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EPIDEMIOLOGIC TRENDS IN DRUG ABUSE—San Diego County, California Drug Abuse Patterns and Trends in San Diego County, California Michael Ann Haight, M.A. 1 ABSTRACT San Diego continues to be one of the epicenters for methamphetamine abuse in the Nation. Fifty-one percent of the 2004 treatment admissions (excluding alcohol) were for primary methamphetamine abuse, up from 47 percent in 2001. Male methamphetamine admissions have increased with the passage of Proposition 36, which mandates treatment for persons arrested on drug charges. Cocaine/crack indicators remained relatively stable in 2004 over the prior 9 years; however, this stimulant remains a serious problem in San Diego. Marijuana also continues to be a serious problem, accounting for nearly 51 percent of drug items analyzed by forensic labs in FY 2004 and for nearly one-quarter of the primary illicit drug admissions in 2004. INTRODUCTION Area Description In 2000, more than 2.8 million persons resided in San Diego County (exhibit 1). More than one-half (55 percent) were White and 27 percent were Hispanic. Projections in 2004 show an increase in the county population to slightly more than 3.0 million, a decrease in the White population (to 52 percent) and a slight increase (1 percent) in the Asian and Hispanic/Latino populations. Median household income was nearly $46,000 in 2000 and was projected at $50,543 in 2004. A major drug problem in the area is methamphetamine. There are several geographic and social factors that foster the manufacture, trafficking, and abuse of methamphetamine in San Diego County. Geographically, the county is isolated from the rest of California. There are 80 miles of border to the south, 70 miles of ocean to the west, mountain ranges to the east and northeast, and a military base to the north. There are three border crossings, including the Tijuana crossing, which is one of the busiest in the world. The border and the coastline represent a particular challenge in attempting to control the import of methamphetamine. In addition, isolated rural areas 1 The author author is affiliated affiliated with The Silvergate Group, San San Diego, California. 220 are ideal for the establishment of small methamphetamine clandestine labs. Issues related to methamphetamine are discussed in greater detail in the section on Drug Abuse Patterns and Trends. Data Sources Data for this paper were provided by the following sources: • Treatment data were provided by the San Diego County Alcohol and Drug Data System for 1987–2004. The 2004 data are annualized, based on the first 9 months of 2004. • Drug Abuse Warning Network (DAWN) emergency department (ED) data are from the DAWN Live! System, Office of Applied Studies (OAS), Substance Abuse and Mental Health Services Administration (SAMHSA). The unweighted data are for the first 6 months of 2004 and represent between 6 and 9 of the 17 eligible hospitals reporting during that period. All DAWN cases are reviewed for quality control, and, based on the review, cases may be corrected or deleted; therefore, the data reported in this paper are subject to change. The data are unweighted and are not estimates for the San Diego area. These data cannot be compared with DAWN ED data for 2002 and before, nor can they be used for comparison with future data accessed through DAWN Live!. Only weighted data released by SAMHSA can be used in trend analysis. A full description of DAWN can be found at . • Forensic laboratory data were provided by the National Forensic Laboratory Information System (NFLIS), Drug Enforcement Administration (DEA), for fiscal year (FY) 2004 (October 2003– September 2004). • Drug price information is from the National Drug Intelligence Center (NDIC) for July through December 2004. • Seizure data on methamphetamine were provided by the DEA. Proceedings of the Community Epidemiology Work Group, Vol. II, January 2005
• Acquired immunodeficiency syndrome (AIDS) data were taken from the San Diego County Health and Human Services Agency, “Human Immunodeficiency Virus (HIV) Surveillance Report.” In addition, findings from the 2003 Arrestee Drug Abuse Monitoring (ADAM) program and the 2002 DAWN medical examiner/coroner system are presented in the discussion below on methamphetamine. DRUG ABUSE PATTERNS AND TRENDS At the January 2005 CEWG meeting, members focused on the abuse of stimulants, primarily methamphetamine and cocaine. The primary focus of this paper is methamphetamine abuse, a major problem in San Diego County. Methamphetamine San Diego continues to be one of the epicenters for methamphetamine abuse in the United States. While abuse indicators are mixed, they clearly show that methamphetamine is a major problem in the county. As noted earlier, the manufacture of methamphetamine continues to be a problem. Prior to 1989, there were many small methamphetamine labs in San Diego, operated by local “cookers” and outlaw motorcycle clubs. Over the years, however, the production and abuse of methamphetamine “waxed and waned.” The Chemical Diversion and Trafficking Act of 1988 and the Chemical Control Diversion Act of 1993 helped to curtail access to the precursors used to make methamphetamine. In addition, a DEA sting effort, Operation Triple Neck, resulted in arrests and the closing of stores that supplied equipment and chemicals to the methamphetamine cookers. Most methamphetamine indicators declined for a time, but new sources and distribution networks emerged so that… • Mexican nationals and Mexican-Americans, operating on both sides of the border, began to produce large quantities of high-purity methamphetamine. • The already established networks used to distribute other illicit drugs were used to distribute methamphetamine. • The profits from these operations were large. EPIDEMIOLOGIC TRENDS IN DRUG ABUSE—San Diego County, California In FY 2004, methamphetamine accounted for 26.7 percent of all drug items reported by NFLIS; amphetamines accounted for less than 1 percent (exhibit 2). Slightly more than one-half (51 percent) of primary illicit drug admissions in 2004 were for primary abuse of methamphetamine (exhibit 3). Trend data from 1987 through 2004 show that methamphetamine treatment admissions (n=6,973) and total treatment admissions (18,009) peaked in San Diego in 2002. The 2003 data provide more detailed information on primary methamphetamine treatment admissions. Also, as shown below, major changes have occurred in the referral patterns and in the demographic composition of methamphetamine treatment admissions… • Nearly three-fourths (72.3 percent) of the 6,365 primary methamphetamine abuse treatment admissions in San Diego County were referred by the criminal justice system, compared with only 14 percent in 1987. • The proportion of male methamphetamine treatment admissions increased, reaching 58 percent in 2003. • The median age of methamphetamine admissions increased, reaching 33 in 2003. • The percentage of Hispanic methamphetamine admissions increased from 12 percent in 1991 to 28 percent in 2003. At the same time, White admissions decreased from 79 percent in 1991 to 55 percent in 2003. Over the years, a number of factors were associated with increases in total admissions and those for methamphetamine, including the following: • Law enforcement actions in the late 1980s and early 1990s, such as Operation Triple Neck • The establishment of the Methamphetamine Strike Force (MSF) • The establishment of and increase in the number of drug courts • The passage of Proposition 36 in 2000, which mandated treatment of drug users involved in the criminal justice system. Some of these external factors are graphically depicted in exhibit 4, together with treatment admissions data. Note that “budget problems” in the State Proceedings of the Community Epidemiology Work Group, Vol. II, January 2005 221
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NATIONAL INSTITUTE ON DRUG ABUSE EP
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Foreword This publication includes
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EPIDEMIOLOGIC TRENDS IN DRUG ABUSE
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2 EPIDEMIOLOGIC TRENDS IN DRUG ABUS
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Epidemiology of Drug Abuse: CEWG Ar
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• The city of Atlanta has become
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In the first 6 months of 2004, trea
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eports (exhibit 2), while African-A
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population) than in 2002 (17.2 per
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16 EPIDEMIOLOGIC TRENDS IN DRUG ABU
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data from the Drug Abuse Warning Ne
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than age 18, compared to 4 percent
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More often than not, marijuana use
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Solomon, L.; Flynn, C.; Muck, K.; e
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• Logan International Airport and
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In 2002, heroin/morphine was indica
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The FY 2004 racial distribution for
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• Emergency department (ED) drug
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monly mentioned secondary drug amon
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Between 2001 and 2003, the Illinois
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In the NIHU Study, 20 percent of pa
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Ecstasy remained available in most
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66 and analyzed by the Division of
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ounce in the Denver metropolitan ar
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18 at the time of admission to trea
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Injecting had been the most common
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alcohol; 651 involved alcohol-in-co
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The economy in Hawai'i, after a dec
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Methamphetamine remains the leading
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methamphetamine, representing 76.5
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Of interest in this chart is the ag
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98 weighted DAWN data released by S
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A total of 5,425 cocaine arrests wa
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data, however, rising from 1.5 perc
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According to NDIC, California and M
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and 15 items were identified as pse
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most frequently reported secondary
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esidents are living with advanced H
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112 EPIDEMIOLOGIC TRENDS IN DRUG AB
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(DAWN) that monitors emergency depa
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Beginning in 2003, SAMHSA’s natio
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65 percent were older than 34. The
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the 1,198 drug abuse ED reports in
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“Crystal” or smokeable methamph
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tion was injection (62.9 percent),
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included reports of ED cases involv
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From November 10 to 16, 2004, 18 me
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NFLIS between October 2003 and Sept
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from 12.2 percent in the first half
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156 2003. Anecdotal information on
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Brownsville, and El Paso. African-A
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ground economy, it was estimated th
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According to street interviews, mos
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that crack sells for about $28,000-
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nio and two 2-ounce bottles cost $1
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age may be partially due to the fac
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York and Miami (Pach et al. 2002).
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In 2003, heroin was the primary sub
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opolitan Police Department report t
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International Report
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Among GTC patients, marijuana was t
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Others (63.8 percent) were using a
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Panel on Methamphetamine Abuse: NID
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Appendix A New Drug Abuse Warning N
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DAWN LIVE! The new DAWN includes ca
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Participant List National Institute
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Janie B. Dargan, M.S.W. Policy Anal
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Martin P. Paulus, M.D. Associate Pr
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