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• The city of Atlanta has become an important strategic point for drug trafficking organizations as it is the largest city in the South. It is considered a convenient nexus for all east/west and north/south travel. The city’s major international airport also serves as a distribution venue for illicit substances. • The entire State, Atlanta in particular, has experienced phenomenal growth over the last several years, with a corresponding increase in drug crime and violence. With Georgia bordering North Carolina, South Carolina, Tennessee, Alabama, and Florida, Atlanta is the base for several major dealers who maintain trafficking cells in these States, especially Mexican-based traffickers who hide within legitimate Hispanic enclaves. Data Sources Principal data sources for this report include the following: • Emergency department (ED) data for January through October 2004 were accessed through the Drug Abuse Warning Network (DAWN) Live! restricted-access online query system, which is administered by the Office of Applied Studies (OAS), Substance Abuse and Mental Health Services Administration (SAMHSA). Thirty of the 33 eligible hospitals in the Atlanta metropolitan area are in the DAWN sample. There are 3 more EDs than hospitals in the sample, bringing the total number of EDs to 33. The data reported in this paper were not complete. During the 10-month period, between 18 and 19 EDs reported data to DAWN each month. The data in this paper were updated by OAS on January 17, 2005; they are unweighted and are not estimates for the Atlanta area. Since all DAWN cases are reviewed for quality control, and may be corrected or deleted, the data reported here are subject to change. The information derived from DAWN Live! represent drug reports in drug-related visits; reports exceed the number of ED visits because a patient may report use of multiple drugs (up to six drugs and alcohol may be represented in DAWN). These data cannot be compared with DAWN data from 2002 and before, nor can these preliminary data be used for comparison with future data. Only weighted ED data released by SAMHSA can be used for trend analysis. A full description of the DAWN system can be found at the DAWN Web site . • Drug abuse treatment program data are from the Georgia Department of Human Resources for 8 EPIDEMIOLOGIC TRENDS IN DRUG ABUSE—Atlanta primary drugs of abuse among clients admitted to Atlanta’s public drug treatment programs between January and June 2004. Data for nonmetropolitan Atlanta counties of Georgia were also reported. • Drug price, purity, and trafficking data are from the Drug Enforcement Administration (DEA), the National Drug Intelligence Center (NDIC), and the Office of National Drug Control Policy (ONDCP). Information for 2004 on the price, purity, and source of several drugs was provided by the DEA’s Domestic Monitoring Program (DMP). Additional information came from Narcotics Digest Weekly published by the NDIC. Other data are from the Atlanta High Intensity Drug Trafficking Area (HIDTA) Task Force, a coordination unit for drug-related Federal, State, and local law enforcement agencies. • Forensic drug analysis data are from the National Forensic Laboratory Information System (NFLIS) and represent evidence in suspected drug cases throughout metropolitan Atlanta that were tested by the GBI Forensic Laboratory from October 2003 through September 2004. • Ethnographic information was collected from local drug use researchers and is used for several purposes: (1) to corroborate the epidemiologic drug indicators, (2) to signal potential drug trends, and (3) to place the epidemiologic data in a social context. • Acquired immunodeficiency syndrome (AIDS) data are from the Department of Human Resources and represent AIDS cases in Georgia and a 20-county Atlanta metropolitan from January 1981 through August 2004. Additional information was provided by the Centers for Disease Control and Prevention (CDC). DRUG ABUSE PATTERNS AND TRENDS Cocaine/Crack With 4,582 unweighted ED reports accessed from DAWN Live! for January through October 2004, cocaine was the most frequent illicit drug reported in the metropolitan Atlanta area (exhibit 1). Cocaine ED reports were higher among men than women (exhibit 2), with a ratio of 2.4:1. The cocaine ED reports involved 765 White patients, 2,804 African-Americans, 55 Hispanics, and 958 patients of unknown race/ethnicity. Cocaine ED reports representing patients between the ages of 35 and 54 totaled 3,041 (67 percent Proceedings of the Community Epidemiology Work Group, Vol. II, January 2005
of all ED reports). Exhibit 3 shows the unweighted number of DAWN cocaine reports in 2004 by month. From January through June 2004, cocaine continued to be the primary drug of choice for individuals seeking assistance at publicly funded treatment centers in metropolitan Atlanta. However, the number of primary admissions in metropolitan Atlanta for cocaine (n=1,756) in this period reflects a leveling off of a 2year trend that represented a lower percentage of cocaine-related admissions. From 2000 to 2002, approximately one-half of all treatment admissions in metropolitan Atlanta were cocaine related. In 2003, this percentage decreased to 40 percent, and in the first 6 months of 2004, cocaine-related admissions remained at 40 percent of all admissions. The ratio of men to women in treatment for cocaine was 1.37:1, a proportion that was considerably lower than the 1.65:1 found in 2003. Approximately three-fourths of cocaine admissions in metropolitan Atlanta were African-Americans. The other fourth were mainly Whites, with Hispanics representing nearly 1 percent. This distribution across racial/ethnic groups in 2004 was nearly identical to the demographics of admissions for cocaine in metropolitan Atlanta from the previous year. Whites accounted for a larger proportion of statewide cocaine treatment admissions outside metropolitan Atlanta. Whites represented 45 percent of the treatment population outside the Atlanta area, and African-Americans represented 55 percent. Non-metropolitan Atlanta cocaine admissions, however, increased by 26.4 percent in the first 6 months of 2004. In this same period, those older than 35 accounted for the largest number of nonmetropolitan cocaine admissions (n=3,677). In Atlanta, there was a 31-percent increase in admissions among those age 18–25 and an 18-percent increase in admissions among those age 26–34 from January to June 2004. In the first half of 2004, fewer Atlanta cocaine admissions used the drug orally, and there was an 11-percent increase in injection as a preferred route of cocaine administration. Smoking continued to be the most preferred route; it was reported by nearly 76 percent of those admitted for cocaine treatment. According to the DEA and Atlanta HIDTA, cocaine remains readily available in Atlanta. Atlanta is a growing distribution hub for surrounding States and Europe. Atlanta also serves as part of a smuggling corridor along the east coast. Powder cocaine and crack dominate the Georgia drug scene. The primary sources for cocaine are Texas and California. HIDTA intelligence analysts implicate Mexico-based drug trafficking organizations, whose members blend within enclaves of Hispanic workers. According to EPIDEMIOLOGIC TRENDS IN DRUG ABUSE—Atlanta HIDTA and NDIC, prices remain relatively stable in Atlanta. Powdered cocaine typically sells for $75– $100 per gram. Crack rocks sell for as little as $3. In 2003, members of the Atlanta HIDTA Task Force seized 186.69 kilograms of powdered cocaine and 7.56 kilograms of crack cocaine. Both quantities were similar to what was seized in 2002. The Georgia Threat Assessment (DEA 2003) reports that other than marijuana, crack is the most widely available drug in the city. Officials estimate that 75 percent of all drug-related arrests involve crack cocaine. However, crack has become more difficult for undercover officers to purchase, and it seems to have decreased somewhat in popularity. Powder cocaine availability at the retail level in Georgia is limited, except in large cities such as Atlanta. NFLIS reported that cocaine accounted for approximately 40 percent of confiscated substances in suspected drug cases that were tested in forensic laboratories between October 2003 and September 2004 (exhibit 4). Heroin The indicators of heroin use in Atlanta are mixed. However, ethnographic data obtained through corroboration with local street outreach workers suggests that heroin use is increasing. The preliminary unweighted data accessed through DAWN Live! show that the number of ED reports of heroin from January through October 2004 (n=413) was less than the number of reports for cocaine, marijuana, methamphetamine, and benzodiazepines (exhibit 1). A sizeable majority of the heroin ED reports involved males (exhibit 2), with a 3.6:1 male-tofemale ratio. Heroin ED reports involving African- Americans exceeded those for Whites (1.6:4). The ED heroin reports involving Hispanics hovered around 1 percent (n=5). More than one-half of all the heroin reports represented patients between 35 and 54 years of age (n=230). Twelve percent of reports involved patients age 18–24. The reasons for contact with the emergency departments tended to be seeking detoxification or mental status concerns. Data on visit characteristics show that 21 percent of Atlanta heroin-involved ED patients were referred to detox/treatment (compared with 13 percent nationally), and 19 percent were admitted to psychiatric or other inpatient units (similar to the national percentage). Although injection was by far the most frequent route of heroin administration, approximately 10 percent of heroin-involved patients with a documented route of administration reported inhaling, sniffing, or snorting their heroin. As shown in exhibit 3, heroin ED reports peaked in July 2004 at 57. Proceedings of the Community Epidemiology Work Group, Vol. II, January 2005 9
Page 1 and 2: NATIONAL INSTITUTE ON DRUG ABUSE EP
Page 3: Foreword This publication includes
Page 6 and 7: EPIDEMIOLOGIC TRENDS IN DRUG ABUSE
Page 8 and 9: 2 EPIDEMIOLOGIC TRENDS IN DRUG ABUS
Page 11: Epidemiology of Drug Abuse: CEWG Ar
Page 16 and 17: In the first 6 months of 2004, trea
Page 18 and 19: eports (exhibit 2), while African-A
Page 20 and 21: population) than in 2002 (17.2 per
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Page 24 and 25: EPIDEMIOLOGIC TRENDS IN DRUG ABUSE
Page 26 and 27: data from the Drug Abuse Warning Ne
Page 28 and 29: than age 18, compared to 4 percent
Page 30 and 31: More often than not, marijuana use
Page 32 and 33: Solomon, L.; Flynn, C.; Muck, K.; e
Page 44 and 45: • Logan International Airport and
Page 46 and 47: In 2002, heroin/morphine was indica
Page 48 and 49: The FY 2004 racial distribution for
Page 58 and 59: • Emergency department (ED) drug
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Page 62 and 63: Between 2001 and 2003, the Illinois
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In the NIHU Study, 20 percent of pa
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Ecstasy remained available in most
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62 EPIDEMIOLOGIC TRENDS IN DRUG ABU
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EPIDEMIOLOGIC TRENDS IN DRUG ABUSE
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66 and analyzed by the Division of
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ounce in the Denver metropolitan ar
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18 at the time of admission to trea
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Injecting had been the most common
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alcohol; 651 involved alcohol-in-co
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The economy in Hawai'i, after a dec
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Methamphetamine remains the leading
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methamphetamine, representing 76.5
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Of interest in this chart is the ag
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98 weighted DAWN data released by S
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A total of 5,425 cocaine arrests wa
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data, however, rising from 1.5 perc
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According to NDIC, California and M
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and 15 items were identified as pse
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most frequently reported secondary
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esidents are living with advanced H
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112 EPIDEMIOLOGIC TRENDS IN DRUG AB
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(DAWN) that monitors emergency depa
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Beginning in 2003, SAMHSA’s natio
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65 percent were older than 34. The
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the 1,198 drug abuse ED reports in
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“Crystal” or smokeable methamph
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tion was injection (62.9 percent),
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included reports of ED cases involv
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From November 10 to 16, 2004, 18 me
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NFLIS between October 2003 and Sept
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from 12.2 percent in the first half
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156 2003. Anecdotal information on
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Brownsville, and El Paso. African-A
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ground economy, it was estimated th
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According to street interviews, mos
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that crack sells for about $28,000-
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Benloton, X-man, 911, Lean Back, Se
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DAWN ME mentions for marijuana-invo
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ecstasy. MDMA ED mentions may be st
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the deaths, while Whites constitute
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2000 reported that the average hero
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for this drug, making olanzapine th
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ADHS/DBHS reported that more than o
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Marijuana is widely available in Ar
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212 2004. Data from 2000-2002 DAWN
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purity dropped to 14.4 percent in 2
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No recent GHB incidents or deaths w
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correspond to decreases in total ad
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228 reports in drug-related visits;
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Marijuana Arrests for marijuana-rel
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positivity. UHS staff believe, on t
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236 are not estimates for the repor
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were evident. Excluding missing dat
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The characteristics of other opiate
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June 2004 (exhibit 6c). A minority
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Deaths involving depressants were a
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imipramine) are an older class of m
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The term “lag” refers to the pe
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costs $1,200-$1,500, compared with
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ties. In the DFW area, Mexican mari
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The 2004 secondary school survey re
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nio and two 2-ounce bottles cost $1
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age may be partially due to the fac
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York and Miami (Pach et al. 2002).
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In 2003, heroin was the primary sub
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opolitan Police Department report t
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International Report
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Among GTC patients, marijuana was t
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Others (63.8 percent) were using a
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Panel on Methamphetamine Abuse: NID
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Appendix A New Drug Abuse Warning N
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DAWN LIVE! The new DAWN includes ca
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Participant List National Institute
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Janie B. Dargan, M.S.W. Policy Anal
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Martin P. Paulus, M.D. Associate Pr
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