NATIONAL INSTITUTE ON DRUG ABUSE EPIDEMIOLOGIC ...

Key informants continue to report the widespread and
increasing use of blunts, especially utilizing flavored
cigars. The combination of marijuana and PCP continues
to be frequently reported. Blunts laced with
crack (called “Turbo”) are still common, but less so
than the marijuana/PCP combination. Blunt users
commonly ingest beer, wine coolers, whiskey, alprazolam,
or diazepam along with the blunt. Less commonly,
blunt smokers use powder cocaine, vodka,
barbiturates, clonazepam, oxycodone, cough syrup,
and/or methamphetamine. These comments by users
continue to underscore the common practice of multiple
drug use, either simultaneously or sequentially.
According to the National Drug Intelligence Center,
the retail/street-level prices per bag of marijuana
ranged from $5 to $35 in the first half of 2004.
Phencyclidine (PCP)
PCP began to gain popularity as an additive to blunts
in 1994, and its use has increased since 2000. Users
describe its effects as making them hallucinate and
feel “invincible,” “crazy,” “numb,” or “violent.”
In the unweighted data from DAWN Live!, there
were 129 reports of PCP among cases categorized as
“seeking detox” (n=14), “suicide attempt” (n=9), or
“other” (n=115) in the first half of 2004 (exhibit 1).
PCP was detected in 441 decedents from 1994 through
the first half of 2004, making it the fifth most frequently
detected drug during that time period, behind
cocaine, heroin/morphine, alcohol-in-combination, and
diazepam (exhibit 2).
In 2003, PCP was mentioned as a primary, secondary,
or tertiary drug by 4.3 percent of all treatment admissions.
The average number of drugs of abuse mentioned
by primary PCP treatment admissions was 1.92.
In the first half of 2004, PCP was mentioned as primary,
secondary, or tertiary drug in 4.6 percent of all
adissions, and the average number of drugs of abuse
mentioned by primary PCP treatment admissions was
1.89.
Urinalysis data of booked arrestees from Philadelphia’s
APPD in the first half of 2004 showed that 4.1
percent (n=1,023) of the 25,178 tested arrestees in the
sample were positive for PCP, making this drug the
sixth most frequently detected drug by APPD.
PCP remains readily available. It is more commonly
found on mint leaves for use in lacing blunts or for
rolling and smoking. Additionally, some users prefer
PCP in liquid form that is used by applying the drug
EPIDEMIOLOGIC TRENDS IN DRUG ABUSE—Philadelphia
to cigarettes. This method is referred to as “sherms”
or “dip sticks.”
Benzodiazepines
Benzodiazepines, particularly alprazolam (Xanax)
and diazepam (Valium), continue to be used in combination
with other drugs.
There were 1,015 reports of benzodiazepines in the
unweighted data from DAWN Live! for the first half of
2004. The leading case types for this class of drugs
were “overmedication” (n=361), “other” (n=350), “suicide
attempt” (n=138), and “seeking detox” (n=135).
Diazepam, having been detected by the ME in 559
decedents from 1994 through the first half of 2004,
ranks fourth among drugs present in mortality cases
in Philadelphia (exhibit 2). While users new to treatment
report that diazepam has become less popular in
recent years, alprazolam use has increased. Alprazolam
tied for the 12th most frequently detected drug
among decedents by the Philadelphia ME (n=244)
from 1994 through the first half of 2004, including 31
cases in the lattermost half-year.
Treatment admission reports for 2003 and the first
half of 2004 show benzodiazepines as primary drugs
of abuse in 67 and 19 cases, respectively (exhibit 4);
these drugs were reported as secondary or tertiary
drugs of abuse in 382 additional cases in 2003 and
172 additional cases in the first half of 2004. Most of
the reports of benzodiazepines as secondary or tertiary
drugs of choice indicated that heroin was the primary
drug. Those who reported using benzodiazepines
as their primary drugs of abuse used an average
of 2.0 drugs in 2003 and 1.63 drugs in the first half of
2004. Benzodiazepine abuse was reported by focus
group participants as common among users of heroin,
oxycodone, cocaine, marijuana, and cough syrup.
Since spring 2000, all focus groups have reported that
alprazolam has overtaken diazepam as the “most
popular pill” on the street.
Deaths with the presence of oxazepam (Serax) have
been increasing. There were 16 positive toxicology
reports for oxazepam in 2003 and 24 in the first half of
2004 (exhibit 2). In the 10½-year period, 1994 through
mid-2004, 153 mortality cases tested positive for this
drug, making oxazepam the 19th most frequently detected
drug.
Deaths with the presence of olanzapine (Zyprexa)
have been increasing. In 2003, there were 43 positive
toxicology reports for olanzapine, and there were 18
in the first half of 2004. In the 10½-year period, 1994
through mid-2004, 137 mortality cases tested positive
Proceedings of the Community Epidemiology Work Group, Vol. II, January 2005 187