NATIONAL INSTITUTE ON DRUG ABUSE EPIDEMIOLOGIC ...

EPIDEMIOLOGIC TRENDS IN DRUG ABUSE—St. Louis
Patterns and Trends in Drug Abuse in St. Louis
Heidi Israel, Ph.D., R.N., L.C.S.W., 1 and Jim Topolski, Ph.D. 2
ABSTRACT
Heroin and cocaine indicators remained mixed,
while methamphetamine has increased in St. Louis
indicators. St. Louis and St. Louis County law enforcement
personnel continue to devote many resources
to methamphetamine, and labs in rural areas
continued to be a problem. Club drug use/abuse
continued to be sparse and decreasing. Marijuana
indicators have been trending up in St. Louis for
some time. Primary marijuana treatment admissions
more than doubled between 1997 and 2001
and remained at this elevated level. In the St. Louis
area, 5 percent of HIV cases had a risk factor of
injection drug use, and another 5 percent were
among men who have sex with men and also inject
drugs.
INTRODUCTION
Area Description
The St. Louis metropolitan statistical area (MSA)
includes approximately 2.6 million people living in
the city of St. Louis; St. Louis County; the surrounding
rural Missouri counties of Franklin, Jefferson,
Lincoln, St. Charles, and Warren; in Illinois, East St.
Louis; and St. Clair County. St. Louis City’s population
has continued to decrease to approximately
350,000, many of whom are indigent and minorities.
Although violent crime has generally decreased, it
remains high in drug-trafficking areas. St. Louis
County, which surrounds St. Louis City, has more
than 1 million residents, many of whom fled the inner
city. The county is a mix of established affluent
neighborhoods and middle and lower class housing
areas on the north and south sides of the city. The
most rapidly expanding population areas are in St.
Charles and Jefferson Counties in Missouri and St.
Clair and Madison Counties in southern Illinois,
which have a mixture of classes and both small towns
and farming areas. The populations in these rural
counties total more than 800,000. The living conditions
and cultural differences have resulted in contrasting
drug use patterns.
Much of the information included in this report is
specific to St. Louis City and County, with caveats
that apply to the total MSA. Anecdotal information
and some treatment data are provided for rural areas
and for the State. Limited data are also available for
other parts of Missouri and offer a contrast to the St.
Louis drug use picture.
Policy Issues
Methamphetamine production and use is a major
concern for both law enforcement and the legislature.
Small labs continue to place a hardship on law enforcement
in terms of personnel and resources. The
legislature has taken bold moves to require precursor
drugs, such as pseudoephedrine, that are sold in local
retail stores to be locked up or placed behind pharmacy
counters. While this policy may now slow
down local producers, it does not address the major
source of methamphetamine in the Midwest—a fact
that gets lost in the local problem of small “mom and
pop” lab seizures.
Missouri has been in a budget crisis for years, and St.
Louis County has more recently reported budget
deficits and resulting cuts in services. The areas that
suffer first are psychiatric services and treatment services.
Limited treatment continues to be available for
drug abusers. The addiction model as understood
through experience and research has shown that
treatment services are cost effective to both society
and the individual, yet the trend is to not offer these
services. The result is that some of these indicators
cannot fully reflect the degree of use or abuse of the
substances tracked.
Data Sources
The sources used in this report are indicated below:
Emergency department (ED) data were accessed
from the Drug Abuse Warning Network
(DAWN) Live!, a restricted-access online system
administered by the Office of Applied Studies
(OAS), Substance Abuse and Mental Health
Services Administration (SAMHSA). The unweighted
data are for 2004, updated in December
1 Dr. Israel is affiliated with the Division of Infectious Diseases, Saint Louis University Medical School, St. Louis, Missouri.
2 Dr. Topolski is affiliated with the Division of Evaluation, Policy, and Ethics, Missouri Institute of Mental Health, St. Louis, Missouri.
Proceedings of the Community Epidemiology Work Group, Vol. II, January 2005 211