NATIONAL INSTITUTE ON DRUG ABUSE EPIDEMIOLOGIC ...

the following characteristics: more than one-half of
the patients were Caucasian, and nearly 60 percent of
the patients were older than 35. The top two reasons
for the ED visit were seeking detox or psychiatric
condition. The dispositions for most of the cases included
referral to treatment, admission to the psychiatric
unit, or discharge to home. Only three of the
cases reported resulted in immediate death.
Among treatment admissions for illicit drug abuse in
the first half of 2004, the proportion for primary cocaine
abuse reflected a slight decrease compared with
all of 2003 (exhibit 1a). Cocaine remained the most
common primary drug of abuse among all admissions
(33.6 percent), followed by marijuana (29.6 percent)
and heroin (10.8 percent). In the first half of 2004,
the typical cocaine admission was an African-
American male age 35 or older who smoked the drug.
Although the DEA’s emphasis has shifted from cocaine
to methamphetamine and heroin, law enforcement
sources, the DEA, and street informants continued
to report high quality, wide availability, and low
prices for cocaine. Cocaine is used and most available
in the urban areas. Powder cocaine grams sold
for $100–$125; purity averaged 70 percent (exhibit
1b). Crack prices remain at $20 per rock on the street
corner. All cocaine in St. Louis is initially in the
powder form and is converted to crack for distribution.
Cocaine was readily available on the street corner
in rocks or grams. The price of a gram of crack in
Kansas City was lower than in St. Louis at $100–
$120. The “rock” price is the same in smaller cities
outside St. Louis when it is available, but the gram
price is higher.
The continued use of cocaine has potentially severe
long-term consequences by contributing to the spread
of sexually transmitted diseases (STDs) through multiple
partners. Drug and alcohol use continues to contribute
to unsafe sex and multiple partners. Crack
cocaine is considered to be a primary risk for HIV in
many research trials.
Most cocaine users smoke crack cocaine, though
some use powder cocaine. Only injection drug users
(IDUs) who combine cocaine and heroin (“speedball”)
use cocaine intravenously. Younger users tend
to smoke cocaine. Polydrug use is also evident in the
treatment data. The reported use of marijuana, heroin,
and alcohol in addition to cocaine suggests this trend
will likely continue.
Heroin
Heroin-related deaths reported by the St. Louis
City/County ME leveled off in recent years. In 2003,
EPIDEMIOLOGIC TRENDS IN DRUG ABUSE—St. Louis
there were 61 heroin-related deaths (exhibit 1a).
Statewide heroin deaths caused by overdose alone
were not much higher, because heroin purity is higher
in the St. Louis area than in other cities in Missouri
and heroin is available primarily in the St. Louis and
Kansas City areas. More heroin deaths occurred in St.
Louis County than in the inner city in 2000–2002;
these deaths support other reports that heroin use is
increasing in the suburbs.
Heroin consistently appears in all indicators. In the
unweighted data accessed from DAWN Live!, heroin
ED reports for 2004 indicated that almost 61 percent of
the patients were Caucasian, 22.5 percent were between
the ages of 18 and 24, and 50 percent of the 560
ED reports were for detoxification or withdrawal. Heroin
ED mentions had risen steadily from 1995 to 2002,
when mentions totaled 1,167. The increase in heroin
mentions among many age groups over the 7 yearperiod
(1995–2002) indicates the wide availability of
this drug in this MSA. Among those who made ED
mentions of heroin in 2002, the three top reasons for
seeking medical intervention were overdose, withdrawal,
and seeking detoxification.
While heroin treatment admissions increased dramatically
as a proportion of all admissions between
1996 and 2000, they leveled off in 2001–2003. In the
first half of 2004, this trend appeared to continue.
There are limited slots for admissions to State-funded
methadone or modified medical detoxification in
Missouri, which may influence these data. While
heroin availability increased throughout the region,
the decrease in admissions may in fact be a result of
lack of adequate treatment resources; alternatively,
the new users of heroin have not yet been driven to
treatment. When queried, private treatment programs
stated that 25 percent of their admission screens were
for heroin abuse, but admission depended on “ability
to pay.” Some heroin abusers in need of treatment
utilize “private pay” methadone programs. Rapid
detoxification, using naltrexone, is still a treatment
option at private hospitals, but it is expensive. About
37 percent of heroin admissions were younger than
25 in the first half of 2004. Of all heroin admissions,
intravenous use was the primary method of administration
in St. Louis County, but inhalation was more
popular among admissions in St. Louis City. The
increased availability of higher purity heroin has led
to a wider acceptance of the drug in social circles.
One of the reasons for its acceptance is that it does
not have to be injected to get the desired effects.
A steady supply of Mexican heroin remains available.
The DEA has made buys of heroin in the region in
addition to buys through the DMP. Mexican black tar
heroin showed a peak of 24.0 percent purity in 1998;
Proceedings of the Community Epidemiology Work Group, Vol. II, January 2005 213