 1983 (9,229). This number of cocaine exhibits continues to approximate the number of marijuana exhibits. The median percent purity for cocaine in 1984 ranged between 40 percent and 60 percent; in 1983, the median purity was in the 30s. The number of treatment admissions to state-funded treatment programs in New York City with cocaine as the primary drug of abuse increased seven percent between 1982 and 1983 (from 1,804 to 1,936). Between 1983 and 1984, the number increased a dramatic 63 percent (from 1,936 to 3,159). These increases come at a time when treatment programs funded by the State have been operating at capacity or above. Nevertheless, cocaine admissions represent an increasing proportion of admissions to New York City programs. In 1981, cocaine admissions represented six percent of all admissions; in 1982, seven percent; in 1983, nine percent; and 1984, 15 percent. . The New York City Department of Health reports 91 deaths due to cocaine in 1984 compared to seven such deaths in 1983. In previous years, the reporting of deaths due to cocaine was negligible Street Studies Cocaine continues to be readily available throughout Hew York City at stable prices. According to street sources, purity and quantity may even be increasing. Freebasing is gaining in popularity, with more basing galleries being set up in private homes. 11-118 6TI~I1 Year 1979 1980 1961 1982 1943 1984 1985 aSource: DAWN, Imputed Data. New York State Division of Substance Abuse Services, Bureau of Management Information Services. New York City Police Department Laboratory. bsource: CSource: Quarter Ist 2nd 3rd 4th Total Tutal Ist 2nd 4th Total Ist 2nd 3rd 4th Total Ist Znd 3rd 4th Total Ist 2nd 3rd 4th Total Ist Table 2. Cocaine New York City Cocaine Indicators, 1979-1985 Emergency Room Episudes -A. A. A. A. EXEE Zr2p 299 396 551 606 653 472 397 479 557 726 807 785 668 (N.Y. HSA) 3 1,324 2,182 2,159 Treatment Admissions with Cocaine as Primary Drug of Abuse b 343 365 394 399 42) 352 328 330 365 382 429 416 44) 502 420 441 337 518 497 544 105 875 778 801 855 1,501 1,431 1,592 1,804 1,936 3,159 Median Purity of Police Exhibits of Cocaine © N.A. N.A. N.A. N.A. N.A. N.A. N.A. 28% 38% N.A. 43% 52% Although coca paste or "basuco" has been talked about and some people claim to be using cocaine in this form, the use is not widespread. In fact, the New York City Police Laboratory has analyzed fewer than five exhibits of coca paste and there were doubts about the exhibits' authenticity that were analyzed. Characteristics of Identified Cocaine Users In the past few years some changes have been noted in the demographic characteristics of admissions to New York City's treatment programs reporting cocaine as the primary drug of abuse. First, their age has been increasing. In 1982, the median age of cocaine admissions was 25 years of age; in 1983, it was 26 years; and findings for 1984 show the median age to be 27 years. Second, the sexual distribution is changing somewhat. In 1982, females represented 20 percent of admissions; in 1983, they represented 25 percent; and findings for 1984 show them to represent 28 percent of admissions. Finally, the ethnic distribution shows stable trends among treatment admissions. In 1982, blacks represented 52 percent of cocaine admissions; in 1983 they represented 51 percent; and, findings for 1984 show blacks representing 52 percent of admissions. During the same period Hispanics have increased in proportion among cocaine admissions from 21 percent to 22 percent, and whites have decreased from 27 percent to 5 percent. Current Trends in Other Drug Activity Marijuana Marijuana continues to be widely available throughout the City. Problems associated with its use may be indicated by an increasing proportion of treatment admissions with marijuana as the primary drug of abuse. Treatment admissions with marijuana as the primary drug of abuse represented about nine percent of admissions to New York City programs in 1983 and 11 percent in 1984. In the first quarter of 1985, 13 percent of treatment admissions indicated marijuana as the primary drug of abuse. Marijuana-involved DAWN episodes have been fairly constant in the last two Jsars dupsh a quarterly average of 188 episodes in 1982-1983 and 178 in 1983- . In addition, the New York City Police continue to make arrests and seizures involving marijuana. In 1983, for instance, the Police Laboratory analyzed 9,661 exhibits of cannabis; by 1984 the Laboratory analyzed 12,452 such exhibits -- an increase of 29 percent. PCP and LSD PCP activity continues to increase in the City. The New York Police Laboratory analyzed 2,116 exhibits of PCP in 1984, 73 percent more than in 1985 (1,225). DAWN emergency room data show an increasing trend with a quarterly average of 124 PCP-involved episodes in 1981-1982, 163 in 1982-1983 and 260 in 1983-1984 -- an increase of more than 100 percent over the past II-120 three years. Treatment admissions with PCP as the primary drug of abuse represented about two percent of all treatment admissions to Hew York City programs in 1984, In the first quarter of 1985, three percent of admissions indicated PCP. Although DAWN data show a declining trend in LSD episodes, LSD appears to be available on the streets of the City. The Street Studies Unit of the Division of Substance Abuse Services finds the substance at major copping areas, and the New York Police Laboratory continues to analyze about 300 LSD exhibits per year. Psychoactive Prescription Drugs Although a variety of psychoative prescription drugs are available in the City, trends in DAWN's data show a declining or stable number of episodes involving such drugs. Drugs showing downward trends include amitriptyline (Elavil), flurazepam (Dalmane), and seco/amobarbital (Tuinal). Drugs showing stable trends include d-propoxyphene (Darvon), doxepin (Sinequan), and phenobarbital. Although emergency room episodes involving diazepam (Valium) show a leveling trend in the past two years, these episodes are the most numerous among the prescription psychoactive drugs with 289 as a quarterly average in 1982-1983 and 298 as a quarterly average in 1953-1984, The New York City Police Laboratory reports an increasing number of exhibits of diazepam (from 1,169 in 1983 to 1,606 in 1984) and d-propoxyphene (from 335 in 1983 to 538 in 1984), seized in arrests or bought as undercover buys. Among drugs found on the street is the combination of glutethimide (Doriden) and codeine (e.g., Empirin - 4), also known as "Hits," "Loads," or “Dors and Fours." This combination appears to be popular among those who want the effects of heroin but who hesitate to use drugs intravenously. The New York City Police Laboratory analyzed 283 exhibits of codeine and 110 exhibits of glutethimide in 1984, 11-121 DRUG ABUSE TRENDS IN NEWARK, NEW JERSEY John F. French Chief, Data Analysis and Epidemiology Aleohol, Narcotic and Drug Abuse Unit New Jersey Department of Health June, 1985 Treatment Data During 1984, there were 2,382 admissions to drug abuse treatment by Essex County residents. For the fourth year in a row there has been a decrease in admissions as shown below: Year Admissions Percent Change 1978 3,850 1979 5,892 +53.0 1980 8,041 +36.5 1981 6,050 -24.8 1982 4,252 -29.7 1983 2,554 -39.9 1984 2,382 -6.7 Note: Counts will vary slightly in different tables due to missing data for one or more variables for a few cases. Admissions peaked in 1980, then dropped each succeeding year. By 1984, there is a clear indication that the downward trend is leveling off. The effects of the introduction of fees-for-service and the apparent leveling off this year are clearly shown by the average monthly admissions shown below where admissions have increased slightly since the second half of 1983: Admissions Monthly Year Averages 1978 321 1979 491 1980H1 700 1980H2 642 1981H1 548 1st fee schedule —> 1981H2 460 fee increase —> Iona i fes decrease — AGRI] 236 ee increase —> 1983H2 189 1984H1 198 1984H2 200 11-122 Although when taken on an annual basis, admissions appear to be continuing to decline. We emphasize again that 1984 admissions have increased from the last half of 1983, so that interpretation of the following graph must take this into account. Figure 1 shows trends for all admissions, for total heroin admissions, and for first heroin admissions (those with no prior treatment experiences). FIGURE 1 TREATMENT ADMISSIONS 1977-1984 9S 8 4 2 3 0 - o 6 BO =n 52 9 4 ws os 4 5 gr m = 3 2 Zz b 2 — 4 = o i I I 1 ¥ i I 77 78 79 80 81 82 83 84 0 1ST HER + HER ADM ¢ ALL ADM As we have previously reported, the patient mix shifted because of the fee systems placing differential barriers to treatment based on ability to pay. Figure 2 shows the numbers of admissions for each half year during 1982-1984 for white and non-white males and females. The sharp drops in the slopes of non-whites over this time period compared to those for whites speak for themselves. It is important to see that in 1984 there has been a slight increase in admissions of black males, who have been under-represented in admissions for several years. The previous decreases in other admission categories appear to be leveling off. I1-123 FIGURE 2 Vid TREATMENT ADMISSIONS 1982-1984 1.3 ~ 1.2 -— 1.1 5 0.9 0.8 0.7 0.6 0.5 0.4 0.3 0.2 0.1 + + — 0 T T T T 82H1 82H2 83H1 83H2 84H1 84H2 NUMBER OF ADMISSIONS Thousands 0 WH MALE + WH FEM ¢ OTH MALE A OTH FEM Heroin In 1982, 81.6 percent of all admissions for Essex County residents were for heroin abuse. In 1983, this dropped to 71.3 percent, while in 1984, there was a further decrease to 65.0 percent, as shown below: Total Heroin Heroin as % of Total Category Adm Adm 1984 1983 1982 White Male 434 247 56.9 58.6 61.5 White Female 162 82 50.6 53.1 53.9 Black Male 967 655 67.7 75.3 85.5 Black Female 598 425 71.1 79.6 92.1 Other Male 185 109 58.9 68.2 70.7 Other Female 36 30 83.3 83.9 78.0 Total 2,382 1,548 65.0 Tied 81.6 II1-124 This decline in percent of heroin admissions is attributed to black male and female decreases from 85.5 to 67.7 percent and 92.1 to 71.7 percent, respectively. At one time, heroin accounted for over 95 percent of black female admissions, and only slightly less for black males. Again, this can be related to fee structures as well as sharp reductions in capacity of the Detox Unit, which serves mainly inner city heroin addiets. Table 1 (on the following page) shows the numbers of first admissions for heroin abusers by year of first use (a cohort). Assume that the distribution of lag from first use to first admission remains constant for all cohorts, and that any barriers to treatment during any given year are equal for all cohorts. Thus, even though admissions after 1980 decreased dramatically, we are assuming that the barriers of fees for service and reduction in treatment capacity affected all cohorts equally. Given this assumption, then the proportion of users entering treatment from the newer cohorts should remain constant if incidence remains constant. The proportion of users who enter treatment during their first three years of use provides a gross measure of incidence. In 1975, when incidence was at the end of a peak starting in the early 1970's, and when prevalence was high, 15.4 percent of first admissions had started use from 1972 - 1975. This percent decreased each year until 1980, when it hit a low of 10.1 percent, confirming other data which indicate low incidence in 1977 - 1978. The proportion of new users then increased again until 1983, when it reached 15.3 percent. However, in 1984, it declined to 12.4 percent. The decline in the numbers of admissions is undoubtedly a function of constraints on treatment availability, but the reduction in the proportion of new users in 1984 indicates a decline in incidence which might be reflected in a decline in prevalence. Cocaine Cocaine abuse continues to increase sharply in New Jersey. Because a major portion of the treatment system is devoted to opiate (primarily heroin) treatment, cocaine admissions as a percent of total admissions does not adequately reflect its prevalence. Table 2 shows primary cocaine admissions as percents of all and of non-heroin admissions for the years 1979-1984. Cocaine admissions increased from 75 in 1979 to 334 in 1984. Meanwhile, primary heroin admissions decreased from 5,303 to 1,545. This decline is the major factor in the decrease of total admissions from 6,074 to 2,382 during the same time period. Admissions for other drugs (including cocaine) has remained very stable. Cocaine admissions as a percent of total admissions increased from 1.2 percent in 1979 to 14.0 percent in 1984, an impressive increase. However, when cocaine is considered as a percent of non-heroin admissions, the increase is dramatic. Cocaine now represents 40.0 percent of all non-heroin admissions--up from 9.7 percent in 1979. II-125 TABLE YEAR OF FIRST USE BY ADMISSION YEAR - 1ST HEROIN ADMISSIONS 157 ADHISSION YEAR USE ; YW 1975 1976 {977 1978 1979 1980 1981 1982 1983 1984 HE us NB elt us Em asi mm Tm oA lw 65 104 108 76 28 25 16 Boone BY om 52 7 ip 79 29 19 2 75 Hw 57 B21 91 32 17 23 76 37 73 60 7 91 76 277 2 5 7 8 7 Bi 91 56 2 10 12 78 1 2 104 8 40 18 19 79 35 BS 102 60 2% 21 BO 2 7 #9 a 30 Bl 2% 4 27 18 82 17 30 28 83 11 18 8 3 oun me wie Wow nw um Tat om ms 18T PERCENT ADMISSIONS BY YEAR Use 1975 197% 1977 1978 1979 1980 198% 1982 1983 72 OBM.4 TI Tb Bd 4A3 ahS 0 WE 9 #2 FES RY RE AT RE AES TS Te Ne 5 B59 as Ties mE SSF RIVSANRE #3 Beh LPuEeg gE TRE cage i gig Lag ig eniiag 76 LEE hl hE gy Tale Liggi tig, 77 5.5 shppeasiggeiiiggi Uagnvisg tiling 78 IRE ge ig ORE Ugg 79 2.60 40 gg Wig gEitiey 80 Li CU RRIICRT 9. BI Esa 82 23° 48 83 2.5 OF We. 180 108. 10 Cv 100 i010 100 10 PERCENT ADMISSIONS DURING 1ST THREE YEARS OF USE YR 1975 1576 1977 1978 197% 1980 {981 1982 1963 1984 BA BE BY Br WA Wi RS BL BI 5d II-126 TABLE 2 Codaine Admissions 1979 - 1984 Admissions Cocaine as Percent of . Cocaine Other Year Total Heroin Other* Cocaine Adm Adm 1979 6,074 5,303 771 75 1.2 9.7 1980 8,195 7,365 830 99 1.2 11.9 1981 6,050 5,163 887 142 2.3 16.0 1982 4,252 3,466 786 170 4.0 21.6 1983 2,554 1,828 726 232 9.1 32.0 1984 2,382 1,545 834 334 14.0 40.0 * Other represents all admissions other than primary heroin, and this includes cocaine. As a secondary drug problem, cocaine has been reported in the past by about 35-40 percent of all admissions. In 1984, in addition to the 334 admissions who reported cocaine as the primary drug of abuse, another 838 reported it as a secondary problem. Thus, 1,172 admissions (49.2%) reported cocaine as a major abuse problem (primary or secondary). The 49.2 percent who reported cocaine as a major problem is surpassed only by heroin, with 69.3 percent of admissions reporting heroin either as a primary or secondary problem (in the vast majority of cases as a primary problem). Marijuana is a distant third, with only 13.6 percent of admissions reporting it as a major problem. Other Drugs Reports of "other opiates" as a major drug of abuse in Newark is most often codeine, usually used in combination with glutethimide, a sedative/hypnotic. Other opiates are reported as a major problem by 9.6 percent of all admissions. Reports of Hits (the combination of codeine and glutethimide) are not representative of prevalence because of the policy of many outpatient programs to refuse admission to these users until inpatient detoxification has been completed. The result of this policy is that abusers either refuse to admit their use of Hits at admissions, or, knowing the policy, do not present for admission. Amphetamine use is still practically non-existant in Newark, with only 31 admissions indicating it as a major problem. Illicit methadone admissions remain at fairly low levels, with 31 pgimary and 72 secondary admissions. 11-127 Other Indicators Hepatitis There were 139 cases of Hepatitis Type B reported during the year, although this low figure is the result of new, inexperienced personnel in the reporting system. (There were 112 cases reported during the first half of the year, but only 27 during the second half.) Arrests CDS arrests increased 13.3 percent, from 5,419 in 1983 to 6,142 in 1984. Arrests are as much a function of police practice as they are a reflection of prevalence. But to the extent that police practice remains the same, then these data can be used to provide a gross measure of prevalence. A comparison of arrests with Hepatitis Type B incidence in Figure 3 shows that there is a similar pattern of trends for arrests and for Hepatitis, when the latter is lagged by one year. FIGURE 3 7 HEPATITIS B AND CDS ARRESTS 1971-1984 6 5 0 Vv. 33 4 (' oa 3 i 3 m sC — 4 2 -— 1 wy 0 | 1 i RE 1 1 1 | 1 1 | T 71 72 73:74 75 76 77 78.79 80 81 82 835 84 0 CDS ARRESTS + HEP B*10 LAGGED 1YR I1-128 Anecdotal Information Reports from narcotics law enforcement officers, forensic laboratories and new clients in treatment provide a rich source of information for street drug patterns. These reports are discussed by drug type, with references to specific sources of information when appropriate. Hits are as widely prevalent in Newark as they have been for years, with costs remaining at $12-15 per hit. Unlike findings in Chicago and Los Angeles, purchases using Medicaid for reimbursement are not a signficant source of illicit Hits. Statewide Medicaid reimbursements for glutethimide amounted to about $10,000 in 1983, and only $6,000 in 1984. These relatively insignificant amounts of purchases could not account for more than a small fraction of illicit use. It is interesting to note that reimbursement decreased by 40 percent following the placement of glutethimide in the State's CDS Schedule II. All indications are that most Hits on the streets are diverted from out-of-state. Heroin is still widely available, but the impression of most key informants is that heroin prevalence has definitely peaked, while some believe that it is now declining. Clients say that some former chronic heroin users are now investing more in cocaine purchases, and substituting other opiates (e.g. codeine) or sedative/hypnotics (e.g. glutethimide) for the heroin. The Newark Police Laboratory reports analyzing only about 20 seizures a month of heroin, compared to 80 a month in 1979 - 1980, and 40-50 a month in 1981 - 1982. Narcotics officers report that, although their practices have not changed, their street arrests involving cocaine are sharply increasing, while heroin seizures are decreasing. Heroin purity remains low, at 1-5 percent, with street prices for a nominal 100 mgm bag (actual weight 80-90 mgm) staying at $10 a bag. Practically no heroin is available in large quantities in Newark. New York Quarters are available for $50, but these are often cut after purchase in New York City. Cocaine is now pandemic. Larger quantities (ounces or more) are most often distributed in Newark by Hispanics, whose major source is Union City. However, blacks are now dealing quantities of up to an ounce more frequently now. Prices for ounces remain at $1,500 - $2,000 with high purity (70% and higher). Prices for small quantities are dropping. Grams once had a set price of $100, but are now available for as little as $75 from some dealers, although $80-90 are more common prices. PCP use is on a definite upswing in Newark. Three or four years ago, the Police Laboratory found 1 to 3 cases a month of PCP on vegetable matter (e.g. parsley, spearmint). Recently, the lab is receiving about 12 cases a month. Further in the past, findings of PCP on marijuana were extremely rare, but the lab now receives as many as 6 cases per month. The street names assigned to this combination are "Lovely" or "Boat," the same names used in Trenton NJ, where there has been an epidemic of this combination for several years. LSD remains present at low levels. The police will occasionally seige dots with various cartoon imprints. LSD is more popular in the suburbs of Essex County than in Newark proper, but nowhere in the county is it a major problem. IX-129 MDMA has not been reported by any source. Neither the Newark or the State Police Laboratories have received a single sample, and both police and user sources report that it is not available, although some users report having heard of "Ecstacy." Summary There are some indications that heroin incidence and prevalence have decreased in Newark from the high point of 1979-1981. At the least the increases noted during those years have levelled off. At the same time, Newark is in the throes of a rapid increase of cocaine abuse in epidemie proportions. The use of Hits remains stable, in spite of the re-scheduling of glutethimide in New Jersey. Apparently, out-of-state sources are responsible for the availability of this combination in Newark. Marijuana continues to be widely available, remaining the "beer" of illicit drugs. a not uncommon to hear statements like, "I smoke grass, but I don't do drugs." PCP use, particularly in combination with marijuana has increased with the last six months, although LSD use remains low, and the new "designer drug," MDMA, has not shown up at all. In general, Newark's drug scene continues to follow a fairly conservative inner city pattern of use. II-130 REPORT TO THE COMMUNITY EPIDEMIOLOGY WORK GROUP MEETING XVIII JUNE 25-28, 1985 Mark R. Bencivengo, M.A., Deputy Director Coordinating Office for Drug and Alcohol Abuse Programs, Department of Public Health City of Philadelphia, Philadelphia, Pennsylvania Overview During the six month period July 1, 1984 through December 31, 1984 several of the indicators under study exhibited upward movement. Overall, admissions to drug treatment programs increased 10.9%. Narcotic and Dangerous Drug related deaths increased 28.3% over the prior six month period and 29.1% between 1983 and 1984. Drug Law Offenses and Arrests showed increases in two categories; these were Opiates/Cocaine Derivatives and Dangerous NonNarcotics. Information obtained from representatives of the Drug Enforcement Administration and from individuals working in drug treatment programs indicated a continued increase in the availability of cocaine. This information was corroborated by the other indicators under review. Treatment Admission Data The majority of drug treatment programs under contract with the Philadelphia Department of Public Health report operating at or near funded capacity. This is especially true for programs treating heroin abusers. The tightening of treatment availability is reflected within the admission data contained in Table 1. While admissions across the five categories of substances increased 10.9%, admissions for heroin abuse increased 20.5%. The Table reveals that although admissions have increased, the total remains considerably below the numbers recorded in the late 1970's and early 1980's. However, treatment capacity has been reduced over the last several years primarily as a result of fewer dollars being made available beginning with the block grant funding mechanism in fiscal year 1983. Table 2 reveals that the 1950-54 (N=591) birth cohort continues to produce the majority of admissions reporting heroin as the primary drug of abuse. This cohort increased 26.0% over the prior six month period. The fifteen year period, 1945-59 accounted for 79% (N=1241) of the 1572 admissions for heroin abuse. The aging of the heroin treatment population which is reflected in the admission data, is also reported by the treatment programs. It appears that the incidence of heroin abuse has at least leveled off and in fact has probably declined over the last several years. A review of reported year of first use of heroin for the 1572 heroin abuser admissions entering treatment between July 1, 1984 and December 31, 1984 reveals that the peak first use years for this cohort occured between 1967 and 1972. During this six year period, 45.6% II-131 (N=717) of the admissions began to use heroin. In contrast to this six year period, the twelve year span from 1973-1984 contributed 27.3% (N=429) of the admissions in the second half of 1984. The re- maining 27.1% (N=426) of the admissions began to use heroin prior to 1967. Table 7 contains year of lst use data for the period 1973-1984. Table 3 reveals the distribution of admissions for methamphetamine/ amphetamine abuse. As in prior reports, individuals born between 1955-59 (N=256) made the major contribution to the total (35.3%). In fact, admissions from this cohort increased 16.9% over the first six months of the year. Overall admissions for this group increased by a modest 2.4% marking the fourth consecutive six month period showing an increase. The remaining admission tables numbers 4-6, contain data on admissions reporting barbiturate, illegal methadone and synthetic opiate abuse respectively. Admissions for these substances are not particularly remarkable, and with the possible exception of synthetic opiate abuse in certain areas of Philadelphia and within particular groups, do not constitute a serious problem. Finally, admissions for abuse of cocaine deserves a special mention. The City of Philadelphia began monitoring admissions to drug abuse treatment programs in the early 1970's. Since that time, no substance has exhibited the pattern of increase which has been shown by cocaine. From an insignificant. 87 admissions in fiscal year 1978-79, admissions increased slowly through fiscal year 1982-83 when 195 admissions were recorded. In 1983-84 admissions increased to 439. In the first two quarters of fiscal year 1984-85, 331 admissions for cocaine abuse were recorded. If the trend continues, and there is no reason to believe that it will not, Philadelphia will record approximately 660 admissions for cocaine abuse. This would be an increase of slightly over 50% be- tween fiscal year 83-84 and fiscal year 84-85. The following are the admission figures for cocaine abuse over a period of six and a half fiscal years: Fiscal Year Admissions for Cocaine Abuse 1978-79 87 1979-80 117 1980-81 119 1981-82 "151 1982-83 195 1983-84 439 July-December 1984-84 331 Mortality And Emergency Room Data Table 8 reports Narcotic and Dangerous Drug Mortality by Sex and Race. In the prior report which contained data on the first half of 1984, the statement was made that if drug related deaths were to con- tinue at the same rate in the second half of 1984 as in the first, that total deaths would approach or exceed two hundred for the first time since 1974. This has indeed proven to be the case, with 127 deaths I1-132 recorded in the second half of the year as opposed to 99 in the first half. The total of 226 deaths represents an increase of 29.1% over 1983. With regard to the toxicology results, a sampling of the 127 cases for the period July 1, 1984 through December 31, 1984 is as follows: Substance % Cases N Cocaine 9.4 12 Glutethimide Alone or With Codeine 17.3 22 Methamphetamine/Amphetamine 17.3 22 Morphine 44.9 57 Imputed DAWN emergency room mentions lend further support regarding substances which present problems in the Philadelphia area. No city in the DAWN panel approaches Philadelphia for mentions of Methamphetamine. Mentions for this substance continue to increase, and it must be regard- ed as one of the two or three major drugs of abuse in Philadelphia. Interestingly, by the third quarter of 1984, cocaine mentions ranked second among all drugs contained within the DAWN listing. As stated above, no substance has ever exhibited the steep increases on every in- dicator as has cocaine. Some observers of drug abuse trends in Phila- delphia have predicted that cocaine will surpass methamphetamine as a street problem in Philadelphia. Others have predicted that if present admission trends continue, cocaine will rank above heroin as the primary drug of abuse of people seeking treatment. Anecdotal Information While several of the drug abuse indicators suggest increased drug activity in Philadelphia during the period July 1 through December 31, 1984, the most dramatic evidence for an increase comes from individuals working in programs or involved in law enforcement activities. In fact, public concern about increasingly visible trafficking and abuse resulted in two public hearings on the drug abuse problem in Philadelphia being conducted by the Philadelphia City Council. During the hearings, the substances receiving the most attention were heroin, cocaine, metham- phetamine, and marijuana. A number of witnesses provided testimony which supported the view that the drug abuse problem in Philadelphia has escal- ated over the past several years. This view, especially as it pertains to methamphetamine and cocaine use, is generally supported by workers in a number of drug treatment pro- grams. Staff of one program which treats a large number of Hispanic clients report that methamphetamine use is wide spread and is at higher levels than a year or two ago. Methamphetamine is generally light brown in color but does range from purple to dark brown. The Drug Enforcement Administration corroborates this and reports that departures from a light brown color are the result of extremes in the chemical processing of the substance but that these extremes do not have any effect on quality. I1=~133 With regard to heroin, the quality of the drug varies within different communities. Within the Puerto Rican community, the drug is reported as being of better quality than eight to ten months ago. White heroin is readily available with no brown heroin being seen for a number of years. In a second program which treats very few Puerto Ricans, the quality of the heroin is reported as declining over the last year. Again, only white heroin is available. The Drug Enforcement Administration lends support to these obser- vations. The DEA reports seeing only white heroin on the streets in Philadelphia. There is some speculation that Mexican brown heroin may appear since some brown heroin has shown up in Pittsburgh and the supply may work its way to the larger markets in the eastern part of the State. DEA also reports that heroin in the black community runs about 2-3% pure. In the Puerto Rican community purity is 5-6% with highs of 15% pure. Talwin use is reported as all but dried up. Some scattered use continues but for the most part Talwin users have shifted to other sub- stances. Workers in one clinic reported that users of Ritalin and Talwin have shifted to Ritalin alone. Users of Talwin and Benadryl are now using Benadryl alone. Although glutethimide is a problem among certain groups its use appears infrequently in the Puerto Rican community. Placidyl, on the other hand, does appear with some frequency in the Puerto Rican community. Use of solvents is limited to a few areas of the City. However, in the Fishtown and Kensington areas this group of substances continues to be popular among white males and females. Use begins at an early age, often as young as ten or eleven years, and frequently extends to the late teenage years. Solvent users who continue their use into their late teens or early twenties generally do not move on to some other illicit substance, but gradually shift to heavy alcohol use. Among some groups, solvents are regarded as a gateway drug and use is accepted during the preteen and early teen years. Once an individual reaches his mid-teens the expectation is that he will abandon solvents and move on to use of "real" drugs. Glutethimide is regarded by the DEA as both a diversion and an abuse problem. The drug most often comes from pharmacies which honor forged scripts. Recently, however, law enforcement actions were taken against two pharmacies. It remains to be seen if these actions will disrupt the distribution and use of this drug in Philadelphia. The DEA also mentioned preludin, not as an abuse problem, but as a diversion problem. The DEA reports that the bulk of diverted preludin is not used in Philadelphia but goes to Washington, D.C. The infrequent use of this substance in Philadelphia is supported by the staff of treatment programs who report seeing very few admissions to treatment who report using preludin. Finally, both the DEA and the staff of treatment programs report the widespread availability and use of cocaine. DEA reported that there is little doubt that there was a greater amount of cocaine available on II-134 the streets of Philadelphia in the spring of 1985 than in the fall of 1984. Prices range from $80 to $120.00 per gram, and the quality of the cocaine is generally quite good. The increase in the amount of cocaine use resulted in increased law enforcement activity during the spring of 1985. Several significant seizures were made and at least two major trafficking networks were disrupted. It remains to be seen, however, what if any impact these actions will have on the availability of cocaine. 11-135 TABLE I COMPARISON AMONG DRUGS LISTED AS PRIMARY AT INTAKE TO TREATMENT OVER FOURTEEN SIX MONTH PERIODS METHAMPHETAMINE/ ILLEGAL OTHER SYN. COHORTS HEROIN AMPHETAMINES BARBITURATES METHADONE OPIATES TOTALS FIRST 1978 2,214 385 169 75 255 3,098 SECOND 1978 1,582 414 180 91 275 2,542 FIRST 1979 1,736 467 174 103 318 2,798 SECOND 1979 1,860 527 183 71 408 3,049 FIRST 1980 2,065 762 208 66 356 3,457 SECOND 1980 2,296 635 191 59 309 3,490 FIRST 1981 1,952 814 150 53 291 3,260 SECOND 1981 2,010 792 164 40 304 3,310 FIRST 1982 1,964 666 132 54 303 3,119 SECOND 1982 2,244 533 148 44 301 3,270 FIRST 1983 1,945 563 163 58 278 3,007 SECOND 1983 1,491 645 172 63 282 2,653 FIRST 1984 1,305 708 151 66 272 2,502 SECOND 1984 1,572 725 135 61 281 2,774 6/85 II-136 LET-II TABLE 2 COMPARISON AMONG FOURTEEN COHORTS OF PATIENT INTAKES BY YEAR OF BIRTH LISTING HEROIN AS THE PRIMARY DRUG 1920- 1925- 1930- 1935- 1940- 1945- 1950- 1955- 1960- COHORTS 1919 1924 1929 1934 1939 1944 1949 1954 1959 1964 1965+ TOTALS 1st ‘78 6 20 S9 79 251 S41 877 341 20 1 2,203 2nd ‘78 1 23 : 38 72 155 380 658 260 8 1 1,600 ist ’79 2 29 30 95 164 431 677 290 15 0 1,736 2nd 79 q 10 18 17 97 204 S00 706 249 25 0 1,860 ist ‘80 2 22 46 73 187 q95 82s 376 33 0 2,065 2nd ‘80 2 8 26 76 79 228 S73 903 351 SO 0 2,296 ist ‘81 1 28 49 73 172 480 749 347 46 3 1,952 2nd ‘81 2 14 25 S3 87 196 144 77S 372 q1 1 2,010 ist 82 2 S 27 42 86 173 q20 769 377 62 3 1,964 2nd ‘82 8 10 30 S8 108 188 S535 839 395 72 2 2,244 lst ‘83 3 9 17 S57 68 163 409 731 372 113 3 1,945 2nd ‘83 3 1 8 31 46 126 320 S556 308 849 8 1,491 ist 84 1 1 13 39 449 106 266 469 285 78 3 1,305 2nd ‘84 2 8 14 43 59 17 337 591 313 81 7 1,572 6/85 COMPARISON AMONG FOURTEEN COHORTS OF PATIENT INTAKES TABLE 3 BY YEAR OF BIRTH LISTING METHAMPHETAMINE/AMPHETAMINES AS THE PRIMARY DRUG COHORTS lat 2nd ist 2nd lst 2nd ist 2nd lat 2nd 1st 2nd 1st 2nd *78 *78 *79 *79 ’80 *80 *81 ‘81 ‘82 82 *83 *83 84 *84 1939 23 9 19 15 18 9 17 13 15 10 10 4 1940- 1944 30 30 23 30 25 36 34 25 31 13 18 18 25 26 1945- 1949 68 77 8s 79 78 64 83 74 61 50 64 62 54 72 1950~ 1954 106 108 158 150 205 171 183 179 158 131 111 144 159 130 11-138 1955- 1959 116 121 141 le4 275 218 298 275 226 173 203 200 219 256 1960- 1964 44 56 59 85 148 123 172 186 148 121 119 167 163 178 1965+ HH NN WwW © 13 14 21 40 27 35 38 SO 81 56 TOTALS 387 404 467 527 762 635 814 792 feb 533 563 645 708 725 6/85 COHORTS 1st 2nd lat 2nd lst 2nd 1st 2nd ist 2nd lst 2nd lst 2nd *78 *78 *79 73 ‘80 *80 ’81 ‘81 ’82 ’82 ‘83 ’83 ’84 ’84 COMPARISON AMONG FOURTEEN COHORTS OF PATIENT INTAKES TABLE 4 BY YEAR OF BIRTH LISTING BARBITURATES AS THE PRIMARY DRUG 1939 - oo uv = 8 ON HH NOW Vw VW 1344” S 10 7 13 [oY N A NN NN W 0h §N WW Ww Ww 1945- 1950- 1949 1954 17 54 20 92 = 17 25 21 38 10 35 27 29 6 17 16 22 16 29 10 26 13 36 7 31 39 6 36 11-139 iy S8 77 70 S52 62 62 SY S3 33 37 60 92 36 16 mr 26 22 44 46 74 S3 S3 40 30 45 42 S56 35 26 1965+ ® 0 W NN O O 11 21 10 20 23 21 15 TOTALS 165 180 174 183 208 191 150 164 132 148 163 172 151 135 6/85 COHORTS ist 2nd 1st 2nd ist 2nd lst 2nd 1st 2nd ist 2nd ist 2nd *78 *78 *79 *79 ‘80 ’80 ’81 ’81 ‘82 ’82 ’83 ’83 ’84 ’84 1939 = WwW =U = WES NN SEW TABLE S COMPARISON AMONG FOURTEEN COHORTS OF PATIENT INTAKES BY YEAR OF BIRTH LISTING ILLEGAL METHADONE AS THE PRIMARY DRUG 1940- 1944 AN BO = WW = = ww Ww se [ Oo 1945- 1949 17 21 14 11 9 10 10 7 12 12 11 1950- 1954 38 43 43 31 27 26 23 15 20 22 21 19 30 25 II-140 1955- 1959 11 19 22 19 13 19 8 13 19 13 17 18 11 12 1960- 1964 fd Oo oO A H = NN 2 HNO Ww 1965+ TOTALS 74 91 103 71 66 59 53 40 54 44 58 63 66 61 oC ON += OO O +» © © O00 O00 © O00 © 6/85 COHORTS lst 2nd lat 2nd lst 2nd ist 2nd ist 2nd lst 2nd lst 2nd *78 *78 *79 *79 ’80 ’80 ’81 ’81 '82 '82 r83 ‘83 ’84 ‘84 1939 15 12 14 17 25 17 13 16 17 8 10 11 13 6 19490- 1944 11 16 16 28 19 8 15 12 20 18 16 10 TABLE 6 mE 50 129 $3 112 62 130 91 168 83 117 s1 120 53 99 58 104 4 95 Bh 110 59 101 47 93 58 92 48 109 II-141 1955- 1959 42 69 80 8s 92 oe 82 75 83 79 64 86 67 79 COMPARISON AMONG FOURTEEN COHORTS OF PATIENT INTAKES BY YEAR OF BIRTH LISTING OTHER SYNTHETIC OPIATES AS THE PRIMARY DRUG 1960- 1964 8 12 1s 19 24 17 27 35 28 23 29 33 30 29 1965+ N WN & WO NNO =» O OO » O TOTALS 255 275 318 408 356 309 291 304 303 301 278 282 272 281 6/85 CvI-1I YEAR OF 1ST USE 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 2nd 76 167 168 108 29 5 172 171 92 S55 2nd 77 115 109 80 71 27 TABLE 7 YEAR OF 13T HEROIN USE BY YEAR OF ADMISSION (SEMI-ANNUAL DATA) (SOURCE: UNIFORM DATA COLLECTION SYSTEM) YEAR OF ADMISSION 1st 2nd ist 2nd lst 2nd 1st 2nd 78 78 79 79 80 80 81 81 108 65 80 99 29 99 82 83 108 66 71 66 29 112-102 74 91 71 Sq S3 77 84 71 72 61 q1 S56 18 63 86 S56 S52 43 26 38 42 S1 55 46 q2 6 13 le 29 46 47 S52 46 3 13 28 23 29 43 6 10 19 27 '% 84q 72 66 S53 35 S50 S52 36 21 2nd 82 99 82 77 69 46 43 S53 46 34 1st 83 76 62 60 S6 S59 SS S3 68 39 16 7 78 49 45 53 38 39 43 27 42 24 11 1st 84 66 40 a4 34 29 q2 35 33 38 24 6/85 2nd 84 69 S3 a8 36 41 30 39 37 30 23 11 12 YEAR 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 M/B 101 177 227 137 125 99 104 60 60 68 49 68 49 62 80 TABLE 8 NARCOTIC AND DANGEROUS DRUG RELATED MORTALITY BY SEX AND RACE M/W 34 30 39 54 55 48 42 58 42 51 60 59 74 68 76 F/B 14 20 37 25 21 15 11 6 13 14 17 17 15 20 21 II-143 F/W 14 14 12 10 10 22 19 21 21 31 HISP NN Ov Ug NNW w 9 on 10 18 TOTALS 158 236 314 233 212 178 171 139 129 150 151 173 166 175 226 6/85 TABLE 9 DRUG LAW OFFENSES AND ARRESTS BY DRUG TYPE AND ACTIVITY OPIATES/COCAINE : : DERIVATIVES MARIJUANA SYNTHETIC/NARCOTIC DANGEROUS NON-NARCOTIC 1983 1984 1983 1984 1983 1984 1983 1984 SALE 176 241 438 389 32 37 54 118 OFFENSES MANUFACTURE 303 276 ‘341 262 42 as . 123 125 POSSESSION 742 866 2061 2004 80 60 326 298 TOTALS 1221 1383 2795 2655 154 128 S503 541 SALE 205 321 442 400 41 47 70 147 ARRESTS MANUFACTURE 353 354 413 324 el 40 108 99 I POSSESSION 730 231 2290 2123 7° 97 320 320 1 I~ ' S TOTALS 1288 1606 3145 2847 181 184 498 566 6/85 DRUG USE IN ARIZONA, JULY - DECEMBER 1984 N. Bruce McAlister, M.A. Philip H. McAvoy, M.S. Terros, Inc. 4545 North 27 Avenue, Ste A-14 Phoenix, Arizona 85017 In the 1980 Census, Arizona ranked twenty-ninth in population with 2,718,425 people. The state has two Standard Metropolitan Statistical Areas (SMA's), Phoenix and Tucson. Phoenix has 55.5 percent of the state's population and Tucson, 19.5 percent. Since each encompasses 8 percent of the state's area, 75 percent of the population resides in 16 percent of the area. This report will include information concerning all of Arizona, and, where good data are available, will address the Phoenix, SMSA specifically. Data Sources The Arizona Department of Public Safety (DPS) receives Unified Crime Report (UCR) data from the various law enforcement agencies within the state, compiles these, and forwards these to Washington. They have made these figures available to us for this report. The 1984 figures included in this report lack data from one agency that normally accounts for 9 percent of Phoenix data, or 5.6 percent of state data, due to computer problems. When the final figures are available, the appropriate tables will be revised and will be presented in the next report. One additional problem with the UCR reports is that natural and semisynthetic opiates and cocaine are all combined under one heading before transmission to the state. This prevents ready untangling of the proportion of arrests for the major components, cocaine and heroin. The Arizona Department of Health Services' Community Programs Data System (CPDS) is the source for Table I and for other information concerning treatment entries throughout the report. A11 agencies receiving state treatment funds report to this system. Half-year data suffers since some agencies lag behind in their reports dur- ing the first half of the fiscal year, catching up during the second half. Another problem with this data derives from the fact that Arizona does not use a system of unique client identifiers. Therefore, reports of first entry into treatment versus readmission represent the experience, in most cases, of each separate reporting agency. For this reason, comparisons of this sort are not used in the present re- port. The Maricopa County Juvenile Court reported the data from which Table VII is drawn. Like the UCR, their data is made available on a calendar-year basis. Maricopa County is coterminous with the Phoenix SMSA. II-145 Emergency room mentions supplied by the Drug Abuse Warning Network (DAWN) have been combined to present half-year figures for the drugs we believe to be most signifi- cant. The Phoenix office of the U.S. Drug Enforcement Administration (DEA) supplies monthly summaries of prescription drug thefts in this area. They have also supplied much of the information concerning local drug prices and their understanding of how drugs are coming into Arizona. Finally, newspaper clippings are scanned for useful information, and the reports of the 24-hour crisis line operated by Terros are also checked. Prices of drugs as they have been reported by DEA, for example, usually agree with the reports of cli- ents of Terros. Opiates Heroin continues to be plentifully available in Arizona. DEA reported that the pre- dominant variety is the Mexican "tootsie roll" we have been seeing for several years. Border seizures of heroin have increased each year for the past six years. During 1984, Arizona's "share"of the seizures were 14.22 kilograms, 29 percent of the year's total border seizures. Interviews with undocumented aliens arrested on narcotic charges has led to the report that their "guides" smuggling them into the United States have usually required them to carry quantities of heroin about or in their persons during the trip. DEA reports that the purity of samples tested has ranged from 10-90 percent, with the majority about 70 percent. At this level, prices range from $400-600 per gram to $5,500-8,000 per ounce. Phoenix area arrests for "narcotics" (opiates and cocaine) have risen steadily : through 1983 and 1984 (Table II). From other UCR data we calculated that Phoenix reported about 68 percent of all drug arrests in 1984, and 78 percent of narcotics arrests. As noted above, Phoenix has about 55.5 percent of the population. Last December we reported that, for the first time, heroin had been supplanted as the modal reason for entry into treatment during the first half of 1984. Revised fig- ures now available and reflected in Table I indicate that this actually occurred during the first half of 1983 and has continued, with treatment entries for all opiates remaining second to those for marijuana for this six-month period. Women comprised 37.5 percent. Whites were 76 percent; Mexican/Americans, 15 percent; Blacks, 4 percent; and American Indians 3.5 percent. This ethnic distribution, which is very similar to the state's ethnic composition, differs markedly from the first half of 1984 when 58 percent were white; 34 percent, Mexican/American; and 6 percent, Black. During the last half of 1984, 64 percent of these entries were aged 25-34, and another 23 percent, 35-44. We are seeing very few young people entering treatment for heroin addiction, or, in fact, for any opiates. The popu- lation is aging. Since 60 percent reported no arrests during the preceding two years, it can be assumed that most are entering treatment voluntarily despite an adequate supply of heroin. DEA reports indicate that Dilaudids, 4 mg., sell on the streets for $50-60 each. Several Terros clients we interviewed stated that they had been buying small quanti- ties for $40. Percodans are reported to sell for $25 each. The category, "other II-146 opiates and synthetics" is tied for fourth place in treatment entries (Table I). In emergency room mentions, this group has held about even with the previous half year (Table V). Phoenix arrests for sales of synthetic narcotics (Table II) of codeine increased from 10,003 units during the first half of the year to 25,822 units during the last half, yet, the overall opiate group thefts were only a lit- tle higher. : Cocaine Cocaine continues to be a very popular drug in the Phoenix area. One DEA report described cocaine as the "drug of choice", and one DEA informant commented that “everybody and his brother is selling cocaine." It appears that, as enforcement measures have intensified in the Florida area, Arizona is becoming a major point of entry for the drug. In 1984, over 52 kilos of cocaine were seized by DEA agents in Arizona. In addition, sheriff'sdeputies in two rural counties seized one ship- ment of about 1,680 pounds and another of above 3,000 pounds during the last half year. DEA reports that the principle dealers continue to be white middle class, although some Mexicans are beginning to deal in significant quantities. Cocaine purity was reported tocontinue at about 70-90 percent. Prices vary with purity, quantity, and dealer. Representative prices are $100-150 per gram, $1,500-2,700 per ounce, $25,000-40,000 per pound, and $44,000-52,000 per kilo. This purity level and price range do not seem to have varied significantly since late 1983. While treatment entries for cocaine dropped 21 percent during this six months, that was less than the overall decline of 32 percent. For the last two years, cocaine has held third place in treatment entries (Table I) after marijuana and heroin. Whites constituted 84 percent of these entries; Mexican/Americans, 8 percent; and Blacks, 5 percent. Just above 51 percent were aged 25-34, and another 26 percent were in the 20-24 year-old group, which is a younger group than the heroin users seeking treatment. These figures are quite similar to our previous report; how- ever, the proportion of women seeking treatment rose from 25 percent to 33 percent. As with heroin, it appears that the majority of these users were also voluntarily seeking treatment, as 58 percent reported no arrests during the preceding two years. Prescription drug thefts of cocaine increased markedly this year--from 32 units to 699 units. This was the largest "haul" since the first half of 1983 when thieves gathered 1,490 units (Table IV). Emergency room mentions (Table V) are up from 38 to 45. Marijuana Again this period, marijuana related treatment entries (Table I) and marijuana re- lated arrests (Table II) lead all other drug categories. Marijuana, if not the drug of choice, is clearly the most frequently used drug other than alcohol. Mari- juana treatment entries are 34 percent of the total, 78 percent are males, 31 per- cent are under age 18, and 45 percent are under 19. Only 42 percent reported no arrests during the previous two years. Probably more of these people are entering treatment under duress than are the heroin and cocaine users. Ethnically, 75 per- cent are white; 15 percent, Mexican/American; and 4 percent each, Blacks and Ameri- can Indians. Again, as noted for heroin users, these are not far from the ethnic composition of Phoenix. No secondary drug problem was reported by 24 percent of the marijuana treatment entries; 54 percent reported alcohol as a second problem drug. II-147 Phoenix area arrests for sales of marijuana were 53 percent of all drug sales arrests; 82 percent of arrests for possession were for marijuana (Table II). A DEA spokesper- son said that a significant amount of sinsemilla is being grown in Arizona, both on private land and on Forest Service land. A newspaper report indicated that marijuana pollen had increased greatly in the year's pollen count. Amphetamines According to DEA reports, motorcycle gangs in Arizona monopolize the methamphetamine traffic. The majority of their supply, in turn, is believed to come from a well-known motorcycle gang in California. However, there is also evidence of an illegal laboratory manufacturing methamphetamine in a rural county of southern Arizona and purchasing their supplies out of state. Another illegal laboratory is believed to have been established in the northwest area of the state. Naturally, little information is available on these labs. Throughout much of the state, "street" methamphetamine sells for $60-100 per gram. For pure methamphetamine, the prices quoted are $85-100 per quarter gram and $1,500- 1,900 per ounce. Pound lots are reported to change hands regularly among the motor- cycle gang groups. Amphetamines continue to tie with "other opiates" for fourth place in treatment i entries (Table I). As in our previous report, women represent 38 percent of entries; 60 percent are above age 25; 86 percent are white, and 7 percent are Mexican/American. Amphetamine and "speed" emergency room mentions (Table V) are up over the first half of the year. One additional item deserves mention here--in the local high schools, “black beauties" are selling for $1.50 each. These are, of course, look-alike drugs that are legal for over-the-counter sales but are packaged to look Tike legal pre- scription amphetamines, and apparently, are often believed to be genuine by the buyers. Benzodiazepines Thieves increased their take of diazepam from 4,917 pills in the first half of the year to 13,105 in the second half (Table IV). However, emergency room mentions for the group are down (Table V), and drug related arrests (Table II) for the group in- cluding these drugs have not changed significantly. Juveniles During the period from July to December 1984, 174 people under the age of 18 entered drug treatment in Arizona agencies. This represents 12 percent of total entries for the period. Marijuana was the principle drug used as reported by 143, or 82 percent, of the juveniles in treatment. In 1984, 83 percent of juvenile drug arrests were for marijuana violations. In Arizona, marijuana is the drug of youth--or at least of youth in trouble. An examination of Tables III and VI indicates that the ratio of juveniles to adults arrested for drug law violations has remained steady at 18-20 percent over the five 11-148 years from 1980 to 1984. Further examination of these same figures offers some additional food for thought. The ratio of males to females arrested for drug law violations has remained nearly even over the period. Adult males accounted for 87 percent of their arrests, while juvenile males were 81-84 percent. In contrast, juvenile arrests for alcohol violations, both DWI and other liquor law arrests, show an increasing proportion of female violators. The idea that the decrease in DWI arrests during this period is a result of the stricter law that came into effect in Arizona in 1983 is inadequate to explain the fact that the decline has occurred over the entire five years. This contrasts with the adult figures, which showed a steady increase until after the new law had taken effect. One last item well worth mentioning as offering some hope for those of us involved in treatment: the number of cases of juveniles sniffing solvents (Table VII) ap- parently peaked in 1982 and has since been declining. Perhaps the educational ef- forts that have been directed at this problem have, at last, had some effect. II-149 Treatment Entries for Selected Drug Groups TABLE I State of Arizona (percent of entries addressed) Period Heroin Jan - Jun 80 231 (31) Jul - Dec 80 290 (40) Jan - Jun 81 273 (34) Jul - Dec 81 293 (37) Jan - Jun 82 256 (33) Jul - Dec 82 369 (30) Jan - Jun 83 385 (22) Jul - Dec 83 366 (27) Jan - Jun 84 460 (23) Jul - Dec 84 357 (26) Amphetamines Jan - Jun 80 52. 7) Jul - Dec 80 45 ( 6) Jan - Jun 81 60 ( 7) Jul - Dec 81 80 (10) Jan - Jun 82 87 (11) Jul - Dec 82 9 ( 8) Jan - Jun 83 153 ( 9) Jul = Dec 83 103 ( 8) Jan - Jun 84 108 ( 5) Jul - Dec 84 88 ( 6) Inhalants Jan - Jun 80 25 ( 3) Jul - Dec 80 28 ( 4) Jan - Jun 81 14 { 2) Jul - Dec 81 35 ( 4) Jan - Jun 82 78 (10) Jul - Dec 82 116 ( 9) Jan - Jun 83 91 ( 5) Jul - Dec 83 39 ( 3) Jan - Jun 84 95 ( 5) Jul - Dec 84 23 ( 2) Source: ADHS Community P Other Opiates & Synthetics 132 (18) 101 (14) 143 (18) 136 (17) 84 (11) Tranquilizers 25 15 WwppoOnWwLWwOINDW er? a? ee? ea ea? Se Ne Se a “ee? rograms Data System 11-150 Barbiturates 25(3) 25 (4) 16 (2) 27 (3) 22 (3) 29 (2) 41 (2) 26 (2) 28 (1) 14 (1) Cannabis 164 (22) 150 (21) 178 (22) 89 (11) 108 (14) 218 (18) 575 (33) 366 (27) 766 (38) 461 (34) PCP al = NANO PLALPNOWWEAN SIN, FI FI Py, Fy, GP SN PI pe = ND NO RD Was Cs aa “at? “sa “a? “a? “a ot? “ei” fd fod Other Sedatives & Hypnotics 28 (1) 15 (1) Hallucinogens 26 (4) 10 (1) 15 (2) 19 (2) 27 (4) 42 (3) 53 (3) 48 (3) 29 (1) 27 (2) Totals 731 717 807 783 768 1249 1752 1336 2018 1356 Offense Sales. Opiates/Cocaine Marijuana Synthetic Narcotics Other Dangerous Drugs Total Sales Percent Change Possession Opiates/Cocaine Marijuana Synthetic Narcotics Other Dangerous Drugs Total Possession Percent Change DWI Source: Arizona DPS UCR 1980 Male 5560 Female ; 859 Totals 6419 TABLE II Maricopa County Drug Related Arrests 1983 1984 Jan - Jun Jul - Dec Jan - Jun Jul - Dec 149 222 234 274 526 492 720 442 21 53 68 79 101 61 40 40 797 828 1062 835 + 3.9 + 28.3 - 21.4 101 175 237 294 2559 2265 3032 2449 30 73 134 76 117 133 134 148 2807 2646 3537 2967 - 5.7 + 33.7 - 16.1 12197 8548 8999 8319 TABLE III Arizona Adult Drug Violation Arrests 1981 1982 1983 1984 7118 7286 7270 8660 1080 1094 1228 1358 8198 8380 8498 10018 27.7 + 2.2 + 1.4 + 17.9 Percent Change Source: Arizona DPS UCR 11-151 TABLE IV Prescription Drug Thefts* Jan-Jun Jul-Dec Jan-Jun Jul-Dec Jan-Jun Jul-Dec Drug Group 1982 1982 1983 1983 1984 1984 Codeine (includ Combin) 8678 18730 16112 8044 10003 25822 Morphine 1163 957 774 39 1176 1308 Methadone 793 304 100 0 924 258 Oxycodone 29171 28989 8023 10329 19064 11987 Propoxyphene 5204 4350 5199 1830 4360 1390 Other Opioids 13612 11121 3166 8326 8397 4737 Totals 58621 64451 33374 28568 43924 45232 Cocaine** 1490 215 0 0 32 699 15.44 gm 45.17gm 28.08gm Barbiturates 15293 11160 18239 4013 9793 1362 Other Sedative/ Hypnotics 4264 2514 3744 1404 3403 728 Totals 19557 13674 21983 5417 13196 2090 Diazepam 28739 16938 19558 5674 4917 13105 Other Benzoia- zepines 3330 2750 2040 4131 4440 5480 Totals 32069 19688 21628 9805 9411 18585 Amphetamine 2142 1023 235 601 911 20 Biphetamine 1399 349 200 200 286 167 Methamphetamine 822 578 0 400 6 0 Others 16421 9426 3689 1947 5854 1837 Totals 20784 11376 4124 3148 7057 2024 *Source: U.S. DEA. Unless otherwise specified, numbers represent dosage units. **Upper line represents dosage units; lower line is grams of flake cocaine. 11-152 TABLE V Emergency Room Mentions Jan-Jul Jul-Dec Jan-Jul Jul-Dec Jan-Jun Jul-Dec Jan-Jun Jul-Dec Drug 1981 1981 1982 1982 1983 1983 1984 1984 Alcohol in Combin. 312 317 226 268 311 244 196 235 Cocaine 31 21 24 24 31 30 38 45 LSD 16 19 6 13 18 16 13 5 Marijuana 26 21 15 10 25 38 21 15 PCP & Combs. 19 17 8 17 25 40 8 21 Codeine 10 10 12 6 9 10 5 12 Heroin/ Morphine 30 21 16 32 74 47 62 64 Methadone 9 4 14 12 18 3 3 2 Oxycodone 36 37 27 27 36 27 29 27 Propoxyphene 36 27 34 37 27 30 25 32 Other Opioids 25 19. 14 14 12 8 14 Barbiturates 76 69 73 74 56 56 44 38 Other Sed/ Hypnotics 61 49 50 47 44 27 24 17 OTC Sleep Aids 25 38 26 36 30 24 26 27 Diazepam 138 117 92 103 106 73 75 63 Other Benzo- diazepines 114 138 115 107 96 79 86 62 Amphetamines 43 24 19 13 20 14 8 17 "Speed" 18 15 20 21 27 20 14 17 OTC Diet Aids 8 11 10 19 11 15 20 11 Diphenhy- dramine 13 13 15 12 17 13 13 12 Diphenylhy- dantoin 37 35 23 29 33 21 25. 19 Amitriptyline comb. 58 67 70 51 47 41 52 36 Other Anti-dep 31 22 29 47 31 17 27 34 Anti-psychotic 50 34 43 55 38 36 38 30 Source: DAWN Emergency Room Reports 11-153 TABLE VI Arizona Juvenile Selected Offenses Offense Group 1980 1981 1982 1983 1984 Drug Violations Male 1309 1650 1675 1577 1814 Female 272 323 361 373 398 Totals 1581 1973 2036 1950 2212 Percent Change + 24.8 + 3.2 -4.2 + 13.4 DWI Male 527 488 462 318 289 Female Sl _60 55 37 58 Totals 578 548 517 355 347 Percent Change - 5.2 -5.6 - 31.3 - 2.2 Liquor Law Violations Male 2286 2473 3049 2712 3133 Female 598 742 981 859 1104 Totals 2884 3215 4030 3571 4237 Percent Change + 11.5 + 25.3 - 11.4 + 18.6 Source: Arizona DPS UCR TABLE VII Maricopa City Juvenile Court Referrals Substance Abuse Offenses Offense 1980 1981 1982 1983 1984 Drugs 847 1030 1048 1104 1125 Sniffing 144 171 240 148 138 DWI 43 35 17 16 18 Liquor Offenses 1162 1222 2465 2537 2051 Source: Maricopa County Juvenile Court II-154 SAN DIEGO COUNTY DRUG USE INDICATORS REPORT JUNE 1985 SUMMARY The following report provides a general overview of drug use information and trends in San Diego County using indicators and data for the years 1980-1984. Treatment data from county-funded drug-free programs indicates that first-time (no prior) admissions in 1984 listed the primary drug problem as methamphetamines (30%), cocaine (24%), marijuana (21%), heroin (14%) and PCP (7%). Methampheta- mines and PCP showed significant increases, while heroin and marijuana admissions were down. First-time admissions were 65% of the total drug-free admissions in 1984. When first-time drug-free heroin admissions are considered along with metha- done (99% are heroin users) detoxification and maintenance admissions, it is clear that heroin is a most serious problem drug. Emergency room (ER) mentions from the Drug Abuse Warning Network show heroin- related mentions up sharply in the last six months of 1984. Methamphetamines showed a 100% increase in mentions and continue to show a steep upward trend. Cocaine also shows a steady upward trend since late 1982. Overall county PCP mentions have been at a steady rate since June 1983. The total narcotic/drug related deaths (per Coroner's Office) during 1984 rose to 167, a 12% increase over 1983, and the highest since 1980. The number of accidental drug deaths (excludes suicides) now stands at 63% of the total. The increase in heroin-related deaths has risen sharply (37% of accidental deaths) and occurred primarily among males in the age range of 20 to 39 years. Cocaine deaths soared to 13 (an 85% increase), matching all of 1982 and 1983 combined. There were over 41 homicide victims for which toxicological tests showed drugs present in 1984. Serum hepatitis incidence has shown a general leveling in 1984. The percentage of cases in the age category "less than 18 years" has dropped to 5.8% of the cases after a 10.7% high in the second half of 1982. Criminal Justice data indicates drug-charge bookings are up 10% in 1984 compared to 1983,with the largest gain in "Dangerous Drugs" (26% increase). This is consistent with the reported increased street use of methamphetamines, cocaine and PCP. Juvenile arrests reported for drug-related offenses are up 11%. The price of small quantities of street-level heroin remains expensive at $25 per balloon (about .13 grams), and purity is slightly increased to the 8-10% range. Cocaine is plentiful and stabilized at a street price of $100-120 per gram with a purity of 20-30%. Methamphetamine abuse has soared as evidenced by increases in street sales of the drug, in ER mentions and crisis intervention contacts. Although PCP abuse does not rank high when reviewing "countywide" overdose and ER mentions indicators, PCP use and all its social, legal and economic ramifications are considered a major drug abuse problem within neighborhoods and communities of Southeast San Diego. Seven homicide victims were PCP users. In summary, heroin abuse is on the increase as shown by the combined drug-free and methadone treatment admissions for primary heroin problems, the rapid rate of emergency room mentions and the greater number of accidental heroin-related deaths. Cocaine, methamphetamine, and PCP usage is rising sharply. 11-155 SAN DIEGO COUNTY DRUG ABUSE INDICATORS REPORT - JUNE 1985 Earle T. McFarland, Analyst, County cf San Diego Department of Health Services, Drug Services Bureau Introduction The following report provides information concerning selected data indicators over the period 1980 through 1984. This report presents a reasonable overview of drug abuse problems and trends in San Diego County through December 31, 1984. The primary focus of the report is on monitoring heroin and cocaine indicators; however, new data and information regarding other drugs showing increased activity has been incorporated whenever possible for comparison and perspective. The continuing indicators presented include: 1) Treatment and Crisis Intervention Services Data; 2) Emergency Room Mentions; 3) Drug-related Deaths; 4) Serum Hepatitis Cases Reported; 5) Criminal Justice Data Concerning Drug-related Crime; 6) Price and Purity of Street Level Heroin. Whenever available, information on recent developments from street sources and law enforcement professionals has been included. Background Currently, the County of San Diego provides, through contract, three long-term residential, one residential detoxification (non-medical), and six regional out- patient treatment programs. Two of the three residential programs are located in the older, inner city area and are coed while the third is located in the country and is for women and their children only. These County-funded programs provide drug-free treatment. Additionally, two private providers, licensed by the State, offer methadone treatment services at five locations in the county. County-contracted service providers report "treatment" and "crisis intervention" episodes to the Department of Health Services, Drug Services Bureau for compi- lation and analysis by the Drug Information System (DIS), an automated, inte- grated data base system. The DIS provides compatible, edited and timely data to the State of California's Drug Abuse Data System (CAL-DADS) and useful monthly and quarterly summary reports to County administrators, monitors, planners and service providers. The DIS maintains an extensive master data base which can be queried in-depth for one-time research or urgent data and also routinely provides treatment cases on magnetic tapes to the State of California, Depart- ment of Alcohol and Drug Programs. A special report for 1984 showed 2,829 clients (or 10.4% of the total) admitted to the County Mental Health Clinics were "intoxicant admissions" of various drug types. While alcohol had, by far, the largest number of cases, 1329 (47%), phencyclidine (PCP) at 608 (21.5%) and methamphetamines at 497 (17.6%) are signi- ficant problem areas. Opioids are at 175 (6.2%) and barbiturates, cannabis, cocaine and hallucinogens make up the remaining 7.7%. 11-156 The private methadone service providers utilize the CAL-DADS admission/discharge reports developed by the State of California as input source documents. The other sources of data include emergency room episodes from the Drug Abuse Warning Network (DAWN) regional reports, drug-related deaths from the County of San Diego Coroner's monthly reports, serum hepatitis type B and type non-A and non-B cases from the County of San Diego, Department of Health Services, heroin price and purity from the Drug Enforcement Administration, and felony and mis- demeanor drug-charge bookings from three County of San Diego jails. In general, the treatment data have been analyzed for the past 5 years, 1980 through 1984, in order to determine changes in drug abuse trends. Treatment and Crisis Intervention Services Data The drug-free treatment information for 1982-1984 is from the County's Drug Informa- tion System (DIS) with emphasis on admission profiles among clients with no prior admissions. Tables 1, 2 and 3 present "heroin" by sex and program environment, and all drugs by year by program environment. It should be noted that the "no prior admissions" made up 65% of the total admissions for the period January-Dec. 1984. As can be seen in Table 1, 1984 heroin first-time admissions are running less than 1983 (30% decrease), but slightly greater than 1982. The male/female distribution has not changed much from the previous 55/45% ratio. Seventy-three percent of the 1984 clients were treated in outpatient clinics (up from 67% in 1983). The de- crease in heroin is. partly due to large increases in admissions for methamphetamines and PCP. Table 2 lists the primary problem drug on admission, in order, from the most to the least frequently cited drug over the last 5 years. Heroin continues to rank fourth overall, with a decline in marijuana admissions since the peak in 1980: marijuana is now down to 113 (21% of the total first-timers), ranking third. Cocaine first-time treatment admissions have continued to fall each year since 1981 (from 163 to 134), a good sign; however, total admissions for cocaine in 1984 were at an all time high of 194 (24% of all admissions), and -cocaine continues to rank second as the primary drug problem reported. As noted above, methamphetamine first-time admissions have sharply increased (44%) from 1983 to 1984 and a 17% increase was noted between the first and second half of 1984. This is certainly in keeping with the steep rise in ER mentions for "crystal". ; PCP admissions have. increased 63% from 1983 to 1984, due mainly to the opening of a new clinic in the Southeast portion of San Diego, an area which has heavy concentrations of minority populations. It is anticipated that the opening of this clinic, along with increased emphasis on the PCP problem by community leaders, may reduce PCP arrests. Comparison of the overall admissions to first-time admissions shows 74% at out- patient clinics and 36% at residential programs were first-timers in 1984. II-157 In Table 4, data for the two private methadone programs (maintenance and detoxi- fication), consisting of 5 clinics,is shown for 5 six-month periods. The data was furnished by the State of California, Department of Alcohol and Drug Programs. An increase of 20% is noted between 1983 and 1984. The data for the last half of 1984 indicete that the County of San Diego had 12% of the State of California's detoxification clients and 15% of the methadone maintenance cases and that the numbers are increasing. Latest 6-month data indicate that 72% of the methadone admissions were for detoxification and 28% for maintenance treatment. Information in the form of Discharge Status was received starting July 1, 1983. Of the 5343 discharged, 90% were in treatment from 1-3 months and 37% completed treatment (or left with satisfactory progress). No significant data are yet available from the new non-medical (drug-free) detoxi- fication facility funded by the County which commenced accepting clients in mid- March 1985. The six-bed facility is currently admitting about 15 clients per month, with a 10-14 day detox routine. The Crisis Intervention Reporting System (CIRS), was started July 1, 1984, as a method of providing fast response services to persons in crisis. It documents the many drug-oriented inquiries received by the outpatient clinics and provides some insight to the current street drug abuse population. Treatment admission data usually reflect more advanced abusers who are willing to make a commitment to remain drug-free. As can be seen in Table 5, five drugs, methamphetamine, cocaine, heroin, marijuana and PCP (in order of greatest number), are the leading primary drugs resulting in referral to crisis intervention program. These are the same drugs and the same order as the drug-free treatment admissions for 1984. It is inter- esting to note that whereas the 21-25 age category has the highest overall 2 number of participants at 26%, heroin and cocaine peak at high ages and marijuana is still the drug of choice of the under 18 category. One difference between the "crisis" and "treatment" populations appears in the sex. Crisis has a male/ female ratio of 65/35 while the treatment ratio is 58/42. Emergency Room Data Drug-related emergency room (ER) mentions are based on the NIDA-operated Drug Abuse Warning Network (DAWN) from sixteen hospitals reporting through December 1984. A drug-related ER mention is defined as a substance reported during a drug abuse episode. Up to four substances may be reported for one drug abuse episode. Figure 1 presents eight frequently mentioned drugs showing activity in San Diego Emergency Rooms, using "inputed" data furnished by NIDA, for the period January 1981 - December 1984. The number of heroin-related ER mentions, which had remained relatively constant in the past eighteen months (near 63 mentions/6 month period), soared to 102 in the last six months. This 28% increase between 1983 and 1984 is consistent with reports of a plentiful street availability, the 20% increase in methadone admis- sions and the 30% increase in heroinerelated drug deaths during the same time period. Drug-free treatment admissions for heroin have declined slightly (8%). The latter occurence is the result of greatly increased abuse of other drugs, notably methamphetamines and PCP, which has kept the county-funded programs full. 11-158 Cocaine ER mentions have continued the sharp increase noted in the previ showing a 60% increase between 1983 and 1984, with a large oT Esta past six months, This is consistent with cocaine drug deaths increasing drasti- cally from 7 in 1983 to 13 in 1984 (86%). Cocaine is plentiful on the streets and the many recent arrests indicate a serious problem. \ Methamphetamine also has continued the sharp rise in ER mentions with a 140% in- crease between 1983 and 1984. Drug-free treatment admissions have also increased 38% for the same period and the local media has reported local narcotic agents are uncovering a growing number of clandestine laboratories producing methamphe- tamine (know locally as "crystal meth" or "speed"). Diazepam (valium) is showing a leveling trend but this tranquilizer continues to bring the most people into ER's. Amitriptyline (Elavil, an anti-depressant) shows an upward swing during the past six months. Marijuana, flurazepam (Dalmane, a non-barbiturate sedative) and PCP have maintained a basically level position in ER mentions. DRUG-RELATED DEATHS The total narcotic/drug-related deaths reported by the Coroner's office (Deaths of Concern) during 1984 rose to 167 (excluding homicides and motor vehicle accidents), the highest since 1980 and a 12% increase from the same period in 1983. The percentage of accidental deaths continues to increase and accounted for 63% (up from 59% in 1983) of the overall total of drug-related deaths through December 31, 1984. Heroin and heroin-in-combination have risen sharply to 39 in 1984 (which is greater than 1981 and 1982 combined) and now amount to 37% of all accidental drug-related deaths. Males in the age ranges 30 to 39 years with 13 deaths and males 20-29 years with 12 deaths account for 64% of deaths due to heroin/heroin-in-combination. Toxicological findings found heroin present in seven homicide victims tested in 1984. The rise of cocaine deaths to 13 in 1984 (an 85% increase) has again highlighted the increased abuse of the drug. Table 6 has been expanded to break out cocaine and show the increase in deaths since 1980. In addition to the above figures, the Coroner's office reports an apparent increase in the presence of cocaine in homicide victims; in 1984 sixteen such instances were noted (a 45% increase). The eight leading causes of drug-related accidental deaths for 1984 were: 1. Heroin = 22 (21%) 2. Other Narcotics = 19 (18%) 3. Heroin-in-combination = 17 (16%) 4. Alcohol only =" 13 11) 5.. Cocaine : = 12 (1% 6. Alcohol/Drug Combinations = 5 (5%) 7. Other Drug Combinations = 4 (4%) 8. Psychostimulants = 3 (3%) 9. PCP, Tranquilizers, Barbiturates, Amphetamines, Other Sedatives = 1 (10%) 106 100% 11-159 Overdose deaths from PCP have remained at a low level (1 in 1984) which is most unusual considering the large amount of usage reported by treatment and crisis admissions and the continuing high number of arrests and bookings from the south- east section of the City of San Diego. In the period 1975 through 1984 sixty- one PCP deaths were reported by the Coroner's office, but 42 (69%) were homicide victims. Another example of low numbers of overdose deaths occurs in the drug methampheta- mine with only 3 in 1984, which is an increase on only 1 over 1983. However, the toxicological findings in homicide victims increased from 2 in 1983 to 11 in 1984. The coroner's office reports that fentanyl-like compounds continue to take their toll, with 24 deaths since mid-1982. Ten deaths were attributed to fentanyl in 1984 and 4 so far in 1985. This powerful synthetic heroin requires sophisti- cated testing in order to detect its presence and is classified as one of the "designer drugs" currently available on the streets. With 24 deaths San Dieyo County has recorded a higher number than any other county in California. SERUM HEPATITIS Reported cases of serum hepatitis (Type P and Non-A Non-B) continue to be moni- tored and analyzed, in six-month intervals, in relation to other heroin usage indicators. Needle-sharing among drug abusers can be and often is one of the primary methods of transmission of serum hepatitis. The data used in this report were based upon cases reported monthly by the County of San Diego, Public Health Services. The major limitations of the data are that only an estimated 10% of the clinically identified serum hepatitis cases are actually reported on a regular basis and that sample is made up of younger, non-affluent, food service workers (who undergo mandatory screening). As can be seen in Table 7 , the leveling off of reported cases first noted in the spring of 1984 again appears to be in evidence and the number of cases in the past six months are only two greater than the previous period. A five per- cent decrease however, from the same period a year ago, is noted. Both of the age categories, "less than 18 years" and "26 years and over" are now showing a decrease in reported cases. The "26 years and over" category is now at the lowest number of cases in the past two years (since the period ending December 1982). No unusual sanitation or hygiene situations that would distort the serum hepa- titis data have been reported in the past six months in San Diego County. Criminal Justice Data Drug-charge bookings for the three San Diego County jails from 1980 through 1984 are shown in Table 8 . The same four violation categories, as listed below, have maintained the top rankings in 1984 with the trends as noted below: 1) All Health and Safety Narcotic Violations; 2) Other Health and Safety Drug Violations (Dangerous Drugs); 3) All Other Health and Safety Marijuana Violations; and 4) Possession of Marijuana (1 ounce or less). 11-160 Narcotic Violations,which appeared to be leveling off between 1981-1983, show a distinct upward trend with 38.4% of the bookings. Dangerous Drugs took another significant increase of 15% from the same time period in 1983, and now make up 37% of the total bookings or drug-charges. Again, this is consistent with the increased use of methamphetamines, cocaine and PCP (in the City of San Diego). The latter two violation categories, Marijuana and Possession of Marijuana, have continued the downward trend which started in the latter part of 1981 and now account for only 20.7% of the total bookings. Overall, drug charge bookings have increased 9.9% from 1983 to 1984. A special computer run by the City of San Diego Police Department of PCP arrests and bookings for the second half of 1984 showed 1097 arrests, a 13% decrease from the previous six months. Almost 61% of these arrests were in the Southeast area,which has reported a continuing and increasing PCP problem. Table 9 displays an updated demographic profile of juvenile arrests for drug- related offenses reported by the State of California Bureau of Criminal Statistics in 1984. The total 1983 figures are also shown to provide comparison. The increase in overall juvenile arrests between 1983 and 1984 was 11% and the per- centage of juvenile drug-related arrests to all juvenile offenses increased to 28%. The percentage of felony arrests increased about 5% between 1983 and 1984 and now stands at 12.4% of the total. Since January 1984, the City of San Diego Police Department and the Narcotics Task Force using undercover police officers have conducted roundups at five area high schools and arrested students and at ledst one mother. Students arrested range in age from 15 to 18 and are all suspected of trafficking in small amounts of drugs. Police said most of the arrests were for selling or offering to sell marijuana, but that some transactions involved cocaine, methamphetamines, PCP and LSD. Including the last raid in May 1985, a total of 188 students were arrested. Price of Street-level Heroin (and other Drugs) Local narcotic task force and other knowledgeable sources indicate that the price of small quantities of street-level heroin has remained basically unchanged for the past six months with a very slight increase in purity. Heroin is apparently in plentiful supply and the current price is $25 per +13 gram balloon with purity in the 8-10% range. The majority of what is being seen 1s mexican brown with occasional instances of mexican "mud" at higher purity. This equates to $1.39 per milligram pure, as shown in Table 10 . Cocaine is also plentiful on the streets at a price $20 to $25 per 1/4 gram (reportedly a slightly higher price of $25 to 30 in the predominately black areas of the City of San Diego) with a street purity of 20-30%. Wholesale prices are in the range of $20,000 to $25,000 per pound with purity of 20-50%. "$5 Readyrock and $10 Readyrock" is reported available for freebasing. 1-16) Methamphetamine use is widespread and increasing rapidly. Almost 30% of the crisis intervention contacts and a sharply increasing number of ER mentions (figure 1) are for this drug. The majority of the crisis contacts are concerning persons 25 years and younger. In spite of intense lab-busting efforts by the local Narcotic Task Force (17 labs closed down in 1985 to date), methamphetamine ("crystal") is plentiful with a street price of $20 per 1/4 gram and with a pound going for $14,000-16,000. PCP is still showing high usage in certain areas of the City of San Diego with arrests down slightly in the six months ending December 31, 1984. The street price for a dipped cigarette is $10 per 1/3 Sherm and PCP is running $13,000 per gallon. Fentanyl-1ike compounds are being sold for heroin in the streets. This very powerful synthetic is very difficult to detect and consequences are not known until months later (see drug-related deaths). I1-162 TABLE 1. HEROIN AS PRIMARY DRUG PROBLEM ON ADMISSION (DRUG-FREE TREATMENT) AMONG RESPONDENTS WITH NO PRIOR ADMISSIONS,BY PROGRAM ENVIRONMENT AND GENDER Program 1981 1982 1983 1984 ‘Environment 1980 M/F Total’ M/F Total‘ M/F Total ME Tod M/F Total Residential 15.16 39 12 16 - 27 3-32 w20 13 37. 30 8:13. 2 Outpatient 38:19 57 33 27 65 21 14 "35 37 23 .80 313027 -57 TOTAL 53 34. 9b S043 92 24 37 ‘55 50 40 90 38 40 78 Source: CODAP Admission Data from County DIS. TABLE 2. PRIMARY DRUG PROBLEM AT ADMISSION (DRUG-FREE TREATMENT) AMONG RESPONDENTS WITH NO PRIOR ADMISSIONS,BY PROGRAM ENVIRONMENT FOR YEARS 1980, 1981, 1982, 1983 AND 1984. PRIMARY DRUG PROBLEM 1980 i 1981 1982 1983 1984 1. Marijuana Bes: 85s ; Res: 5 Be: 5 Bes: TY 5 13 2. Cocaine 6 123 | 10 153 16 134 7 az waz 3. Methamphetamine 14 Ne: 16 90 13 61 25 88 24 139 4. Heroin wn: ile eal Bw oia se 5. PCP 4 3 i 6 8 3 13 n 13 15 24 6. Tranquilizers 1 3% 1 277 1 20 0 4 0 2 7. Other Opiates 2 7 Cs 15 4 14 2 18 0 n 8. Other Sedatives 0 23 0 22 1 10 1 5 0 5 9. Inhalants ] 20 2 a ] 6 0 1 0 1 10. Barbiturates 0 16 ! 0 3-1 2 2 0 5 0 ] 11. Hallucinogens 0 12 3 7.8 0 3 2 4 1 1 12. OTC 1 8 0 I 4 0 3 0 1 13. Alcoho) ] a 0 2 0 1 0 0 0 0 14. Other/none 2 70 1 77 2 n 0 1 1 0 11-163 DRUG-FREE CLIENT ADM1SS10N CHARACTERISTICS ABLE 3. (INCLUDES READMISSIONS) BY PROGRAM ENVIRONMENT FOR THE 12 MONTH PERIOD, Jan. 1, 1984 to Dec.31, 1984 OUTPATIENT RESIDENTIAL % of “% of : CHARACTERISTICS Count Total Count Total PRIMARY DRUG OF USE: Heroin 100 16% 91 44% Other Opiates/Synthetics 17 3 2 1 Alcohol 0 0 0 0 Barbiturates 3 1 2 1 Other Sedatives/Hypnotics 6 1 0 0 Amphetamines 164 25 52 25 Cocaine 161 25 33 16 Mari juana/Hashish 141 22 3 1 Hallucinogens 2 0 2 1 Inhalants 2 0 0 0 Over-the-Counter 1 0 0 0 Tranquilizers 5 1 0 0 PCP 41 6 23 11 Other or None 1 0 1 0 TOTAL 644 100% 209 100% = 853 SEX: Mole 401 62 95 45 Female 243 38 114 35 TOTAL 644 100% 209 100% ETHNICITY: % 1980 census white 82 482 75% 117 56% Black 45 7 56 27 American Indian 1 6 1 3 1 Asian 10 1 2 1 Hispanic "5 101 16 31 15 TOTAL 644 100% 209 100% AGE BREAKDOWN: Under 18 69 11% 0 0 18-20 yrs. 65 10 15 7% 21-25 yrs. 167 26 67 32 26-30 yrs. 189 29 64 31 31-44 yrs 147 23 60 29 45-59 yrs. 7 1 3 1 60 and over 0 0 0 0 TOTAL 644 100% 209 100% * Special Ethnic Grouping ETM 4/23/85 II-164 TABLE 4. METHADONE CLIENT ADMISSIONS AND DISCHARGE STATUS FROM CAL-DADS, DEMOGRAPHIC CHARACTERISTICS BY 6 MONTH INTERVALS FROM PERIOD, JULY 1, 1982 - December 31, 1984 ADMISSIONS July-Dec Jan-June July-Dec Jan-June July-Dec 1982 1983 1983 1984 1984 SEX: Male 1017 1131 1875 1794 1841 Female 606 664 1081 1041 1024 1623 1795 2956 2835 2865 AGE : Under 18 2 0 3 0 0 18-20 yrs. 41 36 63 50 74 21-30 yrs. 815 866 1609 1394 1440 31-44 yrs. 755 876 1170 1285 1251 45 and over 0 6 Mm 106 100 Unknown 10 11 0 - 0 RACE: White 848 924 1371 1282 1250 Black 101 102 249 231 243 Indian 18 14 12 18 15 Asian 25 13 30 24 3] Hispanic 631 742 1294 1280 1326 DRUG TYPE: Heroin 1585 1779 2929 2808 2849 Other Opiates 29 12 22 23 16 Other Drugs/None 9 4 5 4 0 Highest Grade 8 or less 100 113 162 174 180 School Grade 9-11 559 659 1075 1008 950 Grade H. S. graduate 689 767 1244 1245 1288 Compl- Some College 250 228 401 357 382 eted: College Grad. 25 28 74 51 65 Employ- Employed 335 444 704 871 864 ment Unemployed 536 423 450 361 353 Status: Not Seeking 152 928 1802 1603 164 8 DISCHARGE STATUS 12 Mos. (July 83-June 84) Left - Left - Un- Referred Time in Treatment Completed | Satisfactory] Satisfactory or Treatment Progress Progress Transfer| Total % 1. Less than 1 month i 3 47 Z 53 1 2. 1-3 months 665 1220 2704 230 4819 90 3. 4-6 months 7 50 87 5) 195 4 4. 7-12 months 19 28 50 32 129 2 5. 13-24 months 7 19 30 28 84 2 6. 25 months or more 10 19 14 20 63 1 TOTAL 709 1339 2932 363 5343 100%] Source: State of California, CAL DAD System County Level Reports Note: This chart combines methadone detoxification and maintenance admissions. 11-165 TABLE 5. PRIMARY DRUG REPORTED BY PARTICIPANTS IN THE CRISIS INTERVENTION REPORTING SYSTEM (CIRS), OUTPATIENT CLINICS, FOR THE PERIOD JULY 1, 1984 THROUGH MARCH 31, 1985 - 9 MONTHS Drug Age Ranges Under 18 18-20 21-25 26-30 31-44 45% over TOTAL % Methamphetamine/ Amphetamine 22 42 112 79 67 10 332 29.8 Cocaine 8 15 58 63 77 4 222 19.9 Heroin 1 8 51 80 73 6 219 19.7 Marijuana 75 30 33 24 33 7 202 18.1 PCP 5 2 24 20 6 1 78 72.9 Alcohol = 2 8 8. RH 1 34 3.0 Barbs, Hall.,Inhal., Tranq., OTC & others _1 3 4 6 17 a _28 2.5 19 122 287 277 274 36 1,115 100% Male 722 (65%); Female 393 (35%) Ethnicity: White 780 (70%); Black 129 (11.7%); American Indian 9 (0.8%); Asian 17 (1.5%); Hispanic 180 (16.0%) Diazepam COUNTY OF SAN DIEGO 120 4 100 < Flurazepam o 604 Amitriptylige 40 Marijuana ¢ 3; PCP Methamphetamina oA alu Jan-an 1981 dul-Dec 1981 Jan-an 1982 Q)-Dec 1982 Jan-dn 1983 Jul-Dec 1983 Jan-dan 1984 Jul-Dec 1984 Figure 1. Emergency Room Mentions (Imputed) for Eight Frequently mentioned Drugs. Half Year Totals 1981-1984 II-166 TABLE ©. SAN DIEGO COUNTY DRUG-RELATED DEATHS Drug Causing Death 1980 1981 1982 1983 1984 Heroin/Morphine only 8 4 7 13 22 H/M in combination with other drugs 5 11 14 17 17 Total Heroin-Related 13 15 21 30 39 % of Total Drug Deaths 8% 10% 16% 20% 23% Cocaine 3 3 6 7 13 % of Total Drug Deaths 1.7% 2.0% 4.5% 4.7% 7.8% Barbs., Other Sed., Hypnotics, Analgesics, Tranquilizers, Alcohol and other Drugs 157 126 105 112 115 Total Narcotic/Drug Related Deaths 173 148 132 149 167 (Suicide and Accidental) Yo Source: TABLE 7, Office of the Coroner, County of San Diego REPORTED SERUM HEPATITIS CASES - (Type B and Non-A Non-B) by Age Categories for Years 1981 - 1984 in Six-month Intervals 6 mo. Period July-Dec 1984 Jan-June 1984 July-Dec 1983 Jan-dune 1983 July-Dec 1982 Jan-June 1982 July-Dec 1981 Jan-June 1981 Total 265 263 279 284 214 196 198 167 Age Categories (in percentages) 3 Tess 18-25 26 years ' than 18 yrs. years and over : 5.7% 43.0% 51.3% 6.1% 39.2% 54.7% 7.6% 42.6% 49.8% 10.6% 39.2% 50.2% 10.7% 37.9% 51.4% 7.7% 31.6% 60.7% 6.6% 37.9% 55.5% 3.6% 31.1% 65.3% Source: Department of Health Services, County of San Diego 11-167 TABLE 9. TABLE 8. DRUG- CHARGE BOOKINGS - SAN DIEGO COUNTY JAILS (PENAL CODE, VEHICLE CODE AND HEALTH AND SAFETY VIOLATIONS) FOR YEARS 1980 THROUGH 1984 Violation Category 1980 No. % All H & S Narc. (F) 1386 25.5 Other H & S Drugs (F) 1909 35.2 All Other H & S Marijuana (F) 1086 20.0 Possessior Marij. (F) 738 13.6 Inhale Poisonous Fumes (F) 183 3.4 Drugs in Jail (F) ~~ 43 0.8 Narcotics in Jail (F) 65 1.2 Prescription Forgery (F) 18 0.3 5428 100% (F) Felony (M) Misdemeanor 1981 No: 1987 1468 1368 574 208 33 45 17 5700 x 34.9 25.7 24.0 10. 3.6 0.6 0.8 0.3 100% 1982 No. % 2044 38.4 1332 25.) 1172°:22.0 496 9.3 200 3.8 3B 0.7 0 0.6 4 0a 5322 100% 1983 No. 8 2002 35.8 1809 32.4 1079 19.3 393 7.0 228 4.2 34 0.6 37 0.6 1.°0: 5589 100% 1984 2360 38.4% 2282 965 305 140 36 39 WE 6141 37.2 15.7 5.0 2.3 0.6 0.6 0.2 100% | 9.0% increase—| SAN DIEGO COUNTY JUVENILE ARRESTS REPORTED - DEMOGRAPHIC BREAKDOWN OF DRUG-RELATED OFFENSES FOR YEAR 1984 By Sex By Ages Ethricity CRIN _CATCUORY Total M f 10 & 11-14 15-17 Whi. Hisp. Blk. Other a = under rr Felony Narcotics 118 84 34 0 13 105 89 26 2 1 Mari juana 212 185 27 0 35 177 116 28 64 4 Dangerous Drugs 144 94 50 0 16 128 90 25 23 6 Other Drug Violations 12 10 2 0 3 9 12 0 0 0 Driving U/Influence 111-0 0 0 ‘Nn Ge ang 0 SUB TOTAL 497 384 113 0 67 430 313 83 90 1 Misdemeanor Mari juana 1160 967 193 4 288 868 805 223 108 24 Other Drugs 201 155 46 1 21 179 3% 116 46 4 Drunk 531 426 105 0 90 441 322 177 17 15 Liquor Laws 1249 876 373 0 89 1160 965 = 209 47 28 DUI 307 272 35 0 5 302 227 72 3 5 Glue Sniff 59 _40 19 0 12 47 319 30... 4 _6 SuB TOTAL 3507 2736 IN 5 505 2997 2375 827 225 82 TOTALS 4004 3120 884 S 572 3427 2686 910 315 93 1983 DATA For Comparison 3602 2774 828 2 463 3137 253% 727 252 84 % of all Source: CA., Dept. of Justice, Bureau of Criminal Statistics, "Adult and Juvenile Juvenile Arrests Reported, 1984 San Diego County, January-December 1984" Offenses 28% (Advance Copy) II-168 TABLE 10. LOCAL AVERAGE PRICE AND PURITY OF STREET-LEVEL HEROIN Average Average Price Purity $/mg. (pure) 1980 January - June 4.0% $3.00 July - December 5.1% 1.83 1981 January - June 6.1% .76 July - December 7.0% .82 11982 January - June 6.0% : 75 July - December 5.0% 2.00 1983 January - June 10.5% | 1.37 July - December 9.0% i 1.22 1984 January - June 8.0% i 2.40 July - December 9.0% . 1.39 Source: San Diego County Narcotics Task Force and the Drug Enforcement Administration II-169 DRUG ABUSE IN THE SAN FRANCISCO BAY AREA: JUNE 1985 John A. Newmeyer, Ph.D., Haight-Ashbury Free Medical Clinic The author conducted a review of all available drug abuse indicators for the San Francisco Bay Area for the period ending June, 1985. The purpose of this review was to examine local trends in drug abuse during the first half of 1985. Special attention was given to heroin, cocaine, and methamphetamine, which have been the most prominent drugs of abuse locally throughout the early and middle 1980's. Heroin. Deaths attributed to morphine-type alkaloids in San Francisco peaked in Fiscal Year 1976, when some 80 such deaths were reported by the Coroner. This was followed by a steep decline during the late 1970's, to a level of about 10 deaths per year during the early 1980's. A renewed rise followed, with 19 deaths recorded in Fiscal 1983 and 16 in Fiscal 1984. Data for Fiscal 1985 are not yet available, but it was the impression of the Coroner's office that the year's total would be significantly less than that for FY 1984. Deaths in which morphine-type alkaloids are the sole drug detected seem to be especi- ally rare. Data from other Bay Area counties for the past ten years are generally parallel to those for San Francisco County. DAWN reports on emergency-room incidents involving heroin or morphine show a distinctly different trend: the count has been rising steadily since mid-1983. The most recent data is for the fourth quarter of 1984, when 254 heroin/morphine mentions were recorded for the San Francisco/Oakland SMSA. This is nearly four times the average quar- terly count for 1982 and early 1983. Heroin has become more and more the dominant primary drug among admittees to San Francisco's treatment programs. Consolidated data showed that heroin was the primary drug for 69% of Fiscal 1982's admittees, rising to 81% in Fiscal 1984 and then inching up to 82% for the January-April 1985 period. It should be borne in mind that the County's treatment programs have long been oriented toward the heroin user (as opposed to the stimulant user), and that most of these programs have been operating at full capacity, with long waiting lists, for two years or more. The author enjoys special access to data from the Haight-Ashbury Free Medical Clinic, which runs the largest single drug-treatment program. in the Bay Area. During the period from January 1 through May 31, 1985, the HAFMC admitted 631 persons to its drug treatment facility. Three hundred ninety (62%) cited heroin as their primary problem. When data on their claimed year of first use of heroin was examined, three "peaks" were found: one in the late 1960's, one in 1973-1974, and one in the early 1980's. This three-peak pattern has been seen repeatedly 11-170 in similar samples of past HAFMC cohorts. It seems plausible that the data reflect an underlying reality of three specific "epidemics" of new converts to heroin use, one peaking around 1969, the second around 1974, and the third either peaking now, or still ahead of us. An indication pertinent to this last point can be had by looking at the past eight years of HAFMC data, to see what proportion of all first-time admittees for primary heroin use claimed first use of heroin during the three most recent calendar years. If the proportion of new cases to total cases of an "epidemic" is large, that augurs a further rapid growth in total prevalence of cases. The data for the most recent (1985) admission cohort show a "new user proportion" nearly as small as in any of the past eight years. This bespeaks an "epidemic potential" that is much weaker than that prevailing in past years, especially in 1981 and 1983. (see Table 1). Reported burglaries in San Francisco declined by about one-third between 1981 and 1983. A rise of about 7% occurred between 1983 and 1984, followed by a renewed decline of roughly 5% in the first three months of 1985. Reported robberies also declined steeply in the early 1980's, with the rate in mid-1984 some 35% below the peak of three years previous. The rate for this crime category levelled off between mid-1984 and early 1985. These data seem to reflect a decline in heroin-use prevalence during the 1980's. It must be remembered, though, that burglaries and robberies provide only about 15 or 20% of the income used by the purchasers of heroin. Also, the cost per unit of heroin has apparently fallen somewhat in the Bay Area in the past two years, which may relieve the need for property-crime income. Arrests for possession or trafficking in narcotics rose by 20% between January-March 1984 and January-March 1985, according to the San Fran- cisco Police Department. This continues a steady, steep upward trend which began in 1980; the 1985 rate is more than three times that of five years earlier. The 1984-1985 increase was significantly steeper for Whites (+23%) than for Blacks (+13%). : The reported caseload of hepatitis-B (a disease transmitted by sexual practices as well as by needle-sharing) had peaked in San Francisco in the late Summer of 1980. By mid-1983 the case incidence had fallen by fully 75%. The rate of new cases has been declining very slowly from mid-1983 to mid-1985, with about 19 cases reported each month during 1985. Informal observations by Police Department staff or drug program workers with good access to the local "street scene" were obtained. The consensus was that the quality of both "Mexican Brown" and "Persian" heroin has improved during the past year. For "Mexican Brown" particu- larly, the price has stayed the same while the strength has increased, thus providing the user for more total heroin per dollar spent. There is a lot of talk about "China White" on the street; our observers were unsure if this was true heroin or merely a fentanyl-type substitute. The weight of evidence suggests that most "China White" is actually fentanyl. : The demographics of the heroin user admittees in San Francisco were as follows, during January-April 1985: 64% were male and 36% female; 11-171 56% were White, 24% were Black, 16% were Hispanic, and 3% were Asian or Pacific Islander; fully 58% were aged 26 to 35, with 31% aged 36 or older and only 1% aged less than 21. The median age was 32.7, up by .6 years from Fiscal 1984's admittees, and up by roughly ten years from the median age of the heroin users admitted to the Haight-Ashbury Free Medical Clinic in 1971. The demography of the narcotics-law arrestees in the first quarter of 1985 showed the bias one might expect of such a population: 47% were White and 48% Black, while 82% were male and 18% female. A higher proportion of Whites and of females was seen in 1985's arrestees, as compared to 1984's. Generally, no consistent recent trends have been noted in San Francisco's heroin- using population, except that they are growing steadily older and not being replenished by significant numbers of new users in the youngest (under 25) age category. The indicators. for heroin, in summary, are contradictory. Emergency- room counts, program admissions, narcotics-law arrests, and "street" wisdom all point to an increased prevalence of heroin abuse between 1984 and 1985. But overdose deaths, property-crime incidence, hepa- titis-B incidence, and the proportion of recent initiates to heroin use suggest a steady-state or declining trend in prevalence. The former set of indicators seem to the author to be, on balance, rather "weightier" than the latter set, both in terms of validity and in the size of the indicated up or down movement. Therefore, the author judges that the 1982-1984 upward trend has continued, albeit at a slower rate, into 1985, and that the number of heroin addicts active in San Francisco County in mid-1985 is around 6,000. The prevalence for the five-county San Francisco/Oakland SMSA (San Francisco, San Mateo, Alameda, Contra Costa, and Marin Counties) is about 2.8 to 3.3 times greater than that for San Francisco County alone. Cocaine. The San Francisco Coroner reported 12 cocaine-related deaths in FY 1982, rising to 23 in FY 1983, and then holding steady at 23 in FY 1984. Data for FY 1985 will not be available until September, but the Coroner's staff indicated that the number of cocaine-related deaths will show a significant increase over FY 1984. For all of these years, only a few of the decedents-- perhaps 10 or 20%-- showed only cocaine in their systems; the remainder showed cocaine in combination with other drugs, quite frequently methamphetamine or amphetamine. The count of emergency-room incidents involving cocaine in the San Francisco/Oakland SMSA has trended relentlessly upward since mid-1983. A total of 154 such incidents were recorded in the fourth quarter of 1984, nearly 3% times the quarterly rate recorded during 1982 and early 1983. 5 ; : Cocaine remains a distant second place to heroin in its proportion of treatment program admittees in San Francisco County. This proportion is actually declining, from 8.2% of FY 1982 admissions, to 6.7% of FY 1984 admissions and then to 6.0% of admissions recorded during January through April 1985. : The San Francisco Police Department's count of arrests in the "Danger- ous Drugs" category-- which is dominated by cocaine and methamphet- amine-- hardly changed at all between 1980 and 1983, then rose steeply, attaining a rate for the first quarter of 1985 nearly 60% higher than 11-172 that for the 1980-1983 period. This recent rise, of course, may reflect changes in police emphasis rather than in underlying prevalence. Observers at treatment programs and in the Police Department agreed that cocaine continues to play a very prominent role in the local drug use picture. No significant changes in price or quality, or in marketing patterns, have been discerned. There are indications that cocaine is causing more problems because of its use in combina- tion with other drugs (especially with heroin, as "speedballs"), and fewer problems because of its being "freebased". A sample of 20 cocaine users were interviewed by the author's staff during December, 1984, as part of another study. These users gave a consistent picture of the local cocaine market as being very easy to access. About half the cocaine buyers expressed satisfaction with their "deal", while some one-third noted dissatisfaction. It was intriguing that only about 30% of the cocaine buyers spoke of the quality of their supply as "good" or "very good", in stark contrast to evidence from Pharm-Chem Laboratories that "street" cocaine often contained no detectable diluent and rarely contained any psychoactive adulterant. It is the author's belief that cocaine users generally have an expectation of high-quality experience from their prestige drug, which cannot easily be fulfilled by the psychopharmacological realities of the cocaine, however pure. The demography of the San Francisco cocaine user is revealed through treatment admission data and Dangerous Drugs arrestee data. Among 168 persons admitted for primary cocaine problems in January-April 1985, 65% were male; 40% were White, 45% were Black, and 9% were Hispanic; and 34% were aged 25 or less, while 24% were aged 36 or more. The median age was 29.8 years. Apart from a modest increase in the proportion of Blacks, these demographic data were quite similar to those noted a year previously. As for the arrestees, 81% were White during the first quarter of 1985, and 87% were male. The higher pro- portion of Whites and males can be accounted to the admixture of methamphetamine users among the arrestees in the Dangerous Drugs category. Both treatment clients and arrestees should be regarded as a highly particular subset of cocaine users, far more representative of "abusers" than of "users". In summary, all of the indicators for cocaine except the proportion of admissions point in a clearly upward direction. The author believes that the surge in abuse of cocaine which began in 1979 is continuing unabated. Methamphetamine. The County Coroner of San Francisco reported on detection of amphetamine and methamphetamine in decedents as follows: FY 1982, 8 amphetamine and 8 methamphetamine; FY 1983, 17 amphetamine and 19 methamphetamine; and FY 1984, 23 amphetamine and 32 metham- phetamine. It should be noted that these drugs were not necessarily the cause of death or even a contributing factor; they merely happened to be found in the bodies of individuals deemed worthy of a coroner's investigation. Nonetheless, amphetamine/methamphetamine moved up, in FY 1984, to a third-ranked position, close behind cocaine and heroin/morphine, in the count of illicit drugs detected in San 11-173 Francisco decedents. The increase in just two years was striking: the two forms of "speed" were found at triple or quadruple the FY 1982 rate, during FY 1984. The Corcner's office staff felt that FY 1985 was seeing a significant further increase in amphetamine/ methamphetamine detection in the decedents. DAWN reported the following counts of emergency-room incidents for the San Francisco/Oakland SMSA: Calendar Year ~ Amphetamine ~~ Methamphetamine = "Speed" 1981 56 16 46 1982 45 33 88 1983 60 35 104 1984 84 65 231 The four-year trend is clearly upward, modestly so for amphetamine and dramatically so for methamphetamine and "speed" (which is usually also methamphetamine.) . In contrast to the four- or five-fold increase in the "drug crisis" indicators from the Coroner's office and DAWN, the treatment admis- sions for amphetamine primary problems in San Francisco have not increased. The proportion of such problems, of total admittees, was 4.6% in FY 1982, and thereafter fell to 3.3% in FY 1984, and held steady at 3.4% during the first four months of calendar 1985. A special study was made of the fifty persons who were admitted to the Haight-Ashbury Free Medical Clinic between July 15 and November 15, 1984, for treatment of methamphetamine or (rarely) amphetamine problems. Of this group, 70% were male and 30% were female; the median age was 27.5, with only 32% aged 24 or less; and only 16% were Black and 6% Hispanic, with the remainder being White. Fully 88% of the sample reported injection as their primary mode of use, an alarming statistic in an era of high incidence of AIDS. A large minority-- perhaps 45%-- of the male abusers were homosexual or bisexual, which further increases the risk of AIDS transmission. The sample group reported a surprisingly low level of income from licit sources: 68% claimed that they took home less than $400 per month, while an additional 22% reported a take-home income of between $401 and $800 per month. Claimed age of first use of "speed" was older than expected: 42% reported that they had their first experience at age 21 or older. ek Demographic data was available for the 95 persons admitted for "speed" primary problems in San Francisco during January through April, 1985. The data contained no surprises: 71% were male and 29% female; fully 53% were aged 26 to 35, with only 9% aged 20 or less; 87% were White. It was noteworthy that 14% of the "speed" admittees spoke of a secon- dary cocaine problem, and 12% described a secondary heroin problem. In conclusion, all indicators except program admissions are sharply upward for methamphetamine during late 1984 and early 1985. The author believes that the competitive price of methamphetamine vis-a- vis cocaine, and its continued popularity among young gay males, will lead to a further, moderate increase in the prevalence of methamphet- amine use during 1985. | II-174 Other Drugs. Quaalude has virtually disappeared from the local scene. Little or no use of the drug was found in surveys of youth, of gays and lesbians, or of treatment program clients. During calendar 1982, an average of 23 mentions of methaqualone per quarter were recorded by DAWN; during calendar 1984, this quarterly average fell by more than 80%, to 4. There has been much local media attention given to "designer drugs", a catchall category including MPTP, MPPP, fentanyl, and others. There is very little evidence of a significant level of abuse of these drugs in the Bay Area. The author feels that this is a case of "much smoke and little fire" at present. However, the high level of public interest suggests that an unfulfilled demand exists, which may well be met, as so often before, by low-dose LSD masquerading as the desired psychoactive drug. Codeine mentions in the DAWN reportage had fallen from 44 in 1983 to 18 in 1984. Knowledgeable treatment program staff, however, report an increased usage of the drug during 1985. These staff felt that the combined use of codeine and Doriden as "loads" was not occurring in the Bay Area, although much "loads" use seems to be happening in Southern California. Valium abuse appears to be continuing its gradual decline, at least insomuch as it is reflected in DAWN or treatment program data. It remains significant as a secondary drug for a minority of heroin users. Finally, PCP is showing an increasing trend, with the Coroner's count rising from one to five between FY 1983 and FY 1984, and the DAWN count jumping from 61 in calendar 1982 to 131 in calendar 1984. Police Department and treatment program observers concurred that PCP seems much more popular among Hispanics than among other ethnic groups. AIDS. As of early June, 1985, only eight heterosexual IV drug users had been recorded in San Francisco. This was just .7% of the 1,200 AIDS caseload for that city. It appears that San Francisco needle users have much more cautious, - unpromiscuous needle-sharing practices than is the case in New York, where some 25% of the AIDS caseload are heterosexual IV users. However, some 12 to 13% of the gay male AIDS cases (who constitute more than 98% of San Francisco's total caseload) report a history of needle use. The advent of the HTLV-III test for antibodies to the AIDS virus has posed a crucial public policy question to San Francisco: given that very few IV drug users in the city are presently carrying the AIDS virus, is it advisable to institute a case-detection procedure to locate these few sources of contagion, before they can spread the virus widely among the user population, as in New York? Representa- tives of the city's treatment programs and public health agencies are debating this problem, and will attempt to formulate recommendations during July of this year. It appears likely that concern for civil liberties, and doubts about the efficacy of case detection in such a "hidden" population, will prevail over the hope that the virus' spread can be stopped by a rigorously applied testing and quarantining program. 11-175 TABLE l--Proportion of recent initiates among HAFMC clients Proportion claiming first use of Admission cohort ° : heroin in the past 3 calendar years January-June 1978 17.9% January-June 1979 16.2% January-June 1980 21.1% January-June 1981 25.2% January-June 1982 16.5% March and June 1983 27.0% March-June 1984 17.7% January-May 1985 16.7% II-176 Drug Abuse Trends in St. Louis, June 1985 Increased Cocaine and Phencyclidine Abuse Alphonse Poklis, Ph.D. Departments of Pathology and Pharmacology St. Louis University School of Medicine Introduction The following report provides information concerning selected drug abuse data over the three year period of 1982-1984. This report presents an overview of major drug abuse problems and trends in St. Louis City and County through June 1, 1985. The data presented in this report were developed from the following sources. 1. Offices of the Medical Examiner, City of St. Louis and St. Louis County: In all tables data labeled Medical Examiners cases are from this source. 2. Forensic and Environmental Toxicology Laboratory, St. Louis University School of Medicine: The driving under the influence of drugs cases are from this source. 3. Project DAWN: In table, all data labeled emergency room cases are from this source. 4, Treatment Facilities: In tables, all data labeled treatment admissions are from the Division of Alcohol and Drug Abuse, Missouri Depratment of Health developed from the following sources: Archway Communities, Inc. COMTREA NASCO Central Clinic NASCO West DART, Inc. Substance Habit Services Magdala Foundation Salvation Army West End Challenge QQ hao TH . 11-177 5. City of St. Louis Police Laboratory: Police laboratory exhibits are from this source. 6. The Drug Enforcement Administration supplied purity data for heroin and cocaine, and wholesale price data. Opiates During the late 1970's the quality of street heroin had steadily declined; however, beginning in 1981 heroin, both brown and white became widely available. Heroin "Signature" analysis by the Drug Enforcement Administration (DEA) indicates that the white heroin in St. Louis is neither Southeast nor Southwest Asian, but a white grade of Mexican heroin. Analysis of heroin seized by the DEA from July 1984 through March 1985 demonstrated that at the wholesale level (seizures of 33 to 147 gms) purity ranges from 35-48%. Common diluents were quinine and diphenhydramine. In December 1984, two Nigerian women were arrested at Lambert Airport while attempting to smuggle 240 gms of suspected heroin "per os". Analysis demonstrated the material was 61% monoacetylmorphine. Recent additions by Trans World Airlines of direct flights from London, Paris and other European cities to St. Louis may enhance the smuggling of heroin from overseas to St. Louis. Major drug abuse indicators which reflect the increase in heroin availability are treatment admissions, medical examiners cases, and police laboratory exhibits. Admissions to drug abuse treatment facilities have increased from 1982 through 1984 (Tables 1-4). Deaths associated with heroin use have tripled from 1981 to 1984 (Table 5); while St. Louis City police laboratory exhibits have increased 600% from 1981 to 1984 (Table 8). While the price of a capsule of heroin remained $15-$20, the Price Purity Index cannot be calculated as the City Police laboratory does not quantitate heroin in "street" exhibits. T's and Blues From 1977 through 1983 the most prevalent form of intravenous narcotism in St. Louis was the use of pentazocine/tripelennamine combination (T's and Blues). In January of 1983 Winthrop-Beron removed Talwin (pentazocine) from the licit drug market and replaced it with Talwin Nx, a tablet containing pentazocine and naloxone (an opiate antagonist). The Talwin Nx tablets became available to pharmacies in St. Louis in April of 1983, and soon appeared on the illicit drug market. However, since then there has been a continuous decline in T's and Blues abuse whereby a) the new pentazocine tablets do not produce the euphoria sought by addicts; b) the price of the old pentazocine tablets has greatly increased and c) the availability of heroin has increased [1]. Admissions for T's and Blues as a primary drug of abuse to St. Louis treatment programs in 1984 declined to only 28% of 1981 admissions (Table 1). Total treatment admissions for T's and Blues began to decline in the second quarter of 1983 and have continuously decreased (Tables 2-4). Medical Examiner Cases (Table 5), emergency room episodes (Table 6) and 11-178 police laboratory exhibits, all demonstrate a dramatic decline in T's and Blues use beginning in 1983 and continuing to the present. The effectiveness of pentazocine tablet reformulation is demonstrated by a recent study of T's and Blues users at the Veterans Administration Drug treatment clinic in St. Louis [2]. In May, 1983 two hundred clients were interviewed concerning their drug abuse. Half of this group indicated abuse of T's and Blues. However, a follow-up study of this group in September 1984 indicated only 18 of 99 T's and Blues users were still abusing the drug combination. In only eight of these 18 self reporting T's and Blues users was pentazocine use confirmed by urine analysis. Those who used Talwin Nx were also abusing many other drugs. It appears that Talwin Nx is not a primary drug abuse, but only one of many drugs sought by a multiple drug using population. I1licit Methadone In 1984 the Division of Alcohol and Drug Abuse of the Missouri Department of Mental Health convinced a study group to examine Methadone effectiveness, and rules and regulations of methadone use in treatment facilities in Missouri [3]. An additional task of the study group was to determine whether diversion of methadone into illicit markets occurred and if so, recommend appropriate action. The study group concluded that methadone diversion does occur, but the problem is not significant. Methadone is not a "drug of choice" among Missouri narcotic addicts. Methadone is generally diverted only to those who are familiar with it in a therapeutic context. Only 0.2% of Project Dawn emergency room drug episodes in Missouri involve methadone. Additionally, methadone is the primary drug of abuse in only 0.4% of the clients in the Missouri Division of Alcohol and Drug Abuse programs (Table 10). Methadone was considered a factor in only 3 of 79 drug related deaths reported by the Medical Examiners facilities in the St. Louis area in 1982. Interviews with fifty "key informants" drawn from crime and toxicology laboratory personnel, law enforcement agencies, treatment facility workers and clients, disclosed that only 4% (2 of 50) believed methadone diversion was a problem within Missouri. Illicit methadone is available, but only in small quantities. Its abuse does cause a problem for a small, but intractable number of users. However, in the larger context of substance abuse in the State of Missouri, illicit methadone cannot be considered a major social or public health problem, Other Opiates In south St. Louis City and St. Louis County hydromorphone (Diluadid) abuse remains prevelant among white intravenous narcotic addicts. There is no evidence that hydromorphone use is increasing. Admissions to treatment facilities for hydromorphone abuse have remained relatively constant since 1982, (indicated by "Other Opiates" in Tables 1-4). Likewise, emergency room episodes have not significantly increased (Table 6). Increases in hydromorphone City Police Laboratory exhibits in 1983 (Table 8) probably reflect a substitution of Dilaudid for Talwin among black north St. Louis addicts. However, hydromorphone is not sold or distributed as heroin. Most users obtain the drug by purchase within a closed, close knit group of users/dealers, or by fradulent prescription or from "script doctors". The price of Dilaudid tablets remains high, $50/4 mg tablet (Table 9). Codeine or oxycodone is often substituted when hydromorphone is unavailable. 11-179 Cocaine Cocaine is readily available throughout the metropolitan St. Louis area. While the price of cocaine has dropped from $100/gram toward $80/gram the quality of cocaine has also declined. Analysis of smaller quantities of cocaine purchased in April and May, 1985 by DEA showed an average purity of only 25% as opposed 1983 purity of approximately 40-50%. At the wholesale level purity is about 62% at $2,000-$2,400/ounce. While quality may be slightly declining, use of cocaine has increased from 1982 to the present. 1984 admissions of cocaine as a primary drug of abuse to St. Louis treatment facilities are 210% greater than in 1982 (Table 1). Deaths associated with cocaine use have increased steadily in the past years (Table 5) during 1981 and 1982 no cocaine related deaths occurred; however, eight cases occurred in 1984 and from January through May 1985, eleven cocaine related cases have been investigated by the Medical Examiner. The vast majority of these deaths are due to gunshot wounds and reflect the increased violence associated with cocaine abuse and trafficking. City police laboratory exhibits of cocaine increased in 1984 to 156% of 1982 figures. A review of client urine drug screens from treatment facilities indicated that “"speedballing" is gaining in popularity among all intravenous narcotic addicts; heroin and hydromorphone users in both the city and county. Additionally, in several recent Medical Examiner's cases (April and May, 1985) cocaine and phencyclidine in combination have been detected. Phencyclidine The use of phencyclidine (PCP) became widespread in predominately black areas of north St. Louis city beginning in 1982 and since then has increased at an alarming rate. The drug is commonly available on cannabis or cigarettes for approximately $20/stick. Gallons of ether solutions of PCP are imported into St. Louis by dealers in both the Northside of the City and East St. Louis, Illinois. One can purchase wholesale PCP ether solution at $300/f1uid ounce (for dipping joints or cigarettes) by supplying their own amber colored baby food jar. Treatment admissions for PCP as a primary drug of abuse have increased from 28 in 1982 to 111 in 1984, up 400% (Table 1). Most dramatically, city police laboratory exhibits have increased from 12 in 1982 to 430 in 1984, up 3600% (Table 8)!!! Particularly alarming is the involvement of PCP in violent deaths. Prior to 1983, PCP was only occasionally seen in Medical Examiner's Cases (Table 5). However in 1984 twenty-three related PCP deaths occurred. Additionally, of 55 cases of "Driving Under the Influence of Drugs" which occurred from January 1984 through May 1985, 28 (51%) involved PCP intoxicated drivers. Many of these arrests involved vehicular accidents of a bizzare nature. The use of PCP represents an obvious threat to public health and safety. Summary 1. Heroin availability and abuse have increased during 1984. Both white and brown forms are available. II-180 The abuse of T's and Blues (pentazocine/tripelennamine) continued to decline in 1984, Talwin Nx is not a primary drug of abuse, but is occasionally used by a small population of poly-drug abuses. I11icit methadone is not a problem in Missouri. Cocaine availability has increased in 1984, Cocaine use has increased among both narcotic addicts "speedballing" and suburban users. Phencyclidine abuse has dramatically increased and its use is implicated in numerous antisocial violent acts. I1-18]1 References 1, Poklis, A. Overview of Talwin abuse and reformulations in St. Louis in Talwin Nx (pentazocine HC1, naloxone HC1): One year later, Symposium. Internatl. Drug Report 25, 11-12, 1984, True, W.R. Department of Psychiatry, St. Louis University School of Medicine and Veterans Administration Medical Center; personal. communication. Report of the Methadone Study Group to the Division of Alcohol and Drug Abuse, November 1984. Substance Abuse Monograph Series, No. 1-84, Missouri Department of Mental Health. 11-182 Table 1 Year by Quarters Admissions by Primary Drug of Abuse to St. Louis Treatment Facilities 1982 1983 1984 1985 Drug 10 2Q 30 40 1 20 3Q 4Q 10 2Q 3Q 40 1q Pentazocine/ Tripelenamine 40 84 156 146 126 128 58 69 62 54 20.41 37 Heroin 28 64 92 113 107 127 117 104 112 91 83 91 82 Other Opiates 45 77 81 83 94 79 109 77 78 66 43 56 58 Barbi turates 4 4 8 6 9 5 1 7 7-23 1 8 Amphetamines 5:27 30.17 16 21° 17 16 31 19 17 13 20 Cocaine 5 7 10 16 21 12 13. 18 271 16 16 21 28 Marijuana 44 66 59: 73 76 91 176 101 115 97 86 93 113 Phencyclidine 2 4 7.15 1 8 16 23 41 18:24 28 28 I1-183 Table 2 Year by Quarters Admissions by Secondary Drug of Abuse to St. Louis Treatment Facilities 1982 1983 1984 1985 Drug 10 20 30 40 30 20 30 "40 10 20 30: 40 10 Pentazocine/ Tripelenamine §E 7 14 28 20°30 13 15 23 26:21 14 12 Heroin 16 23 29° "40 "29 256 .18 23: 26 13 12 19 20 Other Opiates 7 16. 19° 20 30v 15 23 8 17 11 8 10 8 Barbi turates 49.10 12 9 5.311 1 6 4:2 4 3 Amphetamines 10.20 38 45 30 34-34 29 16 18:21 17 2 Cocaine 9 22 32. 46 44 23 22 40 44 31 28 29 35 Marijuana 22 43 73 62 67 107 81 95 133 101 58 76 108 Phencyclidine 0. 2 6 4 7.11 7 9 <15 11 ‘8 14 12 I1-184 Table 3 Year by Quarters Admissions by Tertiary Drug of Abuse for St. Louis Treatment Facilities 1982 1983 1984 1985 Drug 10 20 30 40.10 2G 3Q 40-10 -2Q 30-49 19 Pentazocine/ Tripelenamine 1 4 6 7 3 6 7 12 10:8. <@~12: 5B Heroin 6 13 19 12- 12- 19 7 10 7.16 "7% 2° 5 Other Opiates 2..3 8 5 9 14 4 6 21-7 "4: °F 9 Barbi turates 3%. 12° 11.13" 20 6 5.8" 75" 8 Amphetamines 9 13 13 32 42 25 12 22 20 22°14 24')¢ Cocaine 5 15 19 19 14 13 14 11 12.1311 26°30 Marijuana 18 30 61 75 87-62 48 B83 74.77 37 851 60 Phencyclidine 0 4 3 2 1 18 9 7 12-.5 6 10:19 11-185 Table 4 Total Drug Mentions for Admission to St. Louis Treatment Facilities 1983 1984 1985 Drug 10 2Q by 40 1Q 20 3Q 4Q 10 2Q 3Q 4Q 1q Pentazocine/ Tripelenamine 46 95 176 181 149 164 78 96 95 86 47 67 54 Heroin 50 100 140 165 148 171 142 134 145 120 101 112 107 Other Opiates 54 96 108 108 113 108 136 91 116 84 55 73 70 Barbi turates 11.18 28 30 29 23 22 33 18 11 12.10.20 Amphetamines 3 60 81 94 88 80 63 62 67 59 52 54 60 Cocaine 19 44 62 81 79 48 49 75 83 60 55 76 93 Marijuana 84 139 193 210 230 260 205 179 322 305 181 220 281 Phencyclidine 2-310--°16. 21 = 26 37-32 M4 68 3 38:52 59 II-186 Table 5 Deaths Associated with Illicit Drug Use St. Louis City and St. Louis County Medical Examiner's Office Drugs 1981 1982 1983 1984 1985 Pentazocine/ Tripelennamine (T's & Blues) 20 20 4 5 0 Heroin/Morphine 5 8 9 16 5 Phencyclidine 2 3 5 23 9 Cocaine 0 0 1 8 11 Table 6 Dawn Emergency Room Mentions: St. Louis Drugs 1982 1983 1984 Cocaine 25 29 43 Heroin/Morphine 29 33 21 Hydromorphone 12 16 15 Cannabis 41 60 57 Phencyclidine 23 39 42 Pentazocine 148 65 32 Speed (amphetamines) 41 46 30 11-187 Table 7 Cases: St. Louis City and County? Frequency of Drugs Detected in "Driving Under the Influence of Drugs" Drug 1983 1984 1985 2G 1H 2H 1H Amphetamine 0 0 1 0 Barbi turates 9 3 3 4 Cannabis? - - 3 3 Chlordiazepoxide 2 0 0 0 Cocaine 2 0 | 2 1 Diazepam 6 2 6 5 Ethchlorvynol 0 0 2 0 Look-A-Likes 0 0 3 0 Methadone 2 0 0 2 Methaqualone 3 1 0 0 Morphine 0 0 1 1 Phencyclidine (PCP) 3 7 10 11 Others® - - 3 Total drugs detected 27 13 31 30 Total positive cases 21 10 22 23 Total cases 32 16 30 32 2 Blood specimen analyzed for drugs in DWI arrest when blood alcohol is less than 0.1 gm/100 ml, b t Phenyton, quinine. 11-188 Excludes PCP/Cannabis (Whack) combination. Table 8 St. Louis City Police Laboratory Exhibits Drugs Ey 1981 1982 1983 1984 Amphetamines 25 40 49 33 Barbi turates 37 32 29 17 Cocaine 90 120 86 141 Codeine : 12 30 20 15 Ethchlorvynol 2 2 7 0 Heroin 53 137 161 317 Hydromorphone 24 25 52 55 LSD 16 + 14 20 Marijuana 2,347 2,464 1,956 2,420 Meperidine x ng 2 4 3 Methadone 3 3 2 8 Methaqualone 15 6 2 Morphine 4 2 2 0 Pentazocine 618 659 342 308 Phencyclidine (PCP) 12 59 164 430 Phenmetrazine 55 45 48 16 II-189 Table 9 Drug Prices Identified by Users, May 1985 (T's and Blues) Talwin Talwin Nx Phenmetrazine Phencylidine (PCP) $20.00-$ 26.00 $ 6.00-$ 10.00 $ 8.00-$ 15.00 $20.00 Drug Cost Dosage Forms Amphetamines $ 2.00-§ 4.00 Capsules, Tablets Methamphetamine $75.00-$110.00 Gram Powder Barbiturates $ 2.00-$ 4.00 Capsule ~ Cocaine $60.00-$110.00 Gram Codeine $10.00-$ 15.00 Tablet (Empirin #4) Heroin $20.00 Capsule (white) $15.00 (brown) Hydromorphone $25.00 2 mg Diluadid Tablet $50.00-$% 55.00 4 mg Dilaudid Tablet LSD $ 4.00 Microdot/hit Marijuana $ 1.00-$ 2.00 Joint $70.00-$ 80.00 Domestic ounce $175.00-$200.00 Sinsemilla ounce Methaqualone $10.00 Lemon 714 Tablet Pentazocine/ Tripelennamine 50 mg Tablet each One tablet each Preludin Tablet Joint or "dip" (wack) 11-190 Table 10 Frequency on Non-Prescription Methadone as a Substance of Abuse at Admission, by Problem Severity Fiscal Years 1980-1983 Fiscal Problem Severity Total Total Non-Rx as Year Primary Secondary Tertiary Non-Rx Meth. Admissions % of Total 1980 20 28 17 62 3496 1.8 1981 26 24 4 54 3980 1.4 1982 22 27 12 61 8116* 0.8 1983 10 20 6 36 19678%* 0.2 Total 78 96 39 213 35270 0.6 *Reflects partial implementation of the automated system. **Relfects full implementation of the system. Source: Missouri Division of Alcohol and Drug Abuse Management Information System (ADAMIS) [3]. 11-19 RECENT TRENDS IN THE USE OF OPIATES AND COCAINE IN THE SEATTLE METROPOLITAN AREA Armold F. Wrede, M.Ed., Planning and Evaluation Section, Division of Alcoholism and Substance Abuse Services, King County Department of Public Health Trends in the Use of Opiate Drugs Recent reports to the Comunity Epidemiology Work Group have indicated that the Pacific Northwest was undergoing a transitional phase in the use of the opiate drugs. Over this period indicators monitored by the King County Divi- sion of Alcoholism and Substance Abuse Services provided mixed messages as to the level of opiate usage in the area. Data from these sources for the 1984 period, however, clearly demonstrate a significant increase in the availa- bility and abuse of opiates is underway in the Seattle SMSA. Drug-associated emergency room admissions are reported to the federal govern- ment's Drug Abuse Warning Network (DAWN) from twenty-four Seattle SMSA hospi- tals. The frequency of opiate drug related emergency room (ER) mentions are displayed for quarterly periods in Figures 1 and 2 for the period from 1976 to the fourth quarter of 1984. The Seattle metropolitan area experienced an epidemic of heroin abuse from 1972 through 1976. This epidemic reached a peak, as reflected in emergency room mentions, during the second quarter of 1976 and then declined rapidly over the following four calendar quarters. For a period of three years the ER data exhibited a statistically significant decline with heroin ER mentions averaging 14.75 per quarter from 1977 through the end of 1980. The fourth quar- ter of 1980 began a rise in the number of heroin ER mentions which have now reached an average frequency of 45.75 for the 1984 period and have averaged 29.75 from 1981 through 1984. Regression analysis of the frequency of heroin- related ER admissions from the second quarter of 1977 through the fourth quar- ter of 1984 finds a statistically significant increasing trend as shown in Figure 1. The use of methadone had resulted in an average of 3.75 hospital ER visits over the period from 1977 through the end of 1980. This average has increased to 8.5 over the 1984 calendar year and 7.75 over the four years since 1980. This increase has paralleled the increase in heroin mentions but remains at very low levels and, unlike the heroin situation, methadone data for recent quarters appear to indicate a slight decline in frequency of visits as displayed in Figure 1. Previous reports from the Seattle area have included propoxyphene in the cate- gory of other opiate drugs. Beginning with this report, propoxyphene has been removed from the other opiate category. The compounds presently included in this category are: codeine, hydromorphone, meperidine and oxycodone. This 11-192 change has modified the picture with regard to trends in the other opiate category, in that data for the period from 1976 through 1984 for this group- ing show no significant trend upon regression analysis. During the 1977 to 1980 p-riod ER visits related to other opiate drugs averaged 33.5 per quarter. From 1981 through 1984, the average number of visits was 31.8. As can be seen from these figures, the number of ER visits related to this grouping of drugs has remained relatively stable over the period from 1977 through 1984. Actual quarterly DAWN ER mentions are displayed in Figure 2. Drug intelligence information from local police narcotics units and the Drug Enforcement Administration confirms the impression drawn from the DAWN reports. Informants indicate that heroin of higher quality is continuing to increase in availability. The primary form of heroin in the Seattle area presently is the Mexican "Black Tar' variety. This relatively new form of the drug has apparently taken over the market in the King County area. While the brown Mexican powdered heroin still appears on occasion and quantities of both south- west and southeast Asian heroin have been seized, these forms are thought to be rare in the street market and Asian varieties are believed to have been seized in transit to other parts of the country. The DEA believes that the Black Tar is transported from Mexican labs through southern California and into the Pacific Northwest. This routing gets some confirmation from the fact that similiar Black Tar samples and an increased availability have also been seen in the Portland, Oregon area. Illegal aliens and Hispanic migrant workers are thought to play an important role in the distribution network for this heroin. This belief is supported by rough data indicating a significant in- crease in heroin abuse in the eastern part of Washington state. This is a heavily agricultural area which provides employment for large numbers of mi- grant farm workers on a seasonal basis. DEA sampling indicates slightly higher levels of purity in samples acquired in the Yakima and Pasco, Washington areas than in the Seattle area. Both of these eastern Washington cities have large Hispanic populations. DEA sources also indicate that traditional dealers in the Black community are not handling the quantities of heroin that they have in the past years. These factors point to the modification of the heroin dis- tribution system in the northwestern region of the country, placing a more primary role on the Hispanic dealers. It is interesting to note that Seattle appears to be the "end-stop'" in this network, since only one sample of Black Tar heroin has appeared in the Vancouver, British Columbia area over the past year. The DEA conducted a study of heroin purity in the Seattle area during 1984. In this study thirty-five (35) gram level samples of heroin were collected and analyzed. All samples of heroin were of the Black Tar variety and the purity ranged from 45-60%. This is an exceptional increase in purity over past ex- perience in the Seattle area and may be partially responsible for the increased number of ER visits and the increase in heroin related overdose deaths to be discussed later in this report. During the most recent heroin epidemic in the Seattle area in 1972-76 purity levels remained under 5% and gram level samples between that time and 1983 ranged between 3% and 5%. In 1983 some increase in purity was noted to a level between 10% and 20%. Present purity levels suggest that potential for significant changes in usage patterns in the Seattle area and problems with pharmacy theft and diversion should these levels drop. Price information from police agencies and street sources indicates that Black Tar heroin is available for between $325 and $400 per gram. Ounce quantities 17-193 are selling for between $6,000 and $8,000. The majority of trafficking in the Seattle area is at the gram level with larger quantities rarely seen. The prices outlined have dropped from those of one year ago which placed gram prices at $400 - $600 and ounces at $7,000 - $10,000. Mexican brown heroin is still available in the area and prices for this form have not changed over the past year with gram quantities selling for $80 - $160. The decreasing price and increasing purity of the Black Tar heroin are classic signs of an epidemic in heroin abuse. The Seattle Police Narcotics Section also reports an increasing availability of Black Tar heroin in the area. Data on seizures of heroin by this agency indicate a decline over the amount seized in 1983. During 1983, 183 grams of heroin were seized by the Seattle Police unit. In 1984, that total fell to 123 grams. Both quantities in 1983 and 1984 are significantly below the 1982 level of 687 grams. These results are displayed in Figure 3. The total weight of seized heroin reported in 1984 has already been exceeded in 1985 with 138 grams confiscated by this unit in the first five months of the year. This fluctuation in the rate of confiscation appears more related to institutional factors within the police agency than to actual drug avail- ability or distribution patterns. The majority of seizures were of gram or smaller quantities, however, two large seizures were reported. One seizure of 17 grams of 90% pure heroin took place in May of 1985 and a second seizure of 93 grams occurred in November. In addition to these quantities, other local police units have been active in confiscating varying amounts of the drug. The most notable of these was the seizure of 23 lbs. of nearly pure southeast Asian heroin at the Seattle International Airport by U.S. Customs agents. This shipment was being transported by a Thai doctor and was believed bound for Detroit, Michigan. Raw opium continues to be a problem of note within Seattle's Asian refugee population, although the quantities confiscated thus far in 1985 do not approach the 7,486 grams seized in 1984. The 1984 seizures all occurred prior to June of that year and involved five separate incidents. To this point in 1985 only one seizure of 420 grams has taken place. The traffic in opium appears to remain confined to the refugee population and intended for consumption within these cultural groups, however, some fear remains regarding the possible expansion of these distribution networks to include southeast Asian heroin and the marketing of both drugs on a wider basis. The review of drug overdose death reports from the King County Medical Examiner strengthens the impression that Seattle is undergoing a significant increase in opiate abuse. While limited staff resources preclude a detailed analysis of - overdose deaths at this time, the available information shows a rise in overdose deaths generally and a significant increase in opiate related accidental deaths. Table I outlines the drugs that were associated with accidental over- dose deaths in 1984. Twenty-eight (70 percent) of the forty reported acci- dental overdose deaths in 1984 were related to the use of opiate drugs. This is a marked increase in the rate of opiate related accidental deaths noted in 1983 and 1982 which have been previously reported at fifteen out of twenty- seven and sixteen out of thirty-two respectively. As noted in our most recent report, this number of opiate related deaths in the Seattle area is uncommon. The number of such deaths in 1984 exceeds even the twenty-two heroin related deaths reported in 1976, the zenith of the most recent heroin epidemic in Seattle. The elevated rate has continued during the first four months of 1985 with fourteen opiate related deaths during this period. 11-194 Although detailed profiles of these cases have not been completed, the following information has been extracted. Eleven of the twenty-eight opiate related deaths were attributed to unspecified narcotics or heroin. It is assumed that these elever deaths involve heroin. Three additional deaths are attributed to un- specified narcotics in combination with alcohol. Nine of these fourteen deaths involved white males ranging in age from twenty-one to forty-nine years of age. One of the unspecified narcotics deaths involved a white male seventy years of age. One of the unspecified narcotics deaths involved a Hispanic male forty- one years of age. Two of these deaths were two black females ages thirty-four and forty. The younger of these had also been drinking. The final death in this grouping also involved alcohol and was that of a black male aged thirty- seven. All but one of these deaths resulted fram the injection of narcotics. One white male aged twenty-one died from an inhaled overdose. A fifteenth death involving the injection of unspecified narcotics and cocaine was re- corded in 1984, This case involved a thirty-four year old white male. In addition to these fifteen deaths two white males aged twenty-one and thirty- two died from inhaled overdoses of morphine. Methadone was responsible for the accidental overdose death of four white males ranging in age from twenty to forty-three years. These deaths resulted from oral ingestion of the drug. A fifth methadone related death occurred to a thirty year old white female who had ingested methadone, diazepam and alcohol. Injected methadone in combination with cocaine was responsible for a sixth death involving a thirty-six year old white male. The source of the methadone involved in these deaths has not been investigated at this time. Three of the five remaining opiate related deaths involved meperidine; two of these in combination with other drugs. All three decedents were white males between the ages of twenty-six and twenty-eight. The last two opiate associ- ated overdose deaths involved codeine in combination with diazepam. Both deaths occurred to white males in their late twenties who had taken the drugs orally. Admissions to King County drug treatment programs for opiate abuse problems in 1984 declined slightly in absolute numbers but increased dramatically in relative terms. Over the course of 1984, a total of 354 persons were admitted to local treatment programs. This number represents 50 percent of all dug treatment admissions for the year. This compares to 442 (34%) opiate abusers admitted in 1982 and 363 (29%) admitted in 1983. Overall treatment caseload data indicate that 1589 cases of opiate abuse were treated in the system during 1984. This number represents 41 percent of the 3872 cases served during the year. These data are perhaps more reflective of local turmoil in the treatment delivery system during the 1984 period than the actual level of opiate abuse in the area. During 1984 a large private proprietary methadone treatment program opened in south King County and this program does not pre- sently report into the data system from which the treatment statistics are taken. This review of indicators associated with opiate use in King County clearly documents a rising level of abuse throughout the area. The prediction made in a previous report would also appear to be validated, in that the indicators suggest a rising level of abuse of the full range of opiate drugs appears to be occurring, rather than a more focused increase in only heroin related cases. 11-195 Trends in Cocaine Usage The increasing use of opiates in the Seattle area described previously follows a period of steadily increasing cocaine usage which continues un- abated. The DAWN hospital ER data, shown in Figure 4 document a consistent increase in the frequency of cocaine related admissions since 1978. Re- gression analysis on these data indicate a statistically significant in- creasing trend. The number of ER admissions by quarter averaged nearly 60 cases in 1984 compared to 39 cases in 1983, Prior to 1981, accidental overdose deaths due to cocaine use were rarely recorded by the King County Medical Examiner. During the twelve-year period from 1968-1980 only eight deaths were attributed to cocaine. This pattern was suddenly reversed in 1981 when six cocaine-related deaths occurred; four attributed to the intravenous use of cocaine and two involved cocaine in cambination with tablet methadone. In 1982, cocaine was the cause of seven deaths, three of which involved cocaine use in combination with a second drug (methadone, diazepam or amoxapine). Six deaths in 1983 were attributed to the use of cocaine; two of these in combination with other drugs (heroin/morphine and diazepam + methadone). Two of the remaining deaths in 1983 were associated with trace levels of morphine indicating that these individuals were in the habit of using opiates in conjunction with cocaine. Four cocaine-related deaths were recorded in the first five months of 1984 and no further cases were reported. Two of the four deaths were associated (as mentioned previously in this report) with opiate drugs; one with an un- specified narcotic and the second with methadone. Both of these deaths were to white males ages 34 and 36. The two remaining cocaine decedents were both white; one a twenty-one year old female and the second a thirty-six year old male, All four deaths resulted from intravenous use of the involved drugs. During the first four months of 1985 three additional cocaine associated deaths have been recorded. Two of these were to white males ages thirty-two and forty-one who had injected the drug. The third involved a white female age twenty-eight who had taken the drug in combination with an opiate and diazepam, Police intelligence reports continue to describe cocaine as the county's most important drug problem. The drug is readily available throughout the metro- politan area and its use cuts across all social strata. Seizures of cocaine by the Seattle Police Narcotics Unit in 1984 totalled 2962 grams. This total is a decline from the 4275 grams seized in 1983, however, only one seizure in 1984 netted over 500 grams as compared to four such incidents in 1983. These data are displayed in Figure 5. The price of cocaine has remained stable in the area over the past three years with gram units selling for between $100 and $150, ounce quantities between $2,000 and $2,600, and pounds between $25,000 and $30,000. Cocaine purity has varied slightly over time and depending on the quantities purchased. Present purity figures indicate that gram lots are running 30 - 40 percent pure, ounce quantities 50 - 60 percent and pounds at 90+ percent. Over the past year smaller quantity units of 4 or } gram have appeared in the street market priced at $50 and $20 respectively and with a purity level of approximately 30 percent, Reported new admissions for the treatment of cocaine abuse in King County facilities dropped significantly in 1984 to only 55 compared to 136 in 1983 11-196 and 199 in 1982, Overall caseload figures, however, raise doubts about the accuracy of these admission numbers. The caseload for cocaine abuse in 1984 was 384 cases comprising nearly 10 percent of the overall drug treatment populacion (third in size behind opiates and marijuana). In addition to the recording problems alluded to, there are same indications that a portion of the cocaine abusers in the Seattle area may be seeking treatment from private proprietary treatment programs which do not report into the data collection system fram which the treatment numbers are taken. This latest review of the indicators associated with cocaine use in King County shows no sign of abatement in the epidemic patterns previously reported. Unless this drug becomes substantially less available the community can only expect increasing numbers of cocaine-related deaths, emergency room contacts and treatment admissions. 11-197 86T-II Heroin/Morphine Methadone 1/76-4/84 Quarterly Emergency Room Mentions - WN Srawawa¥. Regression Trend Line Seen Reported Frequency A a 66 I— 377 Sl II-199 27(- 24|— 21}- 18|— 15}- 12{—- 9|— 6(— 3] ; l 123471 2 34°12 3 4°1.2 341 2.341 2 3412 3412341234 didi & 1982 1983 1984 1981 1979 1980 FIGURE 2 Other Opiates 1977 1978 1976 1/76-4/84 FREQUENCY 3000 2800 2600 2400 2200 2000 1800 1600 1400 1200 1000 800 600 400 200 Nong 1 | 1 | ] Lia 1973 1974 1975 1976 155 1978 1979 1580 Your wo wa 1984 Calendar Yer NOTE: One 3-pound seizure from 1976 was omitted from this analysis. FIGURE 3 Heroin Seizures by Seattle Police Department 1973-1984 II-200 Drug(s) Responsible Frequency Narcotics, NOS* Narcotics + Alcohol Morphine Methadone Cocaine pt = Cocaine + Narcotic Meperidine + Narcotic Merperidine + Other Methadone + Other Codeine + Diazepam Diazepam + Other Antidepressants Other WD Ble on wo on ow nie Total *Not Otherwise Specified TABLE I Accidental Drug Overdose Deaths King County - 1984 II-201 8/v-9L/T eured ¥ MOLI 861 £861 2861 1861 0861 6L61 8.61 L161 9.61 ee 1 v5 2 1re8 lee I1iresiliye £ gz. 7 pe 2 UT TI aT rr er NP Er per ep UTC er I TE RAL A JERS Hh WERE EL LE ES [IE 1 i Fo Re pe LEHBIILRIITRAR 11-202 nn = >» 9 OQ 4800 4400 4200 4000 3400 3200 2600 2400 2200 1800 1400 | SE FE 3d gE) Calendar Year FIGURE 5 Cocaine Seizures by Seattle Police Department II-203 DRUG ABUSE INDICATORS TREND REPORT DISTRICT OF COLUMBIA JUNE 1985 GEORGE C. MCFARLAND, M.S.W. D.C. Department of Human Services Alcohol and Drug Abuse Services Administration This Drug Abuse Indicators Trend Report is prepared as a brief objective assessment of the drug abuse problem in the District of Columbia. The report presents data from a variety of sources that have traditionally been associated with monitoring drug abuse trends. The specific indicators discussed in this report are: . Narcotic-related Overdose Deaths . Bmergency Room Data (DAWN) . Drug Purity Data . Patient Treatment Data . City-Wide Drug-Related Arrests Data + Drug Seizures and Buys . Drug Urinalysis Results Rationale For Selection Of Indicators . Drug-related overdose deaths. It is assumed that the number of drug overdose deaths will increase along with increases in (1) the number of persons who intravenously self administer drugs of varying quantity and quality and (2) availability, purity and decreased price. . Drug-related emergency room mentions. The number of hospital emergency roam mentions is thought to increase as the number of users increase. . Drug purity and price. Changes in purity and potency are considered an indicator of availability. It is assumed that decreases in price and increases in purity are functions of availability. . Admissions to drug treatment facilities. Changes in the number of persons admitted to treatment is a function of changes in the numbers of users of drugs. As the availability of illegal drugs increases, the numbers of users entering treatment should increase. . City-wide drug arrests. Changes in the numbers of arrests for illegal drugs, possession or sale, are a function of changes in availability and drug related crimes. II-204 . Drug seizures and buys. The results of illegal drug seizures and buys by the District of Columbia Police Department serve as an indicator of drug availability by type and to some extent reflect increases or decreases in price and availability. . Drug urinalysis results. Drug urinalysis results mirror broader trends in drug prevalence and preferences. In this connection, the District of Columbia is unique in that all persons arrested and detained in the city's central holding facility are required to submit to urine tests. Narcotic Overdose Deaths Over the past nine years between 1976 and 1984 the District of Columbia has witnessed a dramatic increase in the number of narcotic related overdose deaths. During this period, the number of annual deaths have ranged from a low of seven deaths in 1978 to an all time record high of 140 deaths in 1984. Figure 1, graphically displays the actual number of deaths by years. Between 1983 and 1984 the total number of deaths increased by 103 percent. The most recent data ending April 30, 1985, have already recorded 58 deaths. Should this current rate of deaths continue through the remainder of 1985, we expect the number of deaths to reach 170. During 1984, the city recorded an average of 11.6 deaths per month. However, during the first four months in 1985, for which data are available, the average number of monthly deaths has increased to 14.5. During 1984, the fewest number of deaths, 4, was recorded in April, and the largest number of deaths 21 was recorded in August. See Figure 2 in the appendix. The average age for all overdose victims in 1984 was 35.5 years. The overwhelming percentage of overdose victims, 72 percent, was black males, followed by black females, 21 percent, and white or other males 7 percent. More than half, 57 percent, of all overdose victims tested positive for alcohol content at the time of death. Blood alcohol content levels ranged from a low of .03 to a high of .39. During 1984 the mortality rate due to narcotic overdose deaths was approximately 22.65 per 100,000 District of Columbia residents. For the first time, the city recorded three overdose deaths that were directly attributed to overdoses of cocaine. This points to the increasing problem of cocaine abuse that will be discussed further in this paper, See Figure 3 in the appendix. Emergency Room Data The Drug Abuse Warning Network (DAWN) is a joint project with the National Institute on Drug Abuse (NIDA) and the Drug Enforcement Administration (DEA) which gathers drug related data from hospital emergency rooms to alert federal and local agencies as to the type of drugs being abused. The specific drugs monitored by the city's Alcohol and Drug Abuse Services Administration (ADASA) are; Heroin, Alcohol combined with other drugs, Phencyclidine (PCP), Cocaine, Valium, Marijuana, Dilaudid and Methadone. Figure 4 in the appendix lists the specific number of mentions recorded by the city between 1981 and 1984 by drug type. Between 1983 and 1984, the number of heroin related emergency room mentions increased by forty-one percent. (See Figure 5 in the appendix.) In 1981, the city recorded 825 heroin mentions. In the two proceeding years 1982 and 1983, the number of heroin mentions decreased to 667 and 646, respectively. However, 1984 recorded a total of 1160 mentions, an increase of 80 percent. This increase in heroin related mentions closely correlates with the city's increased overdose deaths. Reported drug mentions of alcohol in cambination with other drugs have remained fairly consistent, and showed only slight 11-205 fluctuations between 616 and 661 in the last two years. Between 1983 and 1984, the number of these mentions decreased by 5 percent. (See Figure 6 in the appendix.) Over the past four years between 1981 and 1984, the number of reported PCP mentions has increased consistently and dramatically fram a low of 179 in 1981 to 965 mentions in 1984. When compared with other drugs of abuse, PCP has showed the single greatest increase over the past four years. Between 1983 and 1984 alone, the number of mentions has increased by 89 percent. (See Figure 7.) For each of the last eight quarters, cocai mentions have registered significant increases. Between 1983 and 1984 the number of Cocaine mentions increased fram 276 to 484, this represents a 75 percent increase in the number of mentions. The magnitude of this increase is displayed in Figure 8. Between 1981 and 1984, the number of Marijuana mentions has shown consistent but small increases. Between 1983 and 1984 these increases were limited to 2 percent, The number of mentions for Dilaudid has continued to show small increases between 1981 and 1983. But, the number of reported mentions between 1983 an 1984 recorded a slight decline fram 110 in 1983 to 103 in 1984. Also, the number of Methadone drug mentions showed same decline between 1983 and 1984. Between 1983 and 1984 the percentage of methadone mentions fell by 45 percent. Overall, the District of Columbia recorded a 39 percent increase in drug mentions between 1983 and 1984 for the 8 specific drugs monitored. With minor exceptions, between 1979 and 1984, the purity of street level heroin has increased and the prices have tended to decline. The purity of heroin in the District of Columbia has increased fram a low of 4 percent to an average of 6 percent. (See Figure 9.) Drug Patient Treatment Data Available data on drug patients show that the number of total admissions to city operated drug treatment centers has increased by 10 percent between 1983 and 1984, The greatest proportion of that increase 63 percent, can be attributed to new admissions In fact, the number of monthly average admissions between 1978 and 1984 has more than doubled. Figures 10 and 11 offer a more detailed view of the specific characteristics of patients in drug treatment. Overall, the demographic profile of patients in treatment has remained fairly stable. However, the greatest increases have been in the admission of both younger and older clients. City-Wide Drug Related Arrests Between 1978 and 1984 the number of arrests for drug sales and possessions has continued to show consistent annual increases. Figure 12 illustrates the amount of the actual increase from year to year. However, it is significant to note that the single greatest increase in th number of arrests occured between 1983 and 1984. Between 1983 and 1984 the total number of arrests increased fram 8,061 to 8,456. This represents a 5 percent increase in overall drug arrests. This rate of increase was consistent for both adults and juveniles. Drug Seizures and Buys Daily, the D. C. Narcotics and Morals Division of the Metropolitan Police Department record city-wide drug seizures and buys. During 1984, the Department recorded 13,131 seizures and buys. During 1984 drug buys most frequently in order were: PCP 30.88 percent, Cocaine 16.19 percent, Preludin 10.03 percent, and unknown drugs .18 percent. (See Figure 13.) Data on drug seizures in order of percent were cannabis 11-206 40.64 percent, PCP 25.18 percent, Heroin 15.67 percent , Cocaine 11.83 percent, unknown drugs 4.07 percent and Preludin 2.6 percent. See Figure 14. Drug Urinalysis Results All defendants arrested in the District of Columbia who are charged with major offenses, are tested for drug use shortly after arrest. Tests are conducted for five substances that includes Opiates, Cocaine, Amphetamine, Methadone, and PCP. Test samples are analyzed by the Pretrial Services Staff using the EMIT system of urinalysis. During a 13 month period an analysis of samples taken from 9,514 defendants who tested positive for drugs was as follows: PCP 41 percent Opiates 25.8 percent Cocaine 26 percent : Methadone 4.3 percent and Amphetamines 3.2 percent overall 53.9 percent of all persons arrested tested positive for one or more illegal drugs. (See Figure 15.) Sameary . The prevalence of Heroin, PCP and Cocaine use has gone up significantly this year. This is reflected in the data on emergency room mentions, overdose deaths, arrests, and urinalysis results. . The number of Heroin and Cocaine related overdose deaths has reached an all time record level of 140 deaths. . The number of overdose deaths recorded in the first four months of 1985 indicates that 1985 will probably record an estimated 170 deaths. . Slightly more than one half, 53.9 percent, of District residents arrested for major offenses tested positive for illicit drugs between March of 1984 and 1985. . Based on data of police seizures and buys, it appears that drugs that are most prevalent are PCP,-41 percent, Cocaine,-26 percent and Opiates ,-25.8 percent. . Drug related arrests have followed an increasing trend. Between 1978 and 1984, the number of total drug arrests has increased 37 percent. . The price and purity level of heroin, which have been the major factors contributing to drug abuse in the District, has became more lucrative. The average purity level of Heroin has continued to increase as the price has decreased. . Between 1983 and 1984, the number of patients entering treatment has increased by 9 percent. Approximately 52 percent were new admissions. I1-207 NIT — DD Mm NARCOTIC RELATED OVERDOSE DEATHS i” DISTRICT OF COLUMEIA 1976-65 FIGURE 1 ha BO Liisi ei eb a Elian ve riers shies Send Pekiondoi sn iB lh 0 42 18 A 1976 1277 1978 1979 1980 1981 1982 1983 1984 YEAR TOTAL DEATHS OVERDOSE DEATHS EAR PLOT 1 II1-2C8 1985 FD ow O- 30 TE Ta NARCOTIC OVERDOSE DEATHS reine e0 mes sme mes ses mas mes we. sees se i me. Wate mas wr DISTRICT OF COLUMEIA 1934 FIGURE 2 E f L. 8 L. x 10 I> ft - 5 0 1 3 1 1 L i 1 \ L i i i JAN FER MAR APR MAY JUN JUL AUG SEP OCT NOV DEC MONTHS DEATHS BY MONTHS OVERDOSE DEATHS me mm em 11-209 FIGURE 3 NARCOTIC RELATED OVERDOSE DEATHS 1978 1979 1980 1981 1982 1983 1984 1985* HEROIN 7 35 56 103 95 58 135 58 HEROIN/PCP 8 10 HEROIN/METHADONE 3 2 HEROIN/DILAUDID 1 HEROIN/PRELUDIN 2 2 2 1 HEROIN/COCAINE 1 2 COCAINE 1 3 DILAUDID 6 3 1 TOTALS 7 42 62 115 100 69 140 58 *THROUGH APRIL 30, 1985 I1-210 FIGURE 4 DAWN DRUG MENTIONS % Change 1981 1982 1983 1984 83 - 84 HEROIN 825 667 646 1160 + 80 ALCOHOL IN COMBINATION 645 661 646 616 - 5 PCP 179 280 510 965 + 89 VALIUM 358 343 287 259 - 10 OCOCAINE 145 188 276 484 + 75 MARIJUANA 139 154 187 191 + 2 DILAUDID 89 95 110 103 - 6 (Hydromorphone) METHADONE 50 50 75 41 - 45 TOTALS 2430 2438 2737 3819 *THROUGH DECEMBER 31, 1984 I1-211 Z2 = 0 xm I NZ OHH - 2 mI DISTRICT OF COLUMRIA HEROIN MENTIONS FIGURE 5 1981-1985 2000 ov eeenens TTT eeesesisesieanes *asnsnsessasistaeratebntbtnceintistatas fisinenentntr nary takiss seeee — TT on NRT IPI PR TE EE SM CO So NI DST He 667 646 1160 Sesser sec esses estes sees tessa ann sean ae 1981 1982 HEROIN MENTIONS HEROIN MENTIONS 1983 YEARS RAR PLOT 1 11-212 15784 FD -1.0 Z2 0 = 4 2 MX on ALLURUL LIX LUNDLNAOLAUN DER a¥D DISTRICT OF COLUMBIA 1981-1984 FIGURE 6 TOO freoeeeneerennnennnnnn, TL Te TLE 661 SUG or ol é Ges eseesssesessatss sera asannes att na sn 6lé 600 1981 1982 1983 YEARS ALCOHOL IN COMBINATION RAR PLOT 1 11-213 1984 mow i 2 CT tr - 2 PCP _DRUG MENTIONS 1000 900 800 70 (1 frre tevin i i tt ieee teats resets atari eaes 4 600 PY ET IrITds79¢7717} BOQ Fee TTT ~+T FIT} 400 es EL TTT TTT mh 1 TT 300 ST 3TH} it tal gE DISTRICT OF COLUMBIA 1981-1984 FIGURE 7 eee eer e ee eres ates estate Nese ease eat e stearate eset esta Tet eee eea00s tes atten en tae canna Sesser ecsnccstrarnaean 100 1981 1982 PCP DRUG MENTION PCP MENTIONS 1983 YEARS BEAR PLOT 1 I1-214 1784 Ir. 3 tf NW ZO = —- 2M COCAINE DRUG MENTIONS DISTRICT-OF COLUMBIA 1981-1984 400 gr pg ge ¥ WE ap ORR RN 300 200 ee NR TE Me TG TARE A ar 145 BE eecccscscesssssesssssessnas cesses sesesencese sss eens essa ess eases esse sseestsessossesasvsnarsennnsressdeceseanven ces essesesese sess ts es eaceses sss ases esta tet ssesesssescesesenvsesensef isos secedeccsorenvanansesttrisrofesetcacsee FIGURE 8 cesses sesssessesncsnae ssseesesesssenacassns 100 1981 COCAINE MENTIONS 1982 . 1983 1984 YEARS BAR PLOT 1 11-215 ~«< — = VD CC TT ii © @ -HEROTN PURITY 1979-1985 FIGURE 9 é pg a A, Fy, SF B® § 88 86 80800608 08080000008 0000000 0000004050030 8000000000000080080000000000000e00.0000000000stetsosesssstsosassansnsnafpoorsscfossancosnans FE = oo ETE aR = RETF AE AR a EE 8 r Ce Ed se aS 3 1979 1980 1981 1982 1963 1984 YEARS HEROIN PURITY HEROIN PURITY EAR PLOT 1 mind 11-216 FIGURE 10 ADASA DRUG PATIENT PROFILE SEX: MALE 69% 72% 68% 65% 69% 68% FEMALE 31% 28% 32% 35% 31% 32% RACE: BLACK 88% 90% 86% 87% 90% 91% WHITE 11% 0% 11% 8% 8% 9% OTHER 1% 1% 33 5% 2% >1% AGE: 16-20 3% 6% 6% 10% 5% 14% 21-25 18% 22% 26% 22% 18% 20% 26-30 46% 36% 37% 35% 39% 23% 31 & OVER 33% 36% 31% 33% 38% 43% MEAN AGE 29 29.5 29 28 30 31% STATUS : VOLUNTEER 67% 65% 72% 60% 52% 55% CRIMINAL JUSTICE 33% 35% 28% 40% 48% 45% MODALITY : MAINTENANCE 61% 62% 77% 76% 75% 73% DETOXIFICATION 7% 17% 7% 5% 6% 7% DRUG FREE 32% 21% 16% 19% 19% 20% ADMISSION: RE-ADM. 69% 66% 65% 61% 64% 48% NEW-ADM. 31% 34% 35% 39% 36% 52% AVERAGE METHADONE DOSAGE (mgm. ) 25.7 28.2 29.7 29.6 27.9 28.8 11-217 FIGURE 11 DRUG PATIENT TREATMENT DATA RE-ADMISSION 1557 1952 1905 11522 1951 1749 1434 NEW-ADMISSION 682 897 1009 822 1273 985 1560 TOTAL ADMISSION 2239 2849 2914 2344 3224 2734 2994 MONTHLY AVERAGE 57 75 84 69 106 82 130 (new-admission) I1-218 oy isd - iM nD 0 DISTRICT OF COLUMETA sate some Sree S0ce Sate Sete Sete Sees Suse Sess Sess 0090 Sete Sees Sous Sess Sess sess Sess Sess DRUG ARRESTS 1978-1980 FIGURE 12 SIGE Feist tin nniiiitis a disrenvs sisunssbattashiins soguiensle sostwnrvn Fos o bests 4s soni 4 46 SURE Rms 4 ty 43 300 an le REE 3 en 8000 TT TTT TT? "3 or or =< =] € Sees asses essesa teeta eates erases e sass ens roses s ant sasenasrsansranarnasssarvsaracasaresensarenerrsaferiaideciiriireccnndicannfiieniaiaann 7000 Nereis 1 td nA T— A 6000 a 1 oe en FEF EF _ S000 TE 8 eae § T 1 oy = te Joie TE = foul & ~5 FR wooo ET TE 3109 1 ] 3000 1978 1979 1980 1981 1782 1983 1984 YEARS URUG ARRESTS DRUG ARRESTS BAR PLOT i 11-219 I. CE POLICE NEPARTMENT DRUG EUYS RY TYPE 1984 FIGURE 13 *Cx= 19 43% ~ N w= XO, 88% * 1984 DRUG RUYS ¥Ax= HERION *F %=UNKNOWN *#R¥= PRELUDIN ®Cx= CANNARIS ®D%= PCP *Ex= COCAINE II-220 I, C POLICE DEPARTMENT Soe aan 000s eens sats sees GSE Gees Gees 060 SOE Be FONT SONS G00 $4 Cees Bese SEG S40F SIM Sums NRUG SETZURES RY TYPE 1984 FIGURE 14 Ln ma or / / ¥ 2.6 % N *C x= Wo. 64% / N / rA¥= 15, 6% TN Mot Lr t f= U4, 07(% ~ fa oo So ~~ a \ or Co Sn \ ¥Ex= 11,837 io x= 11.83) - % / \ z “. ®x[iE= 2%, 18% Fi > ns tl 1984 DRUG SEIZURES ¥Ax= HERION *F %=UNKNOWN ¥E¥= PRELUDIN *C¥= CANNARIS ®[%= PCP 11-221 ¥Ex= COCAINE 3 mM << HH = = 0 CC © “nm PRETRIAL SERVICES (84-85) URINALYSIS RESULTS FIGURE 15 B00 Jor rereinorn ii snnenns Giorsrnivs nase sin susie vatn ks suse as Nr st Yreh eT rs ens he rte s CHAE rp wa ns Sint Sire + 4 hs coi & 3 8 A i 400 EY Jerr esses esses s sess sessss nse essences sssassossnsmissasancsacsae : 7 crete A 3 er : 3 SE, adil na 4 A “% 300 200 100 0! 1 1 L L L L d. 1 AL L L L i MAR APR MAY JUN JLY AUG SEP OCT NOV— LEC JAN FER MAR ~~ MONTHS URINE POSTIVE OPIUM toms COCAINE Fm PCP A-—--4 11-222 2. 3. 4. 5. 6. 7. BIBLIOGRAPHY Carver, John A., Thirteen Month Drug Test Statistics, District of Columbia Pretrial Services Agency, April, 1985. Dawn Drug Alert 12 Quarterly Summary: Bmwergency Rooms : Imputed Mentions, October 1981 to December 1984, Kim Rak Woon, "Narcotic-related Overdose deaths in the District of Columbia", Inter-Departmental Memorandums 1984, April 1985. McFarland, George C., "Alcohol and peyg- Abuse Statistical Report", December 1984. Nestor, James P., "Monthly Narcotic Reports of Total Arrests and Number of Warrants Received and Executed 1984". U. S. Census Bureau, Standard Metropolitan Population Statistical Estimates for 1983. U. S. Department of Health, Bducation and Welfare, Alcohol, Drug Abuse and Mental Health Indicator Trend Report, 1976-1978, 11-223 COUNTRY PAPERS PATTERNS AND TRENDS IN DRUG ABUSE: THAILAND PERSPECTIVES Kachit Choopanya, M.D, Anek Hirunraks, Ph.D. INTRODUCTION Opium use has been popular with Thai and non-Thai (mostly Chinese) in Thailand for several centuries. Before the year 1851, opium use was, to some extent, illegal. In the year 1851, King Rama IV issued an Act to legalize opium consumption among the non-Thai. The "Opium Act" permitted "opium dens" to exist all over the kingdom of Thailand. The opium den was known as a public place where opium addicts could walk in, purchase opium, and smoke. They could stay as long as they wanted, and the house was open 24 hours a day all year round. Starting in 1955, there was some external (international) political pressure to institute a national opium policy. It was debated among the public and the governmental concerns whether opium consumption should be prohibited. Con- sidering the "pros" and the "cons" of the existing Opium Act, the Government decided to reverse the policy to prohibition again. Legislation banning opium followed. The law was put into effect from mid-1959 onward. The public opium dens were removed and have not existed since then. Starting in 1959, opium addicts were required to register as a first stage of the treatment process. It was recorded that there were as many as 70,985 opium addicts registered. Approximately 1 year after opium use was made illegal, new kinds of opiate- derivative drugs came into existence in Thai society. Opium's role from then on was as the raw material for generating morphine and heroin. The richest area for poppy cultivating in Southeast Asia is known as the "Golden Triangle." Geographically, the triangle lies along the boundaries of three countries: Burma, Laos, and Thailand. Most of the cropping area is in Burma, with only about 15 percent of the area in Thailand. The quantity of opium produced in Northern Thailand was estimated at over 100 tons a decade ago. Efforts to reduce the production of raw opium in Thailand have been quite satisfactory. The supply reduction program has been jointly implemented by the governments of several United Nations countries. Opium production has declined from a level of well above 100 tons to somewhere below 50 tons. In 1984, the official estimate shows only 30-40 tons of opium produced in Thailand. However, the gross amount of opium production in the whole triangle area is over 600 tons. A Director, Drug Abuse Prevention and Treatment Division, Health Depart- ment, Bangkok Metropolis. 2 Associate Professor, Facility of Public Health, Mahidol University, Bangkok, Thailand. III-1 EPIDEMIC PATTERNS In 1976, the number of drug dependents in Thailand was estimated to range from 300,000 to 600,000. It is understood that these figures are only rough estimates, without any acceptable scientific support. At present, a reliable figure on the number of addicts is being sought by concerned authorities. A pilot program for obtaining a benchmark estimate was conducted in late 1984 by a multi-disciplinary research group recognized by the Office of Narcotics Control Board (ONCB). This trial project was implemented in only 4 selected provinces out of 73. The model used here is known as the Key Informant Survey System (KISS). The preliminary estimate of the prevalent rate of drug addicts is 700-800 per 100,000 population. Currently, the country's major drug problem is in Bangkok Metropolis. According to treatment statistics, the distribution of treatment cases is: 64%—Bangkok Metropolis 19%—Central Region 10%—Northern Region 4%—Northeastern Region 3%—Southern Region Besides the treatment data, which include 40,000-50,000 addicts, there are also comparable figures from the Correction Department, Ministry of Interior. The distribution of drug types among the various regions in Bangkok Metropolis forms distinctive patterns. Heroin predominates in the central and southern region, at the same incidence as Bangkok, as high as 95 percent. The northern problem mainly concerns opium and heroin, with marijuana use at slightly lower rates. The major problem in the northeastern part of the country is with marijuana and opium, leaving heroin and other drugs as lower-level problems. DRUG DEPENDENCE As mentioned previously, there are currently as many as 300,000 addicts in Thailand. Along with the seriousness—of-the—existing problem, the treatment program of the nation comprises only about 99 treatment centers. Most of the centers are public centers run either by the Medical Department, Ministry of Health, or the Bangkok Metropolis Health Division. However, non-governmental organizations (NGOs) also play substantial roles in supplementing the national treatment program. There are about 12 NGO centers across the country. The complete treatment procedure comprises four sequential steps: (1) pre- admission, (2) detoxification, (3) rehabilitation, and (4) the after-care program. The existing detoxification models are the "methadone method," the "traditional method," and the "therapeutic community method." At the present, there are only a few centers administering the latter two methods. Rehabilitation activities, Whien are part of the treatment process, are still not as widespread as they should Se 111-2 A program for the prevention and suppression of drugs also is currently being implemented in Thailand; however, the prevention program needs to be more directly targeted at the proper population group. High-risk groups include adolescents, night workers, and truck drivers. The effectiveness of the prevention program could also be enhanced through appropriate community and soeial research. DEMOGRAPHICAL AND BASELINE CHARACTERISTICS It has been noted that the drug problem in Thailand is concentrated mostly in the Bangkok Metropolitan Area. The treatment data have shown that as many as 64 percent of the nation's patients come to treatment centers in Bangkok. The findings on characteristics of addicts that will be shown here are based on the treatment data obtained from the voluntary treatment system of the Bangkok Metropolitan Administration. Figure 1 shows the age distribution at first admission of addicts who came for voluntary treatment in Bangkok centers during 1984, The age range from 25 to 29 years comprises 36.7 percent of addicts; 69.7 percent of addicts are less than 30 years old. The average age is 29 years. Male addicts far outnumbered female addicts, at 94.3 percent. The sex dif- ferential, shown in figure 2, is due to sociocultural traditions of Thai society. It is suspected, however, that the percentage of females in the addict population is actually substantially higher than the treatment figure shown here. Educational distribution is shown by five groups in figure 3. Almost 80 percent of the addicts have an education of between 2 and 10 years. This pattern should be taken into consideration along with the educational structure of the nation. Compulsary education was raised from 4 years to 6 years only recently; less than 2 percent of the population have a college education. Employment status is shown on figure 4. Only 4.7 percent of addicts are current students. As many as 45.5 percent have permanent jobs of some kind. Figures 5 and 6 show the distribution of type of drug used and daily expenditure used on drugs. Heroin is the leading drug used among this group of addicts, ranking as high as 97.5 percent. The average expenditure on drugs is 101 baht per day, from a range of 50 baht to over 500 baht. Table 1 suggests trends and changes in characteristics of drug addicts from 1980 to 1984, with 6 months' data from 1985. The number of new admissions is down slightly. The age of addicts is becoming lower, indicated by the percentage less than 30 years old. The other variables remain mostly unchanged during the 5-year period. From the existing research and information, it is expected that heroin will overtake other drugs; however, polydrug use seems to be increasing among Thai addicts. III-3 CURRENT INTERVENTION PROGRAMS The Government of Thailand has declared drugs a national problem. The Narcotics Control Board (NCB) was founded about 10 years ago and, chaired by the Prime Minister, its main responsibility is setting national policy on drug abuse prevention, treatment, and control. There is a secretariat office attached to the Office of the Prime Minister, the Office of Narcoties Control Board (ONCB), which acts as the national coordinating body for all national drug programs. Besides coordinating activities, ONCB also is responsible for policy planning and implementation and for effective utilization of resources. The major approaches of the national drug programs are classified as "Supply Reduction" and "Demand Reduction." The reduction of supply comprises two main activities: suppression, or law enforcement, and crop replacement. The agencies in charge of drug suppression are police departments, the customs department, and ONCB itself. There are at least half a dozen public and private bodies involved in crop replacement activities, including the Ministry of Agriculture and Cooperatives, the Ministry of Interior, universities, local NGOs, UNFDAC, and a few foreign governments. On the demand reduction side, the activities underway are "prevention" and "treatment." The two organizations implementing drug prevention activities are the Bangkok Metropolitan Administration and the Ministry of Education. In addition, there are a few non-governmental organizations involved in the prevention side of the national drug problem. Treatment is essential to demand reduction, and responsible bodies include the Bangkok Metropolitan Administration, the Ministry of Health, universities, the Ministry of Defense, the Ministry of Interior, and various non-governmental agencies. ITI-4 REFERENCES Vichai Poshyachinda, An Interpretive Epidemiology of Drug Dependence in Thailand, Institute of Health Research, Chulalongkorn University, Bangkok, Thailand, May 1978, Health Department, Bangkok Metropolitan Administration, 1984 Annual Report On Drug Abuse, Prevention, and Treatment, 1985. Anik Hirunraks et al., Estimating Number of Drug Addicts Employing Key Informants: A Model Trial, Faculty of Public Health, Mahidol University, March 1985. III-5 TABLE 1 FY 1980 FY 1981 FY 1982 FY 1983 FY 1984 835 12 1. Number of Narcotics Clinics 1" 14 17 17 17 17 2. Number of New Admission 3,731 4,396 4,454 4,645 3,982 1,671 3. Total Admission (cases) 15,280 28,338 33,226 42,206 42,090 21,256 4. Age der ie 0.1% 0.1% 0.1% 0.2% 0.25% -19 8.0% 6.3% 6.1% 20.24 Soe YON] oa raiass | 5% Masw SI 72.5% | 51% )69.7%| 69.18 25-29 28.7% 34.2% 36.9% 36.058 36.7% 5.Sex Male 93.5% 92.6% 92.1% 93.5% 94.2% 93.9% Female 6.5% 7.4% 7.9% 6.5% 5.8% 6.3% 6. Employment Status: Permanent Job 46.9% 46.3% 48.1% 45.1% 45.5% Temporary Job 17.5% 19.1% 16.5% 13.2% 16.4% 47% Unemployed 31.1% 30.5% 30.5% 31.1% 33.4% 32% Students 45% 4.1% 4.9% 4.5% 4.7% Others —- —- —- 6.1% — 7. Type of Drug Use Heroin 96.4% 98.0% 97.3% 96.7% 97.5% Opium 2.0% 0.6% 1.1% 1.08% 0.6% 96.5% Cannsbis 0.5% 05% 0.5% 0.7% 0.7% 35% Others 1.1% 0.9% 1.1% 1.6% 1.2% 8. Prevention Activities (sttendance) 62,267 138,207 586,270 413,343 506,150 247,416 (sessions) 2,174 3,389 9,244 4,497 5,613 2,601 111-6 FIGURE 1--AGE AG ) ( First Admission 50 40 304 0 abejuaduay 10 UNDER 1S 3-19 20-24 23-29 30-34 3339 40-44 4%-47 B50 ONWARDS Age III-7 FIGURE 2--SEX SEX shin ) 1881 ( First Adm TTR (1H iy in rg \ LINO CLE HY iil) pm 1TH 3 0 0.013 3650 OTHER HALLUC. 0.070 0.71 10 0 0 0 TOTAL 890.123 5177.983 6120 3291 1255 173 TOTAL AMOUNT 1085.571 5810.138 4115 215903 1.91 Source: processing from Narcotic Enforc. Central Service data. (*) from a single theft (**) including onetheft(*) and one seizure (20 kg) in an illegal factory. (***) by taking in account the amount (weight), never the pieces. 111-51 ¢G-III TAB N.8. SEIZURES, AND PEOPLE CHARGED WITH DRUG-TRAFFIKING AND SPREADING PER AGE RANGE (A), PER SEX (B). 1983 SEIZURES Kg No. B: M PF M F M PF iIbta104g Ww oo Nn Rome 1,023 31.229 25.2 696 113 804 133 174 47 1,612 5,800 7,771 401 69 7,202 1,030 4,792 625 891 176 14,166 1,018 Italy Source: MNarcotic Enforc. Central Service - Ministry of Interior TAB. N. 9 SEIZURES AND PEOPLE MENTIONED FOR "SMALL QUANTITY". 1983 ho SEIZURES PEOPLE MENTIONED Kg ’ Italian Foreign LATIUM . 185 2,958 Source: marcotic Enforc. Central Service - Ministry of Interior TAB N. 10 PHARMACOLOGICAL TREATMENTS (AS PERCENTAGE ON TOTAL TREATMENTS) CARRIED OUT IN ITALY BY PUBLIC FACILITIES. Trend from June 15th 1984 to March 15th 1985. Data from DRUG ABUSE MONITORING DEPARTMENT of the MIN. INTERIOR Regions V.AOSTA SARDEGNA CAMPANIA SICILIA BASILICATA TOSCANA UMBRIA LOMBARDIA ABRUZZO LAZIO MOLISE TRENTINO ALTO A. PIEMONTE CALABRIA LIGURIA FRIULI VEN.GIULIA PUGLIA EMILIA ROMAGNA VENETO MARCHE 60.1 60.6 57.5 on on on 18,483 18,310 20,747 111-53 OPIATES-USERS (Estimated - TO.DI.), and ADDICTS (over 1 pg/ml morphinuria): ADDICTS MENTIONED { <20 per 1,000 males "at risk" USERS at public Facilities (Services) at residential Therap. Communities § } ---ADDICTS in T.C.: 4,500 (1984, Ist half) >—=—=ADDICTS at Services (1984, Ist half) 4 Sh — J USERS, not yet addicts: ® < (noticeable only through = TO.DI.-1like survey in 3 3 general population) MO o + = © so ~ £12 per 1,000 population "at risk" III-54 SPECIAL PRESENTATIONS NALTREXONE TREATMENT Susan Krill-Smith Director, Outpatient Services Addiction, Research, and Treatment Services Program Denver, Colorado I coordinate outpatient services at the Addiction, Research, and Treatment Ser- vices (ARTS) Program in Denver, and I think it's important to say a bit about what we offer there. We have a Family Intervention Program, which John T. Brewster indicated he would be talking about; we have the Cocaine Clinic; we have the Halsted Clinie, which is a speciality clinic for treatment of health care profes- sionals—doctors, nurses, dentists, veterinarians with addiction problems. We have a narcotic treatment program where we address the problems of the opiate addict with such things as methadone, clonidine, and Trexan, with the addition of family, group, and individual treatment, plus urine monitoring. And we provide "drug- free" treatment to a variety of substance abusers, that is, people using everything from Valium to street heroin to cocaine, and people coming from a variety of socioeconomic groups. It's an interesting clinic in that we unite a pretty varied population of substance users. There are several treatment options for the opiate-addicted or opiate-abusing client, including a therapeutic community, which is fairly traditional; methadone detoxification and maintenance; drug-free counseling/therapy; "kicking cold," and/or Trexan. For those of your who are unfamiliar with Trexan (naltrexone hydrochloride), it is a drug recently approved and released from experimental status by the FDA. Prior to this year, Trexan, or naltrexone, as it was then known, had been researched by a number of programs, including ARTS, since about 1973. To explain simply and briefly, Trexan is a narcotic/opiod antagonist—narcotic/opiod meaning a drug with a morphine-like effect. Trexan blocks the effect of nar- coties, such as heroin, by occupying receptor sites in the brain, sites that narcot- ics would normally occupy. Because Trexan blocks the usual euphoric effects of narcotics, using an opiate such as heroin while taking Trexan would be like taking a drink or "shot" of water. With the reinforcing high quality of the opiates removed, the likelihood of relapse is then greatly diminished while the patient is taking Trexan. Further, Trexan is long-acting and it is not addictive. It does not cause physical or psychological dependence and it has few side effects. Trexan is not a magical cure for opiate addiction or a panacea. It is an option. It should be considered an adjuctive therapy and it is not a fast seller among our clients. In fact if anything, probably we tend to "sell" or promote Trexan through education. Treatment with Trexan eliminates the reinforcing qualities of the opiate—it can be an alternative to methadone. It buys time for our clients; that is, it provides support and reinforcement for abstinence, which can facilitate therapy, counsel- ing, and lifestyle changes that are conducive to recovery. It allows the client time to "get comfortable" with a new drug-free status, while still receiving pharmacologic and program support. Lastly, Trexan can prevent relapse or read- diction. It can minimize relapse or impulsive drug use while it is used by the cli- ent. A 50 mg tablet of Trexan will block or significantly negate the effects of about 25 mg of heroin, which is more than most of our clients would be using. Iv-1 These effects would be blocked for 24 hours. Because of the duration of the drug and its action, dosing can be three times a week, which is something also helpful for our population of clients. As I have mentioned, Trexan is one of many options available for opiate-addicted patients at ARTS, offered in conjunction with therapy, counseling, group and fam- ily treatment, and often self-help groups such as AA and NA. Also urine monitor- ing is used to detect other drugs that wouldn't be negated by Trexan, to see how things are really going. We do find that patients frequently will experiment once or twice with opiates to see if indeed Trexan works. At ARTS, we've we found that Trexan is particularly beneficial to those patients who are employed and socially functioning; those who are opiate-free and leaving prison; those detoxified from methadone maintenance; those leaving residential drug treatment centers; residents of community correctional facilities; sporadic users of opiates; those ineligible for methadone maintenance because of the short duration of their addiction; clients who are opiate-free yet feeling at risk to use or to resume drugs; health care professionals who are at risk to relapse during their high access to drugs, health care professionals who may not practice while on a narcotic substitute such as methadone, and/or who are under strict stipula- tion with their respected professional boards to remain abstinent or lose their licenses. Specifically at ARTS we have been utilizing Trexan as an option for our health care professionals, and for opiate addicts in remission who are transitioning or graduating from the therapeutic community back into the general community. We have used it for clients who have withdrawn from methadone, usually followed by use of clcnidine and then treatment with Trexan as a part of a continuum of treatment, which eventually results in a drug-free status; and last and most related to the topie, for eriminal justice clients. I'd like to describe in more detail our Trexan Program for criminal justice cli- ents. There are a certain number of clients who enter ARTS with some sort of criminal justice involvement, or "motivation" as we call it. Perhaps the client has a probation officer who suggests or stipulates some sort of drug treatment or evaluation; perhaps the client is facing a court date for a drug-related crime. Often clients who we see are incarcerated or committed to a community correc- tions treatment facility, and we have some clients who are referred to us under a treatment contract where we provide treatment for Federal parolees and pro- bationers. For these clients, the end result of continued opiate use can be con- tinued criminal activity, prison, and possibly death. One might assume or consider at least the return to prison, and perhaps eventual death, fairly powerful motiva- tors to stop using. Those of us in the field know that is not usually the case. Unfortunately, death is viewed by our client population as a far off event, unlikely, and pretty minor compared to their daily activities; and, sadly, due to the bureaucracy—the court and legal systems' slowness—other consequences, such as prison, may or may not be certain, may not be swift or immediate conse- quences. For our criminal justice clients, then, Trexan can be a last chance to avoid incarceration. It can be life saving, it can be a strong reinforcer for absti- nence, and a negative reinforcer for impulsive use. And, as mentioned, it cer- tainly ean buy time for therapy, counseling, education, and lifestyle changes. Iv-2 We work to build an alliance with the client and to educate both the client and the criminal justice agency about Trexan and about using it as a part of treatment. We attempt to clarify and formalize the actual consequences and how quickly they will occur with the criminal justice agency. That is for the benefit of both client and therapist. Trexan is not actually court ordered. If after thorough evaluation, it is deemed an appropriate treatment option, it may become a treatment requirement stipulated by the criminal justice agency. The other option for the client entails facing the consequences of continued use or positive urines—-and those consequences are often violations of probation—being removed from a half- way house, or returned to prison. Treatment begins with a thorough drug/aleohol history, a psychosocial history, a physical, and an assessment of various treatment options for the client. Trexan is thoroughly explained and, if chosen as a treatment option, consents and releases are signed by the client. It is particularly important with female clients that we verify that they are using an active form of birth control, due to the lack of real information on the effects of Trexan on the fetus or the pregnancy. There is fur- ther medical and lab work, including a narcan test to determine the abstinence from opiates. Lab work is performed monthly for 6 months following, as rec- ommended by Dupont, which markets Trexan. And following that lab work, liver studies and the like would be performed as needed. The clients who participate in the Trexan program also utilize many of the various counseling and support services offered at ARTS. And this is required because we find that using Trexan alone is not successful. We spend much of the first month or so educating the client, listening to complaints, and talking about this new experience of being drug-free and taking a drug that really doesn't have any effects. We do have a number of clients presently utilizing Trexan as an adjunctive ther- apy. I'd like to just briefly discuss some of their comments about this treatment. We have a nurse who has recently returned to an extremely high drug-access nurs- ing position. She has returned with the support of the program—with urine mon- itoring and with Trexan. She expresses relief, and says that for once there's not a daily struggle when it comes time to dispense medications or face the narcotic cabinet. Another client is a Community Corrections resident. She has a lengthy addiction history, prison experience, and a variety of different treatment experiences, including methadone maintenance and drug-free counseling. She has been on the streets for a number of years, and really hasn't had much drug-free time in her life, probably not even during prison. She refused methadone maintenance when confronted by her halfway house, her community correction facility. She'd been chipping in the house, which means she'd been using sporadically. Actually, spo- radically turned out to be daily, but nevertheless, she became abstinent and chose to use Trexan as an option rather than going to prison. She says she is doing bet- ter than she ever has in her life. She can look in the mirror and see somebody who's "not that bad, anymore". She has a new job, a step up from a pretty routine factory sort of job, and she really appears to be feeling much better about her- self. She's also engaged in therapy and is participating at ARTS, which is some~ thing that didn't occur in the past. Iv-3 The last person I'd like to talk about is one who is a Federal parolee. You'd think the person least likely to succeed probably wouldn't meet the criteria for someone who might benefit from treatment with Trexan. This man is about 45, with a long history of opiate abuse and alcoholism, no job, a background of family violence, on the verge of being kicked out of the program and on the verge of being returned to the penitentiary. He's basically a loser. This man with a lot of ultimatums chose to try Trexan and Antabuse, and has been with us for 9 months now, drug free, stable, really for the first time in his life. He is non-violent, not drinking, and he told us the other day, "Believe it or not, you guys—I turned down stuff for the very first time in my career as an addict." And for him that's a pretty big step. In closing I guess I can say that there are not hoards of clients seeking Trexan, but it certainly offers a much-needed positive option for treatment planning designed to address the chronic lifelong problem of opiate addiction. Any questions or comments? QUESTION: Have you had any of the clients on Trexan who have been in car acci- dents, or required some sort of analgesia, and have you had to go into that? How do you deal with a case where you can't override the drug without almost killing the patient? RESPONSE: We have not had anybody badly injured. We do have all of our patients carry emergency medical ID cards. We've tried to alert hospitals and apparently, and I'm not a medical person, if you utilize Dilaudid and its titrated over a period of time, and the person is monitored very closely, you can override the effects of the Trexan and help the person who is suffering so badly. COMMENT: 1I called the hotline, and what it gets down to is that they will not recommend anything, which makes it absolutely useless: if you want to call up— what they do recommend is some form of an anaesthetic sedative/hypnotic that will just knock them out. RESPONSE: It's something that can only be done in a hospital, and it certainly would leave some problems. But I think for a lot of the people we see there is sort of a choice between living and dying anyway. For many of the people who are using Trexan, they are sort of down to the wire. They are informed that they must carry the ID card and that there could be problems, and then the choice is left to them. STATEMENT BY AN M.D.: A drug such as Dilaudid can be used for treatment and can override the effects of Trexan, given a long period of time in a hospital. RESPONSE—JOHN T. BREWSTER: As you can well understand, there are not very many people standing in line at the door of our clinic waiting to be nal- trexone clients. It is a drug that no self-respecting "hype" would want to be on. We think we need to look into client typologies that do best with the drug, because that really hasn't been investigated. Because of the research we are currently conducting—we have two new grants on tobacco, which we're trying to get into the nomenclature as a drug of abuse—it's being resisted, but we will also be work- ing with the Department of Corrections in Colorado to get a voluntary client who is on parole to be one of these people standing at the gate—to come on to naltrexone, and therefore, to make some recommendations and so forth to that Iv-4 population. Of course there are ethical considerations in doing that kind of research, and we're working that through right now. We want to get a large client population, and it is inmates, the corrections population, right now that we are looking at in terms of our eventual test population. RESPONSE—SUSAN KRILL-SMITH: I think that there is something that happens at treatment facilities that is happening in our program right now, and that is that the few people who are regularly taking Trexan are sharing knowledge with their friends, where somebody is coming in for their methadone dose and someone says, "Hey, what are you doing up here for your meth—try Trexan when you're off of methadone.” And among the nurses, particularly, there is also word getting out that this can provide an additional support when you return to work. That's not all you need, but it's something that can kind of help you over the hump. QUESTION: Could you compare and contrast this treatment with that of Anta- buse, which was popular around 30 years ago? RESPONSE: One major difference is that the person who takes Trexan doesn't become ill when they use opiates on top of Trexan. QUESTION: The issue that there is no reinforcement to negative reinforcement for someone who's expecting positive reinforcement. In terms of having been a fad, a major fad, in the medical treatment community—when you were talking about naltrexone, the major point in each statement about abstinence was the phrase, "while they are on Trexan." What happens when they stop? Can you make a comparison with Antabuse, and what you'd expect to happen with naltrexone, given our history with Antabuse? RESPONSE: Well, one thing is already happening and that is that people think it's a cure, a panacea. The other thing is that like Antabuse, it buys people time to make the other changes they need to. I think that is the most significant thing. If a person needs to use Trexan for 2 years, that's fine, but during that 2 years you are working toward the time when the Trexan might not be the choice, or they move to a place where they can't get it. Or they say, "I've internalized some things and I'm ready to do it on my own." Usually at our program, what we sug- gest in addition are more lifelong kinds of support, like changes within the family, and NA and AA, which is all over the world and always there. Those kinds of things as well as the individual's internal psychic changes. There are two uses of naltrexone that make a lot of sense. First of all, you do research to really know if it's going to parallel Antabuse, in terms of the historical implications of that drug. There's a social control issue, and that is you decrease criminality and illicit drug use. Naltrexone has significant potential implication in that area. Another issue involves dealing with more motivated, impulsive drug users. For example, we treat approximately 100 people in a therapeutic commu~ nity—traditional style. About half or 60 percent are narcotic abusers. They all go on naltrexone. As you know, therapeutic communities are not democratic, so they do go on naltrexone. Not all of them stay on it, but it helps that transition period, which is called reentry. There are a lot of people who tend to relapse during that period of time. So it has significant clinical implications; but the panacea is in Colorado with Antabuse—judges are prescribing Antabuse, not physicians. And it's ridiculous. It's outrageously prescribed. We hope with naltrexone that won't hap- pen. It probably has limited use, but it certainly has some implications. Iv-5 If you're a physician whose license depends on being clean, then naltrexone helps you keeps your license, and it's probably useful to you, and useful to your patients. Naltrexone is an expensive drug, and many of our patients are indigent and can't afford it. We want to keep it available, so we're going to give it to them. But there's got to be some resolution to that. We hope that the government in Colorado will pay for that, or give us some kind of a break. Also, there's a fairly significant amount of time required, in terms of the narcan, physician time, physi- cals, and staff time, to get somebody started on the medication—to keep an eye on them and to evaluate them as good potential patients for that medication. So we're working all that through and we are fairly excited about it, and we do think that it is a positive treatment option. IV-6 Averting Disaster: A Family Treatment Paradigm to Avoid Hospitalization John T. Brewster Clinical Director Addiction, Research, and Treatment Services Program Denver, Colorado When a family is traumatized by the fact that one of their children becomes involved in illicit drug use, it really is kind of irrelevant what that drug is, if the drug is a non-addicting, relatively low-habituating drug like marijuana, or if it's an intensely addictive drug like cocaine. But when a kid experiments and the family is naive about the drug and has value systems built around the fact that drug use is bad, it traumatizes the family. So whether it's marijuana, alcohol, cocaine, or whatever, the family is almost equally traumatized, because they are ignorant of the facts. They don't understand the differentiation of drugs. Although marijuana is a more common and acceptable drug, it still tends to affect many families by paralysis; it victimizes them. They don't know what to do. And too often they hospitalize their kids or put them into relatively expensive treatment programs, which is not always the best thing to do. Now NIDA, and I'm not maligning NIDA, I'm not here to criticize NIDA, is going to be responsive to parents because parents are going to be taking some control of public policy development. They already are. And it's getting stronger. I say that to suggest that the Addiction, Research, and Treatment Services (ARTS), some 3 years ago, without this being the motivation, had recognized that, in Colorado, parents with drug-experimenting, "recreational" drug-using children needed some assistance. They needed some input. They needed some education. They needed technique to know what to do, so that they didn't over-react. Drugs needed to be demystified. The responsiveness of how to deal with an acting-out adolescent needed to be dealt with because, as we all know, adolescence is the issue and not drug use—we all know that obviously. We treat kids and drugs are often a part of growing up. So we began a program called the Family Intervention Project. It trained and educated parents, and didn't deal directly with kids unless they required clinical treatment. And then when the parents felt that they needed some guidance, they would come to our facility and we would give them the information they needed to deal with the situation in their family, for example, drug use accompanied by poor school performance, and other kinds of symptoms of adolescence including acne and sexual activity. I want to share with you what we've done, the outcome of some of that, and I want to suggest to you that it probably ought to be utilized on a broader basis—it's quite simple, it's very reinforcing to the clinician, and it's reinforcing to the agency because what you're dealing with is a healthy but impaired family. You're dealing with a healthy entity, not a pathological entity. ARTS works with very chronic, severe substance abusers for the most part: methadone maintenance, therapeutic communitites, and we have a residential adolescent program as well. Iv-7 Dealing with a healthy but impaired family is a reinforcing element to a pro- gram—it gets your head out of the quagmire, gets into a different form, and it assists a large constituency that needs it: the parents, the families. When we think about kids, we picture them as these beautiful young innocent chil- dren, later turning into gigantic brats, the "disease of adolescence." Parents do react to it. A few years ago long hair was the issue; it was unacceptable; now it's the Mohawk. Adolescence will always be unacceptable, because it must be differ- ent to work out the identity and rebelliousness issues. In the family intervention program, we focus on the parent's plight of confusion, fear, and the deep relationship they have with that child, and how the symptoms of drug use—poor school performance and other issues—are impacting that family, creating a potentially permanent conflict in the family. As the child grows up and exhibits the normal emancipatory kinds of behavior, the potential for long-term conflict exists, where the child not might reconcile with the parents, when they go through adolescence. It is possible that they will never rebound because they become so angry with their parents. The parents are fearful, the children are angry, but there can be some effective interventions. We stabilize the parents, bring them in and talk with them and not with the child. We orient the parent. We teach them about parenting, about adolescence. We do not focus on drugs, ete. Parents want to know about the tangibles: If I know what a drug looks like and if I know how it's used, I can stop my kid from doing it. We initially teach them that is incorrect. That has nothing to do with it. So we really don't talk about these kinds of things. Although there are increasing numbers of younger people using cocaine in this country—95 percent of the kids who come into our residential clinics come in with a combination of alcohol and marijuana abuse as the primary drug problem. If you know the epidemiological literature, alcohol and marijuana are the main drugs. So these are the drugs that we're talking about. We talk to the parents about that, so that they don't have to worry that all their kids are injecting cocaine, although a very small group might be. So the parents understand that their kids aren't neces- sarily addicted, they're not injecting for the most part. Some kids are—some kids are doing all that kind of stuff. But we assist the parent in understanding what the real picture looks like, e.g., social drug/alcohol use, which leads to more seri- ous long-term problems. What we do at this point, once we've educated the parent, defrocked drug abuse, is talk with them, explaining that drug use is a symptom along with other symptoms of adolescence; we focus on parenting skills—cognitive parenting skills. Now remember, we have the child in the office with us because when the parents come to us, they are generally coming with their child. The parents are angry, they are very, very mad at the kid. The kid is resistant, but the kid is under their control, they come to treatment. If the kid refuses to come into the counseling center, the kid is usually too out of control for this approach. So we get the kid in. If the Kid refuses to come to us, he/she usually refuses to come home at night also. He/ she refuses to do anything in the home. And if a child is out of control, the par- ents need more than the family intervention program that I am talking about now. They possibly need a more formalized family therapy or family treatment program, or even a placement out of the home. I'm going to talk to you about the differential costs of outpatient and residential inpatient care in just a second. Iv-8 At this point we've talked about a cognitive behavioral model of how parents ean gain or regain control of their families. And this statement, discipline at the bot- tom, (slide) exemplifies our approach. Not punishment, but discipline. The term means that we model, we respond fairly and quickly to behaviors that we don't accept, and stress there are negative consequences to negative behaviors. It's quite behavioristic; it's simple. It is not difficult, but parents who are potential vietims of the fear of the loss of control of their family due to drug use have to be reminded. In addition, we do have urinalysis on all of our patients. We don't treat anyone without performing a urinalysis. Any Kind of person, it doesn't matter who they are. The outcome of 25 families, if we take a look, is that within 6 months all urines are clean. We have one patient who had no dirty urines at all. The fam- ily thought he was abusing drugs. He was in a drug program in Texas, which referred him to us as a serious drug abuser, and we treated him for 6 months and took random urines, and we observed he never had a dirty urine. The kid always said, "I'm clean, man." I think the parents just thought he was a drug abuser and threw him into a drug program. In 6 months, our patient's urines were clean. Because the parents were taught by surrogate parents, that's me or the other family therapists or counselors, how to respond. We kind of take over a family, in a structured sense. Teaching the par- ent what to do. We relate to the parent, we don't need to relate to the child. The child usually doesn't like us. The child does not like the surrogate parent, because the surrogate parent imposes structure. He imposes consistency, requires that certain behaviors are followed. Remember, we are dealing with a healthy but impaired or flawed family. We are not dealing with seriously pathologically involved youngsters here. So that's a significant thing to remember. But we are meeting the needs of a large group of individuals (families) who are clamoring for this; really wanting it. Not only is it healthy for your clinic population, if you're involved in a clinic profile that deals with chronic severe drug dependent people, but it's got such a positive outcome. There is so much good, and it's profitable. You can make money doing it, and there's nothing wrong with doing that. QUESTION: Do you test the parents too? RESPONSE: I have a pamphlet that's available if you'd like; a contract. It does indicate—yes—that all drug abuse in the family needs to stop. And junior is quick to say, "I'm smoking your stash, Mom, and I'm sick of you nagging me for doing that. If I'm going to quit smoking, you're going to quit smoking." If that happens, yes, we will test everybody in the family. That hasn't happened very often, though for the most part, we do lay guilt trips on parents about their using drugs. I want to share with you some cost data here. When a family is vulnerable, take yourselves—I mean all of us have an impaired time in our life—when a parent is vulnerable, afraid, or unstable, it's like a victim in any situation. I was raised on the streets. I was a pretty wild kind of a young person. I used to vietimize people by getting them unstable. Well, criminals usually take advantage, whether they are bunko or whether they are violent criminals, take advantage of confusion. And they may not even know it, but they do it. Because the person who's being victimized gets confused, afraid. Parents react very similarly to that, as a vic- tim. And what they do when they have a kid who is abusing a drug—alcohol, mari- juana, it doesn't really matter—they could be very seriously involved with it. They could be injecting, whatever; they (the parents) are afraid. Often what's told to them by our current state-of-the-art treatment, which is called inpatient, some- Iv-9 times it's not hospital inpatient, but it's always inpatient, because that's where the money is, very few people make money in oupatient, is to put them in an inpatient substance abuse program. I'm going to share with you some of the inpatient and outpatient rates. My con- tention is that the vast majority of these young people do not need inpatient treatment. I want you to understand that. I believe that vast numbers of young people who are hospitalized, in a variety of hospitals, we have many of them in Denver, need not be there. Should have not been there. And a less restricted care - was never tried first with these kids. Never. With our cocaine patients, for example, we might be treating a hundred of them on any given day, we hospitalize less than 5 percent of them. And we never hospitalize them more than a few days, because it's unnecessary. And they are responding to treatment. Their urines are clean and they are doing alright. With adolescents it holds true; that's our philosophy. A daily rate for inpatient treatment is about $200.00. Maybe $150.00, certainly nothing less. Thirty days is a short-term, non-hospital residential stay or hospital - stay. Forty-five days is more of a common stay, and 90 days is an elongated stay- -outpatient costs, as a comparison, range from $50.00 an hour on up—that's a pretty standard rate for a master's degree person, now, at least in this State— master's degree clinician, social worker, psychiatric nurse, whatever, psychologist, would charge around $50-$55.00 an hour; $70.00 an hour for a physician psychia- trist for the most part; $90.00 an hour for the wealthier psychiatrist. Six months, $900 compared with $6,020 for a 1-month inpatient hospitalization. We are get- ting many calls from parents who are saying, "Look, I got a kid who is smoking dope, and so and so said that I should put him into this 45-day program, and my company has a preferred provider relationship with this program"—they will put him in for nothing, in other words—And I say, "For nothing—is that right?" Nobody pays—that's like perpetual motion. Something that can keep moving— there's no need for energy. We could put everybody in this program if they worked in your company—it wouldn't cost anybody anything. Well, of course, the parent does not understand that. The parent just says that the company will pay for it. Nobody's paying for it, so I'll put my kid in this program. When the kid comes home, after 45 days in the program, and begins using drugs again, the parents pull ‘their hair out and insurance benefits are exhausted. The kid's already "treatment- wise," and has been associated with more severe drug abusers, sometimes with adults, because in many of these inpatient facilities, they mix them (children and adults)—a bad mistake. It's a terrible mistake to take an adolescent and do that. So, in conclusion, our position at the ARTS Programs regarding the family inter- vention client, the healthy but impaired family, the kid who is not "crazy," the kid who is not out of control completely, but a kid who is using drugs experimentally, having deteriorated school performance, maybe withdrawing, with an array of other symptoms, I won't go into them all, but the first concern to the family should be trying outpatient treatment. The Family Intervention Program is a cog- nitive behavior paradigm that should be used for the parents. It's the parents under control in the family, not the therapist. Dependency should not be between that adolescent and that therapist, unless the kid is depressed or clinically involved as I have said. We use contingency contracts with all kids: they all lose something of value if they come up with a positive urine; for example, if a kid has skis, he gives his skis to his brother if he gets a positive urine; if he likes to drive he loses his license for 6 months—these are the types of consequences that IV-10 occur. One kid lost his bedroom for 7 months—his father built a bedroom for him, he moved in, got a positive urine, moved out and gave it to his younger sister who he liked to beat the heck out of most of the time, and he lived in the family room for 7 months on a couch and lost his privacy. Today, he's clean, he's straight and doing fine—a positive outcome. Contingeney contract results, in other words, have a lot to do with success. Are there any questions? QUESTION: I agree, that is a beautiful assessment, but in all the private hospitals in St. Louis, there is about a 60 percent occupancy rate. In the last 3 years, there has not been a private hospital that has not put in a big alcohol and drug abuse treatment program. Particularly for little "Sonny Jim." And I agree with you it is probably a medical or public health disgrace, but everybody gets "Sonny Jim" in for maybe 45 days. And that's because they are running at 60 percent occu- pancy. Nobody's in the hospital, so wings are turned inpatient, particularly for kids. RESPONSE: Yes! Guilt trips on the parents? ANSWER: Yes—whatever works. Every five minutes (commerecials)—"is your son getting bad grades? He's probably a junkie. Bring him treatment right now." QUESTION: How much of the program that you describe is based on urinalysis as the final judge? ANSWER: All of it. QUESTION: Okay. If your kids can beat the "P" test, what does that do? ANSWER: We never had anybody beat the "P" test with us, but maybe they have and we didn't know it. But every time they used drugs, we caught them. We observe urines. We take them two to three times a week. With marijuana it lasts. It's real difficult to fool on that one. Iv-11 DRUG USE AND HOMICIDE Paul Goldstein, Ph.D. Narcotic and Drug Research, Inc. About 2 years ago I presented to this group a conceptual framework dealing with drugs and violence relationships. I will just briefly recap that framework as back- ground for what is to come. I said that drugs and violence could be related in three possible fashions. One is psychopharmacological, the other is economic-compulsive, and the third is sys- temic. Psychopharmacological violence is the violent, irrational behavior that individuals may act out after ingesting some sort of substance. Alcohol, barbitu- rates, amphetamines, and PCP are probably the relevant drugs in this category. ‘Economic-compulsive violence is the violence that may occur in the context of an economic crime committed to pay for drugs. Heroin and cocaine, because they are typified by compulsive patterns of use and because they are expensive drugs, are probably the relevant drugs in this category. Systemic violence is all of the violence attendant to the system of drug use and distribution. This would include wars between rival dealers, violence against people who cannot pay their debts, who sell bad drugs on the streets, who become police informants, ete. My own hypothesis is that most of the violence connected with drugs is of the systemic variety. I am testing that hypothesis in a grant funded by NIDA called DRIVE. DRIVE stands for Drug Related Involvement in Violent Episodes. We are interviewing 150 male drug users and distributors on the Lower East Side of Manhattan. Another grant that I hope will shortly be funded—it's currently pending at NIDA—is called FEM-DRIVE and, essentially, proposes to do the same sort of research with a sample of women. Through those two projects I hope to get a very good handle on the qualitative dimensions of the drugs-violence relationship. What I'd like to talk about today is the quantitative dimensions. I am going to focus primarily on homicide. I will talk a little bit about assault also. We have a number of local studies conducted over the last decade or more indi- cating a very strong relationship between drugs and homicide. One study in Philadelphia estimated that 31 percent of the homicides in that city in 1972 were drug related. The New York City Police Department estimated that in 1981, 24 percent of their homicides were drug related. In 1981, Miami estimated that about 24 percent of their homicides were drug related; and on television, a Miami official estimated that in 1984 one-third of their homicides were cocaine related. We heard Gail Thornton a couple of days ago present data here that 17 percent of the New Orleans homicides were drug related. San Diego also presented data a few days ago that they had seven heroin-related homicides, 11 amphetamine-related homicides, 16 cocaine-related homicides. Let me qualify one thing here. Data from Miami, Gail Thornton's New Orleans data, and the San Diego data were medical examiner data. It is very important in talking about these quantitative dimensions to distinguish the data source, because they are really talking about very different things. Medical examiner data tells us something about the victim. So we know that in New Orleans, in 17 percent of the cases, the medical examiner found traces of various drugs in the victim. We do not know anything about the circumstances and we do not know anything about the Iv-12 perpetrator. All we know is the victim. Police data generally give us more infor- mation about perpetrators and circumstances. We have only one viable national estimate, and that was in a report recently done by Harwood and his colleagues at Research Triangle Institute. That report suggested that 10 percent of the assaults and homicides nationwide are drug related. Now they are quite clear in that report that the existing data upon which to base such national estimates are very poor. Their 10 percent is a very conservative estimate based upon very inadequate data, but it is probably the best estimate that we have. What is amazing in this context is, as we read down from city to city— Philadelphia, New York, Miami, New Orleans, San Diego—that we have the per- centages that we have. We have percentages like one-quarter of the homicides, or one-third of the homicides in given cities being drug related, but there is no national database that currently, systematically, collects this sort of data. The database that should do it is Uniform Crime Reporting (UCR). Uniform Crime Reporting doesn't do it. The coding categories for drug-related homicide do not exist in that report. So we have what may be the single most important cause of homicide in the country and there is not even a coding category for it. It's ridi- culous. And it leads to absurdities like the New York City Police Department, which does code drug-related homicide, though that data has not ever been sub- mitted to UCR, typically reporting more drug-related homicides in New York City for a given year than UCR reports for the country as a whole, including New York City. The situation is absurd.. Let me give you just a few more details. The New York City Police Department (NYPD) obtained medical examiner reports on the alcohol and drug content of homicide victims for the four years 1973 to 1977, and the proportion of homicide victims with alcohol, drugs, or both in their system ranged from 42 to 52 percent. Additional small proportions of homicide viectims—only about 1 percent annually—did not have alcohol or drugs in their blood at the time of death but showed evidence of addiction, such as needle marks. That analysis was only done for 2 years, in 1976 and 1977. We're dealing with very spotty and localized data analyses. None of these analyses are routinely done year after year systematically so that we can get trends. They'll do it for a couple of years, and then it gets dropped. In 1976 and 1977 prior arrest records were compiled for both homicide victims and the arrested suspects. About 53 percent of the vietims and 74 percent of the suspects had at least one prior arrest. The NYPD threw all these arrests into one big pool and looked to see what was there. Drug offenses were the most common prior arrests among both victims and perpetrators. We see in 1976 about 16 percent of the total prior arrests of perpetrators had been drug offenses; in 1977, about 15 percent. The figures are even more striking with regard to homicide victims. Of all the prior arrests of homicide victims, 26 percent were drug arrests in 1976. And in 1977, 19 percent of all prior arrests of homicide victims were for drug offenses. Some additional data from New York City on homicide arrests—I said earlier the NYPD said 24 percent of the homicides in New York City in 1981 were drug related. Some additional data on that. This was the second most common form of homicide in New York City, trailing only the general category of dispute. Hand- guns were used more often in drug-related homicides than in any other form of homicide. Robbery was second. Handguns were used 84 percent of the time in drug-related homicides—61 percent of the time in robbery homicides. In 94 per- cent of the drug-related homicides the vietim and the perpetrator were friends or acquaintances. iv-13 I recently completed a report for the Carter Center of Emory University and the Centers for Disease Control on the health consequences of drug use. In that report I looked at violence; I conceptualized violence as one of the health con- sequences of drug use. We looked at the objective indicators, like years of life lost, visits to emergency rooms, ete., and we found that violence is one of the main factors getting people killed, or into hospitals, right up there with endo- carditis, hepatitis, AIDS, and other more traditional health consequences of drug use. We estimated that in 1980 over 2,000 homicides were drug related. This is a nationwide estimate. Two thousand homicides were drug related, and assuming an average lifespan of 65 years, resulted in a loss of about 70,000 years of life. We further estimated that in 1980 over 460,000 assaults were drug related, and about 140,000 of those assaults resulted in physical injury, which in turn led to about 50,000 days of hospitalization. Given an average figure—I think they estimate about $200 a day for hospitalization—$200 times 50,000—we're over about 10 or 11 million dollars in hospitalization costs associated with drug-related assault. I was going to tell you where those numbers came from. UCR is very weak in assault data. Statistics from the National Crime Survey performed by the Bureau of Justice Statistics are much better for assault data. So we applied Harwood's 10 percent figure to the NCS data to get those assault figures. Now what can we do about this? We seem to have a major problem—the relation- ship between drugs and violence. NIDA is funding some research in getting quali- tative dimensions; the appropriate place to get this drugs/homicide data is in the criminal justice system. I have been working for a couple of years now with the New York City Police Department and with our State Division of Criminal Justice Services, trying to come up with a prototype system in New York State that will get at the sort of data that we want. We feel it's important to get this data, which would lend great legitimacy and urgency to our prevention and treatment efforts in the State. It is, as I said earlier, just absurd that this data is not yet being collected. It should be collected. We have solicited local police depart- ments throughout the State. We've gotten letters of cooperation to participate in a new data collection system. The New York State Division of Criminal Justice Services (DCJS), and the Division of Substance Abuse Services and Narcotic and Drug Research are collaborating in this effort. What we're going to try and do is simulate the experience of New York City. What New York City has done is interesting. Once per year they do a face-to- face debriefing of all precinct-level detective squad commanders. Normally the UCR data is submitted within 30 days of the event and a supplementary homicide report is submitted 30 days later. The number of unknowns in the data submitted that eventually gets incorporated into UCR is enormous. For example, the New York City Police Department and New York State DCJS both publish homicide analyses each year. The New York State report, which is based on the data sub- mitted to UCR, tends to have about 50-60 percent unknown in major categories; categories like circumstances of the homicide and vietim-perpetrator relation- ships. The New York City report runs about 9 percent unknown. And 80 percent of the State's homicides occur in New York City, so you would expect the two reports to be fairly similar. They're not. Why is New York City eliminating these unknowns and getting more complete data? They do a face-to-face debriefing once per year. It was in the context of those face-to-face debriefings that they first learned that drug-related homicide was an important form of homicide, and then created coding categories for it. The fact that up to a year may have elapsed between the actual homicide and the face-to-face debriefing means that Iv-14 trials may have taken place, investigative work may have been completed. UCR tries to get that data in quickly, but the time lag is just so short before the sub- mission that frequently nothing is known about the homicide. In addition to that, police are very reluctant to commit their informed speculations to paper before they have a confession or some sort of adjudication. Many police officers have been embarrassed by defense attorneys who may have subpoenaed case files of the police department. And perhaps, let's say within a few weeks of a particular homicide, the police suspect the victim's wife as the perpetrator. Then a month later they decide that it's the drug dealer that did it. And the speculation that the wife did it is in the police files. The smart defense attorney can get up there and say, "Well, three weeks ago you said the wife did it. Now you say the drug dealer did it. Two months from now who are you going to say did it?" For reasons like that, the police tend to play a lot of their information, things they know about the event, very close to the vest, keep it in their heads and not put it down on paper. New York City, after these face-to-face debriefings, goes back into their original data files and changes them. According to Phil McGuire, who heads the NYPD Crime Analysis Unit, they change 60 to 70 percent of their homicide cases. And these become the permanent files and the files upon which their annual reports are based. Those changed files had never gotten to the State and had never been included in UCR submissions. One thing we've been able to do thus far is to at least get the city to send those data tapes up to Albany, so the State has that data available to them, although they still get them too late for UCR submission. Essentially what we're going to try to do, because a face-to-face debriefing is very labor intensive and not terribly cost-effective, we're going to try and simu- late the debriefing with a form that the State would send to all local police agencies to report on the drug relatedness of homicide and some other factors. The Division of Criminal Justice Services has a few interests of their own that are not being met, so we're going to combine our interests on drug relatedness with some of their interests. Also we're going to be able, through our collaboration with DCJS, to tie in this data set with existing data sets on prior criminal records in New York State, which is called the New York State Intelligence and Identifi- cation System, and which has all the rap sheets computerized. So we can tie all of this together and get prior arrest records on both victims and perpetrators. That's what we're trying to do. Now I cannot guarantee that we're going to be able to achieve all of this. We're working with local police agencies, and we're still in the process of reaching agreement as to what is doable. We will not place an unnecessary burden on local police agencies that will distract them from their work. We also have requested support from the Department of Justice to help carry this off and we don't know if that support will be forthcoming. I think that combined with my other research, the DRIVE and FEM-DRIVE, which gets the qualitative dimensions, this quantitative data will give us a very powerful sense of the drug-violence relationship. I would like to add one more thing, just of anecdotal interest, and then open this up for questions. I have been finding in the current project, the DRIVE project, an increasing amount of violence related to drug paraphernalia. There is a lot of paranoia, a lot of fear on the streets about contracting AIDS. Individuals, I'd say probably 10 to 20 percent—it's not the majority—but about 10 to 20 percent of these street intravenous drug users are very concerned about contracting AIDS. They are attempting to buy clean, unused works. There are beat artists on the streets that are selling used works packaged as new works. If the purchaser gets IvV-15 home and discovers that these are used works and not new works—we've had some cases of people going after the person who sold them those works. We had one case of a double homicide where an individual kept a private set of works in his shooting gallery that someone else had used, and he found out about it. And he went after the guy who had used his works without permission. They got into an argument. He stabbed that guy to death, and then he was also told that a friend of his had witnessed this other person using the works, and this other friend had not told him about it; he got into an argument with his friend over "Why didn't you tell me about it," and stabbed that guy to death also. We've had a number of cases of disputes starting around, "Can I borrow your works?" and people saying, "No. You can't." And an argument ensues that leads to an assault. We haven't had any cases of homicide on that particular issue on the Lower East Side, but lots of fights. One stabbing. Any questions? COMMENT: One part is that it might be very useful to analyze say a thousand sampled incidents of violence that are drug related and try to construct a taxonomy of violent incidents. Thus, to discover which is the most common, second most common, and so on. RESPONSE: What we're trying to do on the DRIVE project is precisely that. We're being guided by that tripartite conceptual framework, though we're already finding some incidents that really don't fit comfortably within it, and we may have to expand the framework a little bit. So that's precisely what we're trying to do. And that is an ideal type, I should say an ideal type framework, because many events have qualities of both. For example, the dispute over "Why won't you let me share your works?" An individual may be high on barbiturates at the time of that dispute, and so the dispute over sharing the set of works, which I would call more in the realm of systemic violence, also has a psychopharmacological component, because one of the individuals had ingested barbiturates earlier. So we may get overlaps and combinations also. COMMENT: You might find that the number one condition is some sort of dispute over a deal gone sour. And isn't there a possibility of using what mechanism existed in either Manhattan or other inner cities to construct a public ombudsman of some sort to settle deals? You need a resolution of conflict or resolution about deals gone sour. Wouldn't it be possible to go to the local churches and find some- one who could resolve those disputes? RESPONSE: I could never, never see that happening. A deal gone sour at the very big level. A big deal. Tens of thousands of dollars. People are not going to the local church, to the ombudsinan, and resolve this on that level. If $10 or $20 is involved, no one is going to that extent. The people who may have beat someone selling them what was allegedly cocaine and wasn't are maybe long since out of the neighborhood. They may be casual transients coming through. The situation - may be resolved by going back and saying, "I demand my money back." And sometimes if you find the guy who sold you the bad drugs, you get your money back if you're bigger than him. QUESTION: In other societies, that are equally poor, deprived, and have an equal number of disputes over money, there must be mechanisms of resolving them short of violence that are well established. Can we begin to establish these in our inner cities? : IV-16 RESPONSE: They don't have the same sort of problem. I would find it pretty difficult to conceive, with the impulsive nature of the people out there, of turning to someone like that, because it requires planning. A dope addict doesn't plan beyond getting his next shot....One thing that I heard a lot was that guys would get beaten. And as long as the beat artists got out of the block for even a day or two then the impulsive anger of the guy who got beaten pretty well dissipated by the time the other guy got back into the neighborhood. It's only when the beat artist didn't get away and got caught within the first hour or two that you're likely to have violence, and in that sort of atmosphere he is not going to run up to him and say, "Listen, let's go to church and talk..." QUESTION: It's just about your categories and types of violence. As you mentioned, I can see overlap. Where do you put something, and I can see that it can be part of both the first and the third, but it's another problem that seems to occur a lot with drug use, and that's child abuse. And I mean not impulsive child abuse, but the kind of systemic, obviously systematic abuse over a period of time, chronic cigarette burns, multiple fractures, bites, which we get in the M.E.'s office, and can't really be explained just by being high, but it apparently is part of that violence. Where do you code some ritualistic, chronic thing like that? RESPONSE: That's one of the concerns we're going to have. If the FEM-DRIVE application comes through, we'll be dealing with the female sample. We are going to have to deal with that issue. It's a good one that you raised. I think there are various levels. There may be the mother out copping drugs for other people to support her habit and leaving the child unattended. There may be that sort of problem. You mentioned the direct violence. Was the mother or whoever com- mitted the direct violence—the bite, the cigarette burn, the beating, whatever— was the person high at the time? If so, on what? Does that seem to account for why it happened? If it doesn't account for why, I mean, not all child abuse by people who use drugs is necessarily drug-related child abuse, there may be child abuse independent of the drugs. Or there may be drug relationships to that abuse. If there are drug relationships, we're going to look for them. And the relationships may be because of what they're high on. And we'll look for that and try to get that. It may be something that stemmed out of neglect through the participation of the parent in the drug business and there was nobody to watch the kid, ete. That's probably closer to the systemic than anything else, but I sort of agree—I'm not real comfortable with it there and that's a place where I might want to try and break out a new category. QUESTION: I was just wondering, because there are so many different reasons, as you say, child abuse and drug abuse many only be an expression of the problems that a person has anyway, whether or not they had drugs. It seems like such a special category. I always just sort of in my mind throw it in with part of the systemic wars and stuff, because we see a lot of it, not necessarily just abusers but there's a lot of it in users. It just fits the pattern. RESPONSE: I'd just like to add to something I said earlier about the M.E. data, and I think you said you might have something you want to say about that also. Just because we find traces of drugs in a homicide victim does not necessarily mean that this was a drug-related homicide. Somebody could have gotten off and while they were sitting in their chair in their apartment a burglar came in through the window and shot them, and the homicide had absolutely nothing to do with the drugs that were used. The mere presence of drugs does not necessarily indicate a drug-related homicide. iv-17 COMMENT: My impression from medical examiners' work is you just have to know the office's limited area and what their capabilities are. Any national M.E.'s data is just totally questionable. I'll give you an example. We do toxicology in St. Louis. The vast majority of homicides a methadologist sends us. There is no bud- get other than a few dollars for post mortem toxicology in Kansas City. Only if they truly think that someone died of drugs, suicide, whatever, and there aren't empty containers there, will they even bother to do an analysis. So like the "Ts and blues" stuff with reports of some of that in Kansas City, the medical examiner may never have even heard of it. The guy's got a bullet wound. Why are they going to spend the money? So, what you get, you get a place like San Diego, which has a very good laboratory in Orange County. Some of the places in California—Orange County, San Diego—have really competent people and good laboratories. Orange County would be excellent data. And there are other counties I'm sure. There are no criteria for why anything is done. That's the whole problem. RESPONSE: So we have a situation where the M.E. data is very unreliable. We know that an awful lot of the drug-related homicides that take place don't necessarily involve drugs being present in the vietim, which is the only thing the M.E. can really tell us about. You've got homicides that occur in the context of a drug-related robbery, where an addict may shoot a store owner. The store owner has no drugs in his bloodstream, but that's a drug-related homicide. You may have a husband and a wife get into a dispute over how much money the husband is spending on his cocaine use. And the dispute turns into a homicide; the husband kills the wife. There is no presence of drugs in her body. It's a drug-related homicide. The M.E. data is insufficient to give us the range and scope of drug- related homicides. It tells us only about the victim; it does not tell us about the perpetrator or the event. COMMENT: From my experience with the police of the M.E.'s office, your explanation as to why uniform crime reports and your city police reports are so different is right on. We'll get victims in there that are unsolved crimes, and yet homicide officers can give you the whole story. This guy has been running this scam on this guy. They know it. But for all practical purposes it's an unsolved crime. QUESTION: Maybe you said it, but I didn't understand it. What about different drugs and violence? Are there differences? RESPONSE: There are certain drugs that are more likely to be psychopharma- cologically related to violence, drugs like aleohol, stimulants, barbiturates, and PCP. Heroin and cocaine, because they are so expensive and because people are so compulsive about their ‘use, are more likely to be related to economic- compulsive violence. In the area of systemic violence, absolutely any drug may be related; children have been stabbed to death over nickel bags of marijuana. Any drug can be related to sytemic violence. And the data does indicate that as individuals' drug use continues, they are more likely to get involved in the drug business in some way, and hence place themselves at risk of being either a victim or a perpetrator of systemic violence. A thirteen-year-old who sells another thirteen-year-old a nickel bag of oregano and says that it's marijuana may get stabbed! May die! It doesn't have to be $100,000 worth of cocaine or whatever to lead to a death...to lead to a homicide. Iv-18 I haven't done any real big analysis like that. One person who has looked at the homicide rate and seen a very interesting relationship to drugs is Margaret Zahn in Philadelphia. She traced the homicide rate in the U.S. over the entire 20th century and found two big peaks. The first was in the 20s and 30s and seemed to be associated with the market for illegal booze during the prohibition years. The second big peak was in the 60s and 70s and seemed to be associated with the big influx of heroin and cocaine of those years. And she felt that there was a clear relationship between homicide and making a market for illegal goods and pro- tecting yourself while involved in illegal transactions. QUESTION: What do you mean by a drug-related homicide? RESPONSE: At this point, what I mean by drug-related homicide is something where I can show a psychopharmacological relation where it seemed to be the result of either vietim or perpetrator ingestion of substances—that they acted differently, because of the substances they ingested, and that difference led to a homicide. Or that it was drug related in the sense that it was in the context of an economic crime to pay for drugs. Or that it was attendant to the drug business and system of distribution in some fashion that would be systemic. There may be other forms of drug relationships, and if so I'm going to have to modify that conceptual framework right now. That's how I see it. And if you have any others, I'm always glad to add a fourth category. With a fourth category, I can make two- by-two tables. QUESTION: In Phoenix, reports talk a lot about seeing a significant number of children hurt, not because the individual has ingested, but because the individual is uncomfortable because he or she has not ingested. Does that come under psy- chopharmacological? RESPONSE: I would definitely say the psychopharmacological. I've done some prior research on prostitution, and I found that prostitutes tended to report that when they assaulted their tricks or robbed their tricks, it tended to be during a withdrawal period. The normal form of prostitution is the gentle con. You get the guy up there and you very gently con him out of as much money as you pos- sibly can. If the woman was feeling nervous, irritable, upset because she was in a stage of withdrawal, she just couldn't go through that gentle con. She would more likely hit the guy over the head with a brick and take what he had, and might go out then and cop drugs, get off, go back out on the stroll, and then behave like the prostitute doing the gentle con, not being the robber anymore, because now she could do that. It's a good point. QUESTION: One other thing that I ran into while in San Diego was-—California State law seems to have a limit on age; toxology tests are not required on anyone under 14. I was looking through the years of data, and I thought there must have been somebody in all these years that overdosed on drugs, and I couldn't find any, after which I quizzed the medical examiner's office, and they said that it was a State law. And it comes back to the fact that they don't have the time or money to do the things they don't have to do under the law. So it's something to consider. QUESTION: Have you ever tried matching your data up against the work that Eric Wish and Company did down in Washington?...Remember the prison survey where they put a detoxant on everybody who came in? Did you ever compare your data against that sort of thing? Iv-19 RESPONSE: Eric and I have been talking about possibly, in the future, getting together and trying to put our respective data sets together or work together. We've talked about it—nothing definite yet. QUESTION: At the last meeting, a special presenter spent an awful lot of energy trying to persuade us that there was a major psychopharmacological component to violence among cocaine users. Have you found that? RESPONSE: I have had some indications that disputes that would have taken place anyway and might not have led to real serious violence may have escalated because of the coke head that one or both of the participants had at the time. We're going to be probing a little bit more deeply into that. I can't give you any- thing definitive, We haven't analyzed any of our data yet. Impressionistically we've heard some stories like that, but I have to do more probing and more analysis. Iv-20 DESIGNER DRUGS James Ruttenber, M.D. Center for Environmental Health Centers for Disease Control Introduction To Designer Drugs Designer drugs include a number of compounds that produce effects similar or identical to currently illegal street drugs. The term "designer" describes the attempt to modify a scheduled drug so that it is legal according to current narcotic regulations. In California, which currently is being considered the home of designer drugs, the major designer drugs that are giving us problems are the analogs of fentanyl and analogs of meperidine. I do not want to say much about fentanyl analogs and I will dispense with them right now. The big problem with fentanyl analogs is the potential for fatal overdose, and a lot has been said about this danger. I question the quality of the data that support the contention that fentanyl analogs are particularly dangerous. As I understand it, approximately 100 overdoses have been recorded in the past 5 years or so. By my simple calculations, if you were to consider that fentanyl analogs are available to approximately 10 percent of narcotics users in California, 90 overdoses over a 5- year period is really not outlandish when compared to over 200 fatal heroin overdoses per year. I think that a lot of emphasis has been placed on the potency of these drugs and the potential for overdose, but nobody with good scientific data has really looked into whether the fentanyls are actually more dangerous than heroin. However, you can not deny the fact that they are dangerous drugs and we should pay attention to them. The other big problem with the fentanyls is the one that we also face with meperidine analogs: they are very difficult to detect and we have no national surveillance program to determine where and how intensively they are distributed. Meperidine analogs (MAs) became famous in 1982 when William Langston discovered cases of Parkinsonism produced by the neurotoxin MPTP, a compound that is produced during the synthesis of the ineperidine analog, MPPP. The reaction that is used to produce MPPP is an equilibrium reaction and almost always produces some MPTP. Some of the street chemists have reportedly tried to purify the MPPP, but we do not have much faith in their quality control. In this presentation, MPPP/MPTP refers to the preparation of the meperidine analog MPPP and its toxic contaminant MPTP. The Centers for Disease Control (CDC) and the National Institute on Drug Abuse (NIDA) began to work with William Langston at the Santa Clara Valley Medical Center in January of this year to identify persons who were exposed to MPTP in 1982. We initially confined our research to cities between San Jose and Monterrey. One of the things that we found early in our investigation was that a number of people reported recent use of a drug that produced symptoms similar to those noted in 1982. In light of these reports, we began to look in other California cities for evidence of recent availability of MPPP/MPTP or other MAs. In April 1985, we set up a surveillance program and an anonymous sample submission program to determine the extent of possible distribution of meperidine analogs. IvV-21 We have been somewhat successful in getting street samples though we have not yet identified any meperidine analogs through the street sample program. We have, however, talked with a number of people in a number of different cities, including San Diego, San Francisco, Los Angeles, and Fresno, who gave us convincing reports of symptoms consistent with those produced after the injection of MPPP/MPTP. The best data we have on the availability of meperidine analogs comes from law enforcement intelligence information. The first piece of recent evidence came from the raid of a PCP lab in Brownsville, Texas, in late 1984. It was subse- quently learned that this lab also was producing a new meperidine analog, which we have named PEPAQOP. It is quite similar to MPPP and also contains a con- taminant, PEPTP, that is an analog of MPTP. We have not yet evaluated the neurotoxicity of this MPTP analog and think it is very important to do so. The other interesting thing about this laboratory raid in Brownsville is that some of the people operating this lab were the same ones who made the original MPPP/ MPTP preparations in California in 1982. Other evidence includes the fact that two methamphetamine labs that were raided in San Diego in late 1984 both had cookbook recipes for the production of MPPP. One lab actually had on hand all chemicals necessary to synthesize MPPP. Additional intelligence evidence is the discovery of a street sample of PEPAOP in Alameda County, California, and the determination that this sample was distributed by the same group that made MPPP/MPTP in 1982, Surveillance For Meperidine Analogs I would like to switch now to the issue of national surveillance for designer drugs. In the first place, it is very clear that we need to enhance our abilities to do screening for snythetic compounds or designer drugs. In many cases, medical examiners, drug treatment centers, and crime laboratories do not have the ability to positively identify meperidine analogs or other designer drugs. We currently are trying to get support to develop a quick and inexpensive analytical procedure for the identification of meperidine analogs in both urine and street samples. Currently, the only way to confirm the presence of meperidine analogs is to send samples to Dr. Langston's laboratory or to the DEA Special Testing Laboratory. Until adequate analytical techniques are developed, screening for the acute symptoms of MA exposure is the only way to determine the presence of these drugs in a specific community. Additionally, drug treatment counselors and clinicians can focus on the acute symptoins of meperidine analog exposure and the chronic symptoms of what we call early MPTP-induced Parkinsonism to help decide whether a patient has been exposed to a meperidine analog. The sequence of symptoms that we are seeing in most individuals is quite different from what Dr. Langston and his colieagues observed for index cases. The index cases that have been described in Science and other journals had severe cases of irreversible Parkinsonism. By far the largest group of people exposed to meperidine analogs have not shown these severe symptoms but have a very subtle sign/symptom complex consistent with early Parkinsonism. I will go through three stages of clinical signs and symptoms produced by meperidine analogs and describe some of the symptoms associated with each stage. First, there is the acute phase, when a person is actually experiencing the psychotrophic effects of the drug. The next phase is observed in persons who continue to use MAs over many days. During periods of continuous MA use, IV-22 symptoms may persist even when the drug user is not experiencing the psychoactive effects of the meperidine analog. These effects may go away if MA use is discontinued. The chronic phase of clinical effects oceurs in patients who have stopped using MAs. The chronic signs and symptoms generally occur after about a year from first exposure, and as far as we can tell, are permanent. These signs and symptoms may also get worse. I will now describe the acute phase symptoms. These are the symptoms that we use to screen people for MA exposure. Inquiring about the symptoms is the only way to tell if someone has used a meperidine analog, unless you are able to get a sample of the suspected MA, or unless you are able to get a urine sample within 24 hours of use of the suspected MA. The two sentinel symptoms that we look for are the reporting of use of a drug that produced an atypical disorienting "high" that was strikingly different froin that produced by heroin or fentanyl analogs; and the reporting of an intense burning that travels from the injection site along the course of a vein. Other common acute symptoms are blurred vision, a metallie or medicine-like taste in the mouth, a jerking of limbs, slow movement, excessive sweating, and muscle stiffness. The chronic symptoms noted for both the phase of repeated MA use and for the period following MA use are the same. They include stiffness and pain in joints and muscles; numbness of extremities; jerking of the limbs; blurred vision; slower and more effortful movement (bradykineoia); drooling; oiliness of the skin; excessive sweating; shaking or tremor; memory loss; and difficulty speaking. In order to screen California drug users for exposure to MAs, we have set up a surveillance system that utilizes State drug abuse treatment programs. In cooperation with the Department of Alcohol and Drug Programs, we have notified all methadone treatment centers of the acute effects of VMAs, and asked that they report suspected exposures to referral centers or to the MPTP clinic at the Santa Clara Valley Medical Center. The referral centers consist of selected drug abuse treatment programs whose staff have been trained to administer a screening interview and to decide whether a drug user has had exposure to MAs. We also have instituted an anonymous sample submission program to provide free and confidential analysis of street drug or urine samples suspected of containing an MA. Sample containers and pre-paid mailers are available at all referral centers. To date, we have not identified any street samples that contain MAs. Three urine samples contained a compound that may be an MA metabolite. We feel a statewide surveillance system should be maintained in California because we are still receiving convincing reports of the continued availability of MAs. It appears that the paucity of street samples is due to the reluctance of users to part with approximately $20.00 worth of a narcotic. It also appears that continuation of the surveillance program will require active long-term support by State, Federal, and county agencies. Conclusion I have provided an overview of the designer drug problem in California and outlined the collaborative efforts that have been implemented to tackle the problem of MAs. Our experience in California has provided convincing evidence that surveillance for the presence of dangerous designer drugs is severely inadequate at the local, State, and Federal levels. The first step in facing the Iv-23 issue of dangerous designer drugs is to determine where they are available. We do not have the ability to do this, and need to develop a strategy to remedy this situation. In the case of the MAs, we do not have the ability to determine if they have been distributed outside of California, because we do not have laboratory support that is adequate to provide identification of MAs in a large number of street drug samples. Additionally, the metabolites of MPPP, PEPAOP, and PEPTP have not been characterized for humans, thus making analysis of urine samples somewhat of a guessing game. Finally, we have no idea of the toxicity of PEPTP, and will probably have to wait sometime for the answer to this important question. Until adequate toxicologic support can be obtained, communities suspecting the presence of MAs must rely on the assessment of chemical symptoms produced by suspicious drugs. Hopefully, more laboratories will develop methods to detect MAs and their neurotoxic contaminants. There also is a strong need for the development of a national surveillance program for all designer drugs. This program should address both the acquisition of representative street drugs and biologic samples as well as the analysis of these samples. Assessment of the presence of meperidine analogs or other "designer narcotics" should also include evaluation of traditional toxicology data from emergency rooms, medical examiner offices, and drug treatment programs. One might expect areas in which designer narcotics have been distributed to have less frequent mentions of morphine in biologic samples. These areas should also have noted an increase in the number of samples containing unidentifiable opiates. QUESTION: Do all of the meperidine analogs produce dependency? ANSWER: Yes, that is a good question. In California, as I said, we really do not know exactly which analogs these folks are using now. We suspected PEPAOP. Everybody we have talked with that has used MAs frequently has reported addiction. Many have reported that MAs are not potent narcotics, and that they have to use them 5 to 10 times a day. QUESTION: What were the characteristics of the 10 percent of the addiets in California who were able to access fentanyl? ANSWER: As I understand it, and this is second or third hand information, Gary Henderson analyzed urine samples from San Francisco methadone clinics and determined that 10 percent of the samples contained fentanyl. I do not think this study was done in a very scientific way and we do not really know whether the drug treatment programs were representative of all drug treatment programs. To my knowledge, they did not go back and interview the individuals that supplied the samples positive for fentanyl. I talked with Gary and others about the symptoms produced by fentanyl. The best that we can determine is that people say it produces effects identical to those of heroin. We have been surprised about the lack of sophistication of drug abusers in California. They often do not even know whether the drugs they have used were synthetic. Iv-24 QUESTION: What is Gary Henderson's address? ANSWER: Department of Pharmacology, University of California, Davis Medical Center, Davis, California 95616. Right now, the place to send samples you might think contain meperidine analogs is Bill Langston's lab at the Valley Medical Center in San Jose. These labs should be notified in advance. In addition, CDC would like to be notified of any suspected MA exposure outside of California. QUESTION: Have you found any cases in Los Angeles? "ANSWER: We have talked with a couple of people that have convincing stories, but we have not confirmed exposure or disease. We have not been able to spend much time in this area, so it is difficult to know with any degree of certainty. QUESTION: What about mortality associated with meperidine analogs? ANSWER: In 1982, when MPPP/MPTP was confirmed to be available, there were really no reports of overdoses or mortality in users. We have asked users of MAs about whether this kind of drug causes an overdose similar to that produced by heroin. Some of them said, "Oh yeah, I have overdosed on this drug." But when we asked them to describe it, what they said is that they fell out or lost consciousnss for about 5 minutes but they came to and were fine. Users of high doses have not reported respiratory depression at all. We recently received reports of deaths due to suspected MAs, but have not looked into these in detail. QUESTION: Is it true that there are many laboratories producing MAs or is it thought that there are only a few laboratories involved? ANSWER: We really don't know the answer to this question. That is something that we can not tell now. I believe that there are a few labs currently in operation. IV-25 COCAINE REALITIES George L. Miller* No longer is the great American pastime restricted to the sport of baseball, eating pizza, and drinking beer. The competition has arrived. It answers to many names: snow, blow, toot, and coke, but not the kind you drink. It is a game where the participants stuff increasingly larger quantities of white powder up their nose, inject it into their veins, or smoke it in a glass pipe. Unlike its competitors, it needs no marketing or advertising. The allure is so great and demand so high that those who sell and distribute never seem to have enough on hand. An estimated 5,000 people a day try cocaine for the first time. The media is increasingly full of stories about athletes, businessmen, politicians, ete., involved in the use or sale of the drug. The evidence from scientific research indicates that cocaine is more addictive than heroin. Laboratory mice will forsake every- thing else to get their next hit. For several years I rode the roller coaster and lived in the nightmare world of cocaine use. It is the drug that, paradoxically, you come to love and hate at the same time. It is the Dr. Jekyll and Mr. Hyde of drugs. At first it's such a wonder- ful seduction, getting high, doing a few lines; no big deal. Somewhere down the path, maybe a few months or a year, the seduction turns into a nightmare. You move back and forth between the real and the unreal, living in the twilight zone between night and day. You become totally obsessed with the drug. Reality turns into illusion—the demon begins to show its real face. Paranoia, depression, and thoughts of suicide begin to follow you around like your own shadow. As the lines of cocaine grow increasingly bigger and longer, so do the shadows of gloom that surround you. Everything in life becomes secondary to the acquisition and consumption of more coke. Your occasional indulgence has turned you into an addict. Buying a gram of cocaine is like putting a gallon of gasoline in your ear, you can't go far on a gallon or a gram. Money loses all of its value; a hundred dollars a day is nothing; one or two thousand a week may keep you pacified. Your greed keeps you from friends, unless you're trying to borrow money or make a score. Even the greatest of man's physical desires, sex, becomes meaningless. Your marriage is a passionate one and your partner has an identity unique unto itself in the form of white powder. The need to stay high becomes a necessity in order to perpetuate the illusion. The demon has sunk its razor-sharp talons deep and won't let go. When you're sober, and perhaps even worse when you're coming down and crashing, the reality of seeing the obscenity of your life and the gradual decay are too much to bear. You have been reduced to a decaying carcass that watches idly as the vultures of * Mr. Miller, an ex-cocaine addict, is a frequent guest on talk shows in the Denver area. IV-26 despair mock and continue to tear away at the flesh of your human spirit and dignity. The further the decay, the more you contemplate suicide. It's not so much that you've emptied your bank account, sold your car, or lost your house—all of the material things can be replaced. It's not until maybe five or six o'elock in the morning when the coke is gone and from the cracks in the window shades you see the darkness fading with the transition from night into day, and your heart is pounding at a frenzied pace against your chest, the sweat is pouring profusely from every pore in your body, your mind racing at a million miles an hour; and then you look into the mirror and staring back is this lonely figure, ravaged and hideous. Chaos all around you, but the destruction from within is the most devastating thing of all. If all of this sounds depressing, well indeed it is. Six years ago when I began my journey into this nightmarish world there were no examples to drawn upon. Cocaine was the drug few had heard about, with little knowledge of its dynamics and characteristics. Had I known the true extent of the journey, I doubt I would have bought the ticket. For those who become involved today and willfully seek the initiation, they have no excuse, for the ritual is well documented and publi- cized. Those who choose to make the journey bind themselves to chains of per- verse temptations and desires only to be led as slaves blindfolded to the precipice of personal and emotional devastation, if not destruction. If you're a coke user and want to quit, you can! Wanting to is the first step. It took awhile to get into and it's going to take awhile to get out. Don't get dis- couraged if you fail over and over again. Gradually you will chip away at the illusion that you're created and the real world will once again come back into focus. Don't ever be afraid to ask for help, whether it be from a friend or a pro- fessional. There is no shame in being human. Part of the human condition is to sometimes do silly and foolish things. Realize you've made a mistake and begin working on changing it. Keep in mind there are virtually thousands of people going through the same things you're going through. Being a cocaine junkie is not an awful lot different from many other addictions (coffee addiction, sugar addiction, cigarette addiction) except the consequences are much more severe. If you know people who are heavy users and you care about them, don't be afraid to confront them with what you see. At first they'll probably deny using it or say they're using very little, but as their nightmare grows and becomes pervasive in their lives they will come back and seek your help. Just being there to listen and give support means a great deal. During my darkest hours of cocaine abuse I would have given anything to have had someone there to talk to and give me sup- port. I would spend days at a time in some dingy, muggy smelling motel room pacing back and forth, peeking frequently from behind the curtains to see if perhaps there was someone out there, paranoia telling me that someone was surely out there and they knew what I was doing. Deep within the paranoia, depression, and confusion, there is the real you struggling desperately against the darkness, trying to return to the world of human relationships where life begins with the rising of the sun rather than ending there. The cocaine phenomenon is a very complex and complicated problem. It's a problem our society has to deal with because it affects everyone. Conventional methods may help, but when you combine the incredible enticing qualities of cocaine and the complexity of the problem, conventional procedures fall short. We must begin to develop creative and innovative approaches if we are to deal Iv-27 with this problem. As the time to respond grows shorter, the quantities of cocaine grow bigger. Some of the most important threads that bind our society are being tested. The question remains, at what point will the fabric loosen and fall apart? Some of you who read this will continue down the same path, hopefully not to the point of destruction. If you're reading this and have never tried cocaine, don't. If you're just getting into it, stop while you can! IV-28 frU.8. GOVERNMENT PRINTING OFFICE: 1985 461 357 20480 PARTICIPANT LIST PARTICIPANT LIST COMMUNITY EPIDEMIOLOGY WORK GROUP June 25-28, 1985 Mr. Steve Antonopulos* Trainer Denver Broncos 5700 Logan Street Denver, Colorado 80216 (303) 296-1982 Mr. Robert Aukerman Director, Alcohol & Drug Abuse Division State of Colorado Department of Health 4210 East 11th Street Denver, Colorado 80220 (303) 331-8206 Dr. Ustik Avico Instituto Superiore di Sanita Viale Regina Elena 299 Rome, Italy 00161 39-6-4990 Ms. Ann Blanken Division of Epidemiology and Statistical Analysis National Institute on Drug Abuse Parklawn Building, Room 11A-55 5600 Fishers Lane Rockville, Maryland 20857 (301) 443-6637 Dr. Robert Booth Program Planning and Evaluation Alcohol & Drug Abuse Division State of Colorado Department of Health 4210 East 11th Street Denver, Colorado 80220 (303) 320-6137 Mr. John T. Brewster#* University of Colorado Health Sciences Center Addiction Research and Treatment Services 3742 W. Princeton Circle Denver, Colorado 80236 (303) 761-6703 * Special presenter Mr. Bruce Bucklin Drug Enforcement Administration System Evaluation and Analysis Unit 2801 Merrilee Drive Fairfax, Virginia 22031 (703) 235-1132 Mr. Richard Calkins Evaluation Section OSAS/MDPH 3500 North Logan Street P.O. Box 30035 Lansing, Michigan 48909 (517) 373-8358 Dr. Kachit Choopanya Director, Drug Abuse Prevention and Treatment Division Health Department Bangkok Metropolis, Thailand 66-2-221-0897 or 221-2141 (ext. 317) Ms. Irene Cohen Commitment Coordinator Alcohol & Drug Abuse Division State of Colorado Department of Health 4210 East 11th Street Denver, Colorado 80220 (303) 331-8217 Ms. Leslie Cohen Birch & Davis Associates, Inc. 8905 Fairview Road Suite 300 * Silver Spring, Maryland 20910 (301) 589-6760 Dr. Raquel Crider ; Division of Epidemiology and Statistical Analysis National Institute on Drug Abuse Parklawn Building, Room 11A-55 5600 Fishers Lane Rockville, Maryland 20852 (301) 443-6637. V-2 Dr. Thomas Crowley* University of Colorado Health Sciences Center Department of Psychiatry 4200 E. 9th Avenue Denver, Colorado 80262 (303) 394-7573 Dr. John Donovan* Research Associate University of Colorado Institute for Behavioral Sciences : Campus Box 483 Boulder, Colorado 80309 (303) 492-6921 Dr. Umberto Filibeck General Department of Social Medicine Ministry of Health Viale dell' Industria ~ Rome, Italy 00100 Dr. Blanche Frank New York State Division of Substance Abuse Services Epidemiology Unit Two World Trade Center 67th Floor New York, New York 10047 (212) 488-3967 Mr. John French Research & Evaluation Alcohol, Narcotics, and Drug Abuse Units New Jersey Department of Health 129 East Hanover Street Trenton, New Jersey 08608 (609) 292-8930 Dr. Manuel Gallardo Department of State International Narcotics Matters Room 7336 Washington, D.C. 20520 (202) 632-7097 ¥ Special presenter V-3 Mr. Fred Garcia Prevention Director Aleohol & Drug Abuse Division State of Colorado Department of Health 4210 East 11th Street Denver, Colorado 80220 (303) 331-8211 Dr. Paul Goldstein*® Narcotic & Drug Research, Inc. Two World Trade Center New York, New York 10047 (212) 488-3962 Mr. James Goss, Jr. 2210 Bolton Drive, #4 Atlanta, Georgia 30318 (404) 351-0051 Mr. James Hall UPFRONT, Inc. 5701 Biscayne Blvd. Suite 602 Miami, Florida 33137 (305) 757-2566 Ms. Linda Harrison Researcher Alcohol & Drug Abuse Division State of Colorado Department of Health 4210 East 11th Street Denver, Colorado 80220 (303) 331-8225 Dr. Wolfgang Heckmann Senator fur Familie, Jugend, und Sport Am Karlsbad 8-10 1000 Berlin 30 Germany 011-49-30-26-04-25-73 Dr. Antoinette Helfrich* 950 South Cherry Street Suite 1220 Denver, Colorado 80222 (303) 430-5686 * Special presenter V-4 Dr. Anek Hirunraks Research and Evaluation Coordinator Department of Biostatistics Mahidol University Bangkok 10400 Thailand 66-2-245-8350 or 66-2-251-1276 Dr. Balkar Husson Patient Management and Needs Assessment Los Angeles County Office of Drug Abuse 849 South Broadway, 11th Floor Los Angeles, California 90014 (213) 974-7181 Mr. Bruce Hutchinson Research Coordinator Chemical Dependency Program Division Department of Human Services Space Center 444 Lafayette Road St. Paul, Minnesota 55101 (612) 296-4612 Dr. Rodolphe Ingold Mission Interministerielle De Lotte Centre La Toxicomanie 57 BD Magneta 75010 Paris France 33-1-240-21-86 Dr. Jane Kennedy Director Substance Treatment Services Denver General Hospital 645 Vannock Street SE Denver, Colorado 80204-4507 (303) 893-7830 Dr. Michael Kirby Director, Arapahoe House 9818 West Belleview P.O. Box 5072 Littleton, Colorado 80123 (303) 762-1550 Mr. Nicholas Kozel Division of Epidemiology and Statistical Analysis National Institute on Drug Abuse Parklawn Building, Room 11A-55 5600 Fishers Lane Rockville, Maryland 20857 (301) 443-6637 V-5 Ms. Susan Krill-Smith* University of Colorado Health Sciences Center Addiction Research & Treatment Services 1827 Gaylord Denver, Colorado 80206 (303) 388-5894 Dr. Richard Linster Center for Crime Control Research National Institute of Justice Office of Research Programs 633 Indiana Avenue, NW Washington, D.C. 20531 (202) 724-7631 Mr. Robert Long Drug Enforcement Administration Office of Intelligence 1405 Eye Street, NW Washington, D.C. 20537 (202) 633-1263 Ms. Sharyn Lumpkins Drug Enforcement Administration Office of Intelligence 1405 Eye Street, NW Washington, D.C. 20537 (202) 633-1263 Mr. Philip MacAvoy TERROS 4545 North 27th Avenue Phoenix, Arizona 85107 (602) 249-6314 Mr. Earle McFarland County Department of Health Services Division of Drug Programs 3851 Rosencrans Street San Diego, California 92110 (619) 236-2966 or 236-2200 Mr. George McFarland Research and Program Analysis Alcohol and Drug Abuse Services Administration (ADASA) 300 First Street NE 3rd Floor Washington, D.C. 20002 (202) 727-0713 * Special presenter V-6 Mr. Harold "Bud" Meadows Assistant Director Alcohol & Drug Abuse Division State of Colorado Department of Health 4210 East 11th Street Denver, Colorado 80220 (303) 331-8207 Mr. Bruce Mendelson Chief Planner Alcohol & Drug Abuse Division State of Colorado Department of Health 4210 East 11th Street Denver, Colorado 80220 (303) 331-8222 Mr. George Miller#* 6200 West 32nd Avenue Wheat Ridge, Colorado 80033 (303) 239-6080 Mr. Manuel Mondragon y Kalb Procuraduria General de la Republica Conjunto Pino Surarez Torre B., Piso 19 C. Postal 06850 Mexico, D.F. 52-5-510-3979 or 518-1628 Ms. Lori Nelson Birch & Davis Associates, Inc. 8905 Fairview Road Suite 300 Silver Spring, Maryland 20910 (301) 589-6760 Dr. John Newmeyer Haight-Ashbury Free Medical Clinics 529 Clayton Street San Francisco, California 94117 (415) 431-2450 Dr. Alphonse Poklis St. Louis University School of Medicine Department of Pathology 1402 South Grand : St. Louis, Missouri 63104 (314) 854-6000 * Special presenter Mr. Eric Rosenquist U.S. Department of State INM/P Room 7811 Washington, D.C. 20520 (202) 632-1518 Dr. James Ruttenber* Centers for Disease Control Center for Environmental Health 1800 Clifton Road, NE Atlanta, Georgia 30333 (404) 454-4374 Ms. B.J. Smith Field Services Coordinator Aleohol & Drug Abuse Division State of Colorado Department of Health 4210 East 11th Street Denver, Colorado 80220 (303) 331-8245 Dr. Enrico Tempesta Department of Psychiatry Drug Dependence and Alcoholism Unit Catholic University of S. Heart Lg. Gemelli 8 Rome, Italy 00168 039-6-33054573 Ms. Gail Thornton New Orleans Health Department 320 South Clairborne Avenue 2nd Floor New Orleans, Louisiana 70112 (504) 525-1251 Dr. David Timken Treatment Services Coordinator Alcohol & Drug Abuse Division State of Colorado Department of Health 4210 East 11th Street Denver, Colorado 80220 (303) 331-8246 * Special presenter V-8 Dr. Agusti Velez Procuraduria General de la Republica Conjunto Pino Surarez Torre B., Piso 19 C. Postal 06850 Mexico, D.F. 510-39-79/518-16-28 Mr. Donnie Walsh Assistant Coach Indiana Pacers 7060 South Marshall Drive Littleton, Colorado 80123 (303) 973-8756 Mr. John Watters Haight-Ashbury Free Medical Clinics 529 Clayton Street San Francisco, California 94117 (415) 398-2040 Dr. Nathaniel Webster Erie County Medical Center 462 Griden Street Buffalo, New York 14215 (716) 898-3625 Dr. Wayne Wiebel Illinois Department of Alcoholism and Substance Abuse 100 W. Randolph Street Suite 5600 Chicago, Illinois 60601 (312) 917-6434 Mr. Arnold Wrede King County Department of Public Health ‘Division of Alcoholism and Substance Abuse Services 1008 Smith Tower Second Avenue and Yesler Seattle, Washington 98104 (206) 344-7635 Ms. Danelle Young Treatment Services—Unit Director Alcohol & Drug Abuse Division State of Colorado Department of Health 4210 East 11th Street Denver, Colorado 80220 (303) 331-8237 V-9 U. C. BERKELEY LIBRARIES CO0L981LA40 ITT | Ty ee - oe - £37, oo S . i CB aw em JB vs