Update on Latest Drug Trends

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Update on Latest Drug Trends

  1. 1. Update on Latest Drug Trends Jane C. Maxwell, Ph.D. Addiction Research Institute The University of Texas at Austin www.utattc.net
  2. 2. Data Sources • Overdose death certificates & Medical Examiner Reports • Poison Control Center cases • Treatment admission records (TEDS) • Emergency room data (DAWN) • Price, purity, supply, trafficking data (DEA) • Surveys (NSDUH, MTF,YRBS) • Community Epidemiology Work Group (NIDA) • Forensic laboratory tests (NFLIS, Police & ME Labs) • AIDS cases (Health Department) • Community Epidemiology Work Group (NIDA)
  3. 3. Drug Use Patterns Vary over Time and Space
  4. 4. Percentage of Drug Items Identified by Toxicological Labs as Heroin by State, 2006 Source: NFLIS
  5. 5. Percentage of Drug Items Analyzed by Tox Labs Identified as Cocaine, by State, 2006 Source: NFLIS
  6. 6. Percentage of Drug Items Analyzed by Tox Labs Identified as Methamphetamine, by State, 2006 Source: NFLIS
  7. 7. % Texas Treatment Admissions by Primary Substance of Abuse: 1987-2009 Heroin Alcohol Stimulants Cocaine Marijuana 60 50 40 30 20 10 0 87 88 89 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 Source: DSHS
  8. 8. And Our Demand for Drugs Influences Drug Use in Our Neighbors
  9. 9. Primary Drug of Abuse at Admission to Treatment: 2007 Cocaine 10% Cocaine 10% Cocaine Heroin 8% 15% Heroin 9% Heroin Cocaine Meth 10% 24% 35% Meth Heroin 22% Meth 10% Meth 8% 42% Meth Meth Heroin 35% Heroin 11% 33% Heroin 31% 15% Heroin Cocaine 31% 22% Cocaine Cocaine 64% 32% Cocaine 47% SISVEA & TEDS
  10. 10. British Columbia Prairie Provinces Ontario Quebec Atlantic Canada
  11. 11. Canadian Methamphetamine Seizures: 1988-2007 3000 British Columbia Prairie Provinces 2500 Ontario 2000 Quebec Atlantic Provinces 1500 1000 500 0 Source: Office of Research and Surveillance, Health Canada
  12. 12. Heroin Sources and Supply Routes
  13. 13. Mexican Black Tar Heroin Mexican Brown Heroin South American Heroin
  14. 14. Heroin Changes • Increasing use by youth nationally. DAWN ED cases for those ages 18-20 increased by 83% between 2006 and 2008. • Texas heroin treatment admissions for those ages 20-29 increased from 35% in 2005 to 41% in 2009; admission for those 40-49 decreased from 22% to 16% in the same period. • So? Cheese Heroin now Heroin. Watch for more and more young users and ways to prevent transition from inhaling to needles.
  15. 15. Texas Heroin Admissions by Age 12000 Group: 2005-2009 10000 8000 50+ 40s 6000 30s 20s 4000 U20 2000 0 2005 2006 2007 2008 2009 Source: DSHS data; analysis by JC Maxwell
  16. 16. Lag Between First Use of Heroin and Admission to Treatment in Texas Under 20 20s 30s 40s+ 30 25 2.8 years 20 15 6 years 10 11 years 25 years 5 0 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 Source: DSHS data; analysis by JC Maxwell
  17. 17. Other Opiates OxyContin, Vicodin, Darvocet, hydrocodone, oxycodone, methadone, codeine, etc.
  18. 18. Source Where Pain Relievers Were Obtained for Most Recent Nonmedical Use among Past Year Users Aged 12 or Older: NSDUH 2006 Source Where Respondent Obtained Bought on Drug Dealer/ Internet Stranger 0.1% Other 1 More than 4% 5% Source Where Friend/Relative Obtained One Doctor More than One Doctor 2% 3% Free from One Doctor Free from Friend/Relative 19% Friend/Relative 7% 56% One Bought/Took from Doctor Friend/Relative Bought/Took 81% 5% from Friend/Relative 15% Drug Dealer/ Stranger Other 1 2% 2% 1 The Other category includes the sources: “Wrote Fake Prescription,” “Stole from Doctor’s Office/Clinic/Hospital/Pharmacy,” and “Some Other Way.”
  19. 19. Reason for Using Prescription Pain Relievers: PATS Attitude Tracking Study: 2005 • Easy to get from parents' medicine cabinets--62% • Available everywhere--52% • They are not illegal drugs--51% • Easy to get through other people's prescriptions--50% • Teens can claim to have a prescription if caught--49% • They are cheap--43% • Safer to use than illegal drugs--35% • Less shame attached to using--33% • Easy to purchase over the Internet--32% • Fewer side effects than street drugs--32% • Can be used as study aids--25% • Parents don't care as much if you get caught--21%
  20. 20. “SYRUP” in Texas Codeine cough syrup continues to be abused. Cut with Karo syrup, jolly ranchers, and soft drink. Rap music on syrup continues. Prepackaged to introduce to youths or ready to add the syrup?
  21. 21. New “Soft” Drinks: Drank and Lean Valerian Roots Melatonin Rose Hips “Slow Your Roll” “Slow Motion Potion”
  22. 22. SIZZURP Cognac, Vodka, and Fruit Flavor
  23. 23. COCAINE Still Around— with New Users
  24. 24. Cocaine • Indicators appear to be down. • Different routes of administration— Crack vs. powder. • Injecting cocaine and heroin either together or sequentially (“Speedball”) • Risky sexual behaviors while smoking crack and trading drugs for sex in crack houses. Impact on HIV/AIDS rates. • Changes in characteristics of users.
  25. 25. Race-Ethnicity of Texas Cocaine Admissions: 1993 v. 2009 Black White Hispanic 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Crack-93 Crack-09 IDU-93 IDU-09 Inhale-93 Inhale-09 Source: DSHS analysis by JC Maxwell
  26. 26. Marijuana
  27. 27. MARIJUANA • Indicators are fairly stable. • Influence of Blunts and Wraps • Use with Fry, PCP, DANK, crack, cough syrup, honey, etc., continues. • Continuing references to pot and PCP and embalming fluid (formaldehyde). • CJ v. Non-CJ treatment admissions
  28. 28. % Texas Secondary Students Who Had Used Marijuana in the Past Month, by Ethnicity: 1990-2008 25% 20% Anglos 15% African Americans 10% Hispanics 5% 0% Source: DSHS
  29. 29. Ways Texas Secondary Students Used Marijuana Most or Always: 2008 9% 8% 8% Joints 7% 6% 6% 6% Blunts 5% 4% Bongs 4% 3% 3% Pipes 2% Other Ways 1% 0% Joints Blunts Bongs Pipes Other Ways Source: DSHS
  30. 30. Relationship of Use of Tobacco, Marijuana & Blunts: 2008 Texas Secondary School Survey Tobacco Marijuana Cigars Ever Never 2.5% Never Ever 62.1% Ever Ever 72.4% Source: DSHS
  31. 31. Addiction Severity Index Problems of Texans Treated with Primary Marijuana Problem: 2009 Sub. Abuse Emotional Non-CJ Referral CJ Referral Social Family Employment Sickness 0.0 20.0 40.0 60.0 Source: DSHS; analysis by JC Maxwell
  32. 32. Cannabis Homologs • Synthetic pot containing compounds that mimic THC • Names include K2, K2 summit, spice, spice gold, spice silver, spice diamond, genie, zohai, space, skunk, yucatan fire, halo, black mamba, damiana, drolle. • Not detected in normal drug screens. • Still legal in most of the U.S. • Side effects include chest pain, tachycardia, skin pain, agitation, confusion, hyperventilation. DSHS, Mathias Forrester
  33. 33. Calls on Marijuana Homologs to Texas Poison Centers 1/1/10-4/31/10 • 36 exposures, 75% male, ages 14-38 • 86% intended to misuse or abuse • 75% using at own home • 33% minor & 33% moderate effect; 22% potentially toxic • 33% tachycardia, 17% vomiting, 14% confusion, 14% confusion Source: DSHS,, Mathias Forrester
  34. 34. SPICE
  35. 35. Alcohol
  36. 36. % of Past Month Alcohol Use Among 12 to 20: 2006 to 2008 24.5-27.4%
  37. 37. % of Past Month Drinkers 12 to 20 Who Purchased Their Own Alcohol Last Time they Drank: 2006 to 2008 8.4-10.1% 24.5-27.4%
  38. 38. % Past Month Alcohol Users in the U.S. Ages 12 to 20: 2005-2006 0% 10% 20% 30% 40% 50% 60% Total Aged 12 to 20 28% 12 to 17 17% 18 to 20 51% Male 29% Female 28% White 32% Hispanic 26% Black 19% SAMHSA, The NSDUH Report: Quantity and Frequency of Alcohol Use Among Underage Drinkers, 4/2008
  39. 39. Average # Drinks per Day on the Days Used Alcohol among Past Month U.S. Alcohol Users Ages 12 to 20: 2005-2006 0 2 4 6 8 Total Aged 12 to 20 4.9 Aged 12 to 17 4.5 Aged 18 to 20 5.2 Male 5.8 Female 4 White 5.3 Hispanic 4.9 Black 2.8 SAMHSA, The NSDUH Report: Quantity and Frequency of Alcohol Use Among Underage Drinkers, 4/2008
  40. 40. Percentage of Texas Secondary Students Who Reported They Normally Consumed Five or More Drinks at One Time, by Gender: 2000–2008 35% 32% 30% 30% 25% 26% 24% 23% 22% 22% 20% 20% Girls 18% 18% 15% Boys 10% 5% 0% 2000 2002 2004 2006 2003 Liu, L. Texas School Survey of Substance Use Among Students in Grades 7-12, DSHS.
  41. 41. Relationship Between Age of Onset of Drinking and Prevalence of DSM-IV Alcohol Abuse and Dependence: 1994 100 90 80 70 60 50 40 No Alcohol 30 Dependence 20 Abuse 10 0
  42. 42. Binge Drinking and Women • Women binge drinkers engaged in anal sex more often than women who drank alcohol without binges (33% vs. 16%) and 3 times the rate of women who abstained from alcohol (11%). • Having multiple sex partners was more than twice as common among women binge drinkers than women abstainers (41% vs. 17%). • Gonorrhea was nearly 5 times higher among women binge drinkers compared to women abstainers (11% vs. 2%). • Among men, rates of risky sexual behaviors/STDs were high, but did not differ by alcohol use. • The findings support the need to routinely screen for binge drinking as part of clinical care in STD clinics. • Women binge drinkers may benefit from interventions that jointly address binge drinking and risky sexual behaviors. • Developing gender-specific interventions could improve overall health outcomes in this population. Hutton, H. et al., (2008). The Relationship Between Recent Alcohol Use and Sexual Behaviors: Gender Differences Among Sexually Transmitted Disease Clinic Patients, Alcoholism: Clinical and Experimental Research
  43. 43. Texas STD Case Rates: 2009 10,000.0 1,000.0 Syphilis Male Syphilis Female 100.0 Gonorrhea Male Gonorrhea Female 10.0 Chlamydia Male Chlamydia Female 1.0 Source: DSHS
  44. 44. % of Weekend Nighttime Drivers with BACs>0.08g/dL or Positive for Drugs in the 2007 National Roadside Survey 16 14.4 14 12 10 % Drivers 8 6 4 2.2 2 0 Alcohol Drugs NHTSA Traffic Safety Facts, 2009
  45. 45. Primary Problem Substance of Texas DUI Admissions to Treatment 1996 2008 Alcohol Heroin 12% 5% Other Opiates Amphet/ Meth Powder Cocaine 67% 75% Cannabis Crack Cocaine Other Maxwell, Impaired Drivers at Admission to Substance Abuse Treatment, RSA Poster, 2006.
  46. 46. Sources of Amphetamine- Type Substances Sources of ephedrine Major producers of methamphetamine
  47. 47. # Methamphetamine Clandestine Laboratory Incidents and % of All Substances Identified That Were Methamphetamine in the US: 1999-2008 # Laboratory Incidents % of All Identified Substances 20000 18% 18000 16% 16000 14% 14000 12% 12000 10% 10000 8% 8000 6% 6000 4000 4% 2000 2% 0 0% 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 Source: NFLIS & DEA
  48. 48. Routes of Administration of Methamphetamine of Clients in Texas Programs: 1988-2009 90 80 70 60 50 Smoking 40 Inhaling 30 Injecting 20 10 0 DSHS data; analysis by JC Maxwell
  49. 49. Early Findings from NIDA Study of Meth in the Austin Area • Users from Austin and other states (CA, ARK, NY) report it’s very available • Powder called Pill Dope, Biker Dope, Bathtub Dope, Crank • Pseudoephedrine easy to obtain in Texas. Sudafeds==“Walfeds”==”Red Hots” Smurfers. • Different recipes for powdered meth. “One Pot” and “Shake and Bake”. BYO. • Ice can be made locally (like rock candy). String, cooler or fish tank, 30 days underground or in dark place, battery charger. Or lithium and copper tubing 52 Source Jane Maxwell
  50. 50. • Methylsulfonylmethane (MSM) being used to cut pure Ice. • Increases in injecting lower potency “home- made” instead of smoking high quality Ice. • Price: $100-120/gm. Ten “points” to a gram. • Taste: “Burns Bad, Tastes Terrible”. • Unclear of source (Mexico or local—or don’t want to say). Role of Mexican Mafia, La Familia, Aryan Brotherhood? • Clients had gained weight and looked good, but self-reports of rage, outbursts, mental obsessions, visions, shadow people, schizophrenic episodes prior to coming to treatment. Source: Jane Maxwell
  51. 51. FINALLY? • Based on previous drug epidemics, it appears we may have reached a point in the meth epidemic where we will see: a decreased number of initiates; communities with substantial numbers of addicts regardless of supply reduction efforts (like crack cocaine in the inner city); meth established with cocaine and heroin as major chronic drug problems, each with its own geography and specific user groups. • If this proves to be accurate, there will be increasing need for treatment for severely impaired addicts, including increased residential treatment capacity. 54
  52. 52. DOWNERS • Barbiturates (phenobarbital), benzos (diazepam-Valium, alprazolam- Xanax, clonazepam-Klonopin, lorazepam-Ativan, chlordiazepoxide- Librium). • Potentiate low-quality heroin (and seen in heroin overdoses) • Come down from speed or cocaine trips • Kids like Xanax (Four Bars).
  53. 53. % Texas Secondary School Students Who Had Ever Used a Prescription Drug for the Experience or Feeling: 2008 14 13 12 10 Percent 8 6 6 5 4 3 3 2 0 Codeine Oxycodone Vicodin Valium Xanax DSHS data
  54. 54. Admissions to Texas Treatment Programs by Primary, Secondary or Tertiary Problem with a Club Drug: 1988-2009 1600 1400 Ecstasy 1200 GHB 1000 Hallucinogens 800 Ketamine 600 Rohypnol 400 PCP 200 0 DSHS data; analysis by JC Maxwell
  55. 55. Ecstasy Indicators in Texas: 1998- 2009 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 PCC Calls Treatment DPS Labs Deaths
  56. 56. Texas Treatment Admissions with a Primary, Secondary or Tertiary Problem with Ecstasy: 1998-2009 White Hispanic Black 100% 80% 60% 40% 20% 0% DSHS data; analysis by JC Maxwell
  57. 57. Piperazines Including BZP & TFMPP • “A2”, “Frenzy”, • “Nemesis,” ”Pure”. • Stimulants which are combined to be alternative to Ecstasy & methamphetamine. • BZP is Schedule 1 but TFMPP is legal in US.
  58. 58. BZP, “P”, “Pure” • Texas DPS laboratory items of Benzylopiperazine (BZP) and trifluoromethylphenylpiperazine (TFMPP) identified. NFLIS
  59. 59. GHB/Fantasy Indicators in Texas: 1998-2009 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 1000 100 10 1 # PCC Calls # Treatment # DPS Labs # Deaths
  60. 60. DISSOCIATIVE DRUGS: PCP, Ketamine, DXM Distort perceptions of sight and sound and produce feelings of detachment, but not hallucinations (Zombie effect)
  61. 61. Salvia Divinorum • Family : Lamiaceae (mint) • Slang: Ska Maria Pastora, La Pastora, Yerba Maria, The Shepherdess, Diviner's Mint, Diviner's Sage • Most potent natural hallucinogen • Clinical: Visual distortions; feeling of unreality; depersonalization, dissociation; motor incoordination. • Many Salvia users try it only once because of unpleasant effects. • Route: chewed or smoked; onset 1 minute; duration 1 hour.
  62. 62. PCP Indicators in Texas: 1998-2009 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 10000 1000 100 10 1 # PCC # Houston # # DPS # Deaths Calls DAWN Treatment Labs
  63. 63. Phencyclidine • PCP, Angel Dust, Killer Weed • Dissolved in embalming fluid or ether (“Fry,” “Amp,” “Water, Water”). • Swallowed, sniffed, smoked on joints dipped in “Fry”. • Menthol cigarettes are dipped into liquid PCP or blunts are laced with powdered PCP. • Out of body strength.
  64. 64. KETAMINE • Anesthetic still occasionally used with humans; primarily known as horse or elephant tranquilizer. • Has stimulant and hallucinogenic properties. • Alters perceptions, leaving user feeling detached from themselves and others around them. • Snorted or swallowed: dose dependent.
  65. 65. Percent of Texas AIDS Cases Reported by Selected Modes of Exposure: 1987-2008 90% 80% 70% 60% MSM 50% IDU 40% M-M & IDU 30% Hetero 20% 10% 0% Source: DSHS
  66. 66. Texas Male and Female AIDS Cases by Race/Ethnicity: 1999-2008 100% 90% 80% 70% Hispanic Male 60% Black Male 50% 40% White Male 30% Hispanic Female 20% Black Female 10% White Female 0% Source: DSHS
  67. 67. WWW.UTATTC.NET

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