NATIONAL INSTITUTE ON DRUG ABUSE EPIDEMIOLOGIC ...

purity dropped to 14.4 percent in 2003 and averaged
10–14 percent in 2004. South American (Colombian)
heroin, which is also white, is of poorer quality. Most
heroin is purchased in aluminum foil or the number-5
gel capsule (one-tenth-gram packages of heroin in
plastic wrap and aluminum foil) for $10 (exhibit 1b).
Heroin costs range from $1.00 per milligram to $1.93
per milligram for Mexican heroin in the recent DMP
analysis. The city is an end-user market and is dependent
on transportation of the heroin from points of
entry into the Midwest. The wholesale price remains
at $250–$600 per gram. On street corners, heroin
sells for $250 per gram. Most business is handled by
cellular phone, which has decreased the seller’s need
to have a regular location. Thus, the risk of being
arrested has declined. In St. Louis and other smaller
urban areas, small distribution networks sell heroin.
Kansas City’s heroin supply differs from that of St.
Louis. Most heroin in Kansas City is black tar and is
typically of poorer quality. The supply is consistent,
and a $10 bag of heroin is available. Heroin has also
become available in the smaller, more rural cities of
Springfield and Joplin, each of which has a small IDU
population that uses heroin and methamphetamine.
Other Opiates/Narcotics
OxyContin (a long-lasting, time-release version of
oxycodone) abuse remained a concern for treatment
providers and law enforcement officials. Prescription
practices are closely monitored for abuse, and isolated
deaths have been reported, but no consistent
reports are available on the magnitude of this potential
problem. OxyContin costs $40 for an 80-milligram
tablet on the street (exhibit 1b).
Other opiates continue to represent less than 1 percent
of all treatment admissions. Methadone remains available,
which is probably a result of prescription abuse
as well as patient diversion.
The use of hydromorphone (Dilaudid) remained
common among a small population of White chronic
addicts. The drug costs $30–$75 per 4-milligram pill.
Abuse of oxycodone (Percocet and Percodan) by prescription
has been noted anecdotally.
Marijuana
In the unweighted data from DAWN Live!, marijuana
ED reports in 2004 represented 23 percent of the total
ED reports for drugs of abuse. In 2002, ED marijuana
mentions were high at 2,866 (exhibit 1a), a significant
62.6-percent increase over 2000. More than 44
percent of the patients in 2004 were younger than 25.
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EPIDEMIOLOGIC TRENDS IN DRUG ABUSE—St. Louis
Marijuana treatment admissions more than doubled
from 1997 (1,573 admissions) to 2001 (3,210 admissions)
and remained stable in 2003 and the first half
of 2004, when they represented 27.2 percent and 29.6
percent of all admissions, respectively (exhibit 1a).
Marijuana, viewed by young adults as acceptable to
use, is often combined with alcohol. The 25-andyounger
age group accounted for 65.6 percent of
primary marijuana treatment admissions in the first
half of 2004. Some of the prevention organizations
report a resurgence in marijuana popularity and a
belief by users that it is not harmful.
Because of the heroin, cocaine, and methamphetamine
abuse problems and the recent “club drug”
scare in St. Louis, law enforcement officials have
focused less attention on marijuana abuse. Limited
resources require establishing enforcement priorities.
Often, probation for marijuana offenders requires
participation in treatment for younger users who do
not identify themselves as drug dependent. In focus
groups with African-American adults from various
social groups, more than one-half identified regular
use of marijuana but did not identify this use as problematic.
This ethnographic information supports the
idea of cultural acceptance of marijuana use.
Marijuana is available from Mexico or domestic indoor
growing operations. Indoor production makes it
possible to produce marijuana throughout the year. In
addition to the Highway Patrol Pipeline program,
which monitors the transportation of all types of
drugs on interstate highways, Operations Green Merchant
and Cash Crop identify and eradicate crops.
Much of the marijuana grown in Missouri is shipped
out of the State.
In 2004, 1 pound of sinsemilla sold for $700–$1,800
in St. Louis (exhibit 1b).
Stimulants
Methamphetamine, along with alcohol, remained a
primary drug of abuse in both the outlying rural areas
and statewide. (Most of Missouri, outside of St. Louis
and Kansas City, is rural.) Methamphetamine continued
to be identified as a huge problem in rural communities.
In the unweighted 2004 DAWN Live! data, methamphetamine
ED reports totaled 150. Ninety-one percent
were Caucasian, with no predominant age group. ED
methamphetamine mentions in St. Louis increased in
the late 1990s and totaled 150 in 2002 (exhibit 1a).
Methamphetamine (“crystal” or “speed”) was found at
very low levels in city indicators in 1995, but reported
Proceedings of the Community Epidemiology Work Group, Vol. II, January 2005