NATIONAL INSTITUTE ON DRUG ABUSE EPIDEMIOLOGIC ...

that crack sells for about $28,000–$30,000 per kilogram,
$800–$1,600 per ounce, $27–$45 per gram, and
$7–$10 per rock.
DAWN figures for cocaine-involved deaths, which declined
steadily from 1995 to 1999, showed a 26-percent
increase in 2000 (to 492 from 394 in 1999) (exhibit 1).
For the cocaine drug-related deaths in 2000, 40 percent
involved one drug, 36 percent involved two drugs, 16
percent involved three drugs, and 8 percent involved
four or more drugs. No DAWN mortality data were
available for 2001, but in 2002, there were 421 deaths,
more than for any other drug in New York City DAWN
data.
The NYPD reports a decline in cocaine arrests since
1995 (n=40,846) (exhibit 1). The number of cocaine
arrests in 2002 was 13,574, a 67-percent decrease since
1995. Of the cocaine arrests in 2002, 79 percent involved
crack.
Another important indirect indicator of cocaine involvement
is the number of births in New York City to
women who admit using cocaine during pregnancy.
This not only indicates use among women, but it underscores
a serious aspect of the cocaine problem. For
several years, the number of women using cocaine during
pregnancy increased. In 1989, the number of births
to women who used cocaine peaked at 3,168. After
1989, the number steadily declined to 354 in 2003—an
89-percent decline over 14 years (exhibit 1). It should
be noted, however, that the change between 2002 and
2003, 2 percent, is the smallest decline in recent years.
Heroin
Heroin indicators generally increased during this reporting
period (exhibit 3). The number of heroin ED
mentions in the New York metropolitan area remained
relatively stable between 1995 (n=10,706) and 2002
(10,397). The New York metropolitan area recorded a
rate of 123 heroin mentions per 100,000 population for
2002, almost the same as the rate for 2001 (127). The
estimated national rate was 36 heroin mentions per
100,000 population.
Primary heroin admissions to treatment programs in
New York City gradually increased between 1995 and
2003, from 18,287 to 23,563, a 23-percent increase
(exhibit 3). In the first half of 2004, primary heroin
admissions remained at the same level as in the previous
year, 11,878, and constituted 34 percent of New
York City’s 34,676 drug and alcohol treatment admissions
(excluding alcohol-only).
Intranasal heroin use may have peaked in the second
half of 1998, with 62 percent of heroin admissions to
168
EPIDEMIOLOGIC TRENDS IN DRUG ABUSE—New York City
all New York City drug treatment programs reporting
this as their primary route of administration. Since then,
the proportions reporting intranasal use declined
slightly, to 60 percent in 1999 through 2002, 59 percent
in 2003, and 61 percent in the first half of 2004.
Meanwhile, heroin injection increased among heroin
admissions, from 32 percent in the second half of 1998
to 37 percent in 2003, and 36 percent in the first half of
2004.
Exhibit 4 highlights general demographic characteristics
of heroin abusers admitted to all New York City
treatment programs in the first half of 2004 by mode of
use. In general, primary heroin admissions were overwhelmingly
male (75 percent), older than 35 (71
percent), more likely to be Hispanic (53 percent) than
Black (26 percent) or White (18 percent), usually readmissions
to treatment (88 percent), and likely to
report cocaine as a secondary drug of abuse (38 percent).
Compared with heroin injectors, intranasal users
were more likely to be Black (32 vs. 16 percent) and
have some criminal justice status (36 vs. 26 percent). In
contrast, primary heroin injectors were more likely than
intranasal users to be White (30 vs. 11 percent), to report
cocaine as a secondary drug of abuse (45 vs. 35
percent), and to have started use before reaching age 20
(56 vs. 41 percent).
In addition to heroin admissions to traditional treatment
programs, heroin admissions for detoxification or crisis
services in New York City have become sizable in
number. These special services are usually short term,
provided in a hospital or community-based setting, and
medically supervised. In 1995, 4,503 such admissions
were reported for heroin abuse; by 2003 that figure
increased to 16,058, essentially the same as in 2002
(16,083). In the first half of 2004, the number of admissions
to crisis services for heroin was 8,350.
DAWN medical examiner (ME) figures for heroininvolved
deaths in the New York City metropolitan
area show a pattern of steady increases since 1999 (exhibit
3). In 1999, there were 174 such deaths, and in
2000, there were 194 heroin-involved deaths. No
DAWN mortality data were available for 2001, but in
2002, there were 224 heroin-involved deaths.
ADAM urinalysis data show fewer adult arrestees testing
positive for opiates than for marijuana or cocaine.
In 2003, 23.3 percent of females tested opiate-positive,
as did 15.0 percent of males. The percentage for New
York City females was the highest for the 10 CEWG
areas where adult females were tested in 2003.
NFLIS data show that 14 percent of the cases for New
York City in 2004 (9,071) were related to heroin.
Proceedings of the Community Epidemiology Work Group, Vol. II, January 2005