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228 reports in drug-related visits; reports exceed the number of ED visits because a patient may report use of multiple drugs (up to six drugs and alcohol may be presented in DAWN). This paper focuses on demographic characteristics of different drugs in drug-related visits. These data cannot be compared with DAWN data from 2002 and before, nor can these preliminary data be used for comparison with future data. Only weighted ED data released by SAMHSA can be used for trend analysis. A full description of the DAWN system can be found at the DAWN Web site . • Treatment admissions data were available for all five bay area counties for 1999 through the first half of 2004. These data were compiled by the California Department of Alcohol and Drug Programs (DADP). In addition, admissions data for San Francisco County were provided by the San Francisco Department of Public Health for fiscal years (FYs) 2000 through 2004. • Medical examiner (ME) data on drug mentions in decedents in three counties (San Francisco, Marin, and San Mateo) were provided by the DAWN mortality system for 2002, along with comparable data for 1997–2001. The DAWN system covered 100 percent of the metropolitan statistical area (MSA) jurisdiction and 100 percent of the MSA population in 2002. • Reports of arrests for drug law violations and counts of reported burglaries were provided by the San Francisco Police Department (SFPD) for 2001 through 2004. • Arrestee drug testing data are from the Arrestee Drug Abuse Monitoring (ADAM) program, National Institute of Justice, for San Jose and Sacramento for 2003 for adult males and for San Jose for adult females. • Price and purity data came from the Drug Enforcement Administration (DEA), Domestic Monitor Program (DMP), and referenced heroin “buys,” mostly made in San Francisco County. Preliminary data for 2003 were compared with those for 1994–2002. Data on trafficking in heroin and other drugs were available from the National Drug Intelligence Center’s (NDIC) report, Narcotics Digest Weekly, December 28, 2004. Additional data on trafficking and production were provided by the National Drug Threat Assessment 2004 publication of the NDIC. EPIDEMIOLOGIC TRENDS IN DRUG ABUSE—San Francisco Bay Area • Ethnographic information was obtained through interviews with treatment program staff and outreach workers in January 2005. Their observations were compared with those they made in December 2003 and May 2004 and pertained mostly to San Francisco County. • Acquired immunodeficiency syndrome (AIDS) surveillance data were provided by the San Francisco Department of Public Health (SFDPH) and covered the period through September 30, 2004. • Hepatitis B (HBV) data for San Francisco County were available for 1996 through the first half of 2004 and were provided by the SFDPH. • Hepatitis C (HBC) virus prevalence estimates were provided by the Urban Health Study (UHS) for 2003. DRUG ABUSE PATTERNS AND TRENDS Cocaine/Crack Local observers note two interesting developments: youths are injecting crack which they “break down” with vitamin C powder and African-Americans have shifted somewhat away from smoking crack and toward snorting powder. Unweighted data accessed from DAWN Live! show that reports of cocaine in 2004 represented patient who were predominantly Black; 65 percent were male. There were twice as many reports involving those older than 45 (36 percent) than younger than 30 (18 percent). Smoking was the preferred route of use for three-fifths of these patients. In the five-county bay area, the overall number of admissions for drug treatment, other than alcohol, declined steadily between 1999 and 2002 and then rose slightly to a new level in 2003 and 2004 (exhibit 1). The proportion of cocaine/crack admissions among these admissions rose from 24 to 26 percent between 2001 and 2003. Among these admissions, more than 87 percent cited smoking—presumably of crack—as the preferred route of use. During FYs 2000 to 2004, San Francisco County cocaine admissions fluctuated narrowly, with no particular trend, in the range of 2,250 to 2,600 (exhibit 2). According to DAWN data, ME death mentions involving cocaine in three bay area counties fluctuated within a narrow range, with no particular trend, between 1997 and 2000 (exhibit 3). In 2002, however, total mentions were 39 percent below the 1997–2000 average. Proceedings of the Community Epidemiology Work Group, Vol. II, January 2005
Cocaine-positive tests among arrestees in San Jose and Sacramento, nearby metropolises which are ADAM sites, may give some indication of cocaine use prevalence in San Francisco. During 2003, 13 percent of adult male arrestees in San Jose and 22 percent of those in Sacramento tested positive for cocaine. The two areas had, respectively, the fourth and ninth lowest proportions of cocaine-positive arrestees among all 39 ADAM sites. For adult female arrestees in San Jose, 10 percent tested positive—the second lowest proportion among 25 ADAM sites. There were nearly 3,800 arrests on cocaine-related charges in San Francisco in 2004. According to the NDIC, local prices for powder cocaine in 2004 were $16,000–$21,000 per kilogram, $530–$800 per ounce, and as low as $10 per quarter gram. Crack prices were around $600 per ounce and $20–$50 per “rock.” These prices were up slightly from 2002. To summarize, cocaine use in the bay area is low compared with use in the rest of the United States. The indicators do not reflect any consistent upward or downward trend in the past 3 years. Heroin According to the unweighted DAWN Live! data, reports of heroin during 2004 involved patients who were two-thirds male and nearly two-thirds White. Thirty-nine percent were older than 45, and only 19 percent were younger than 30. Injection is the overwhelming preference (93 percent) as the route of use. The number of treatment admissions for primary heroin problems in the five-county bay area fell by more than half between 1999 and 2004 (exhibit 1). As a proportion of all primary drug admissions excluding alcohol, heroin constituted 64 percent in 1994, 55 percent in 1999, and only 36 percent in 2003. Injection remains by far the predominant route of use: 80 percent reported that route, as compared with 14 percent who reported inhalation as the preferred route. San Francisco County heroin admissions fell by 9 percent between FYs 2002 and 2004 (exhibit 2). ME death mentions involving heroin in 2002 were at their lowest level in 6 years (exhibit 3). The count for 2002 was 43 percent below the average for 1997– 2000. Males accounted for 87 percent of the heroinrelated death mentions in 2000. The median age of the decedents was 40. In the ADAM program in 2003, 3.1 percent of adult male arrestees in San Jose and 6.9 percent of those in EPIDEMIOLOGIC TRENDS IN DRUG ABUSE—San Francisco Bay Area Sacramento tested opiate positive; the median across the 39 ADAM sites was 5.8 percent. Of female arrestees in San Jose, 3.4 percent tested positive, well below the 25-city median of 6.6 percent. Arrests for heroin-related offenses totaled 6,136 in 2002, 16 percent higher than in 2001 and 3 percent higher than in 2000. However, in 2003 such arrests were about 30 percent below, and in 2004 about 55 percent below, the 2002 level. Because many heroin users support their habits through property crimes, reported burglaries may be a good indicator of use. The number of such reports in San Francisco fell by 49 percent between 1993 and 1999 (11,164 to 5,704). After that low point, the count rose to 6,706 in 2001, fell to 5,507 in 2003, and rose again to nearly the 2001 level in 2004. These changes may reflect the price of heroin more than the prevalence of users; it is noteworthy that reported burglaries and the local price of heroin are both barely one-quarter of what they were 20 years ago. The DEA’s DMP tested heroin street buys in the San Francisco area during 2003. The 27 buys were all of Mexican origin. The 2003 samples averaged 11 percent pure and $0.98 per pure milligram (exhibit 4). Of the last 10 years, 2001, 2002, and 2003 were the 3 with the highest average price and lowest average purity. Prices of Mexican black tar heroin ranged from $9,200 to $30,000 per kilogram and from $230 to $850 per ounce in 2004. Gram prices ranged from $50 to $75. In 2002, prices were $16,000–$30,000 per kilogram, $450–$850 per ounce, and around $60 per gram. In summary, most indicators point to a decline in heroin use in the period from 2000 to 2004. Other Opiates Local observers note a significant increase in oxycodone availability and usage. ME death mentions in the overall “narcotic analgesics” category fluctuated within a narrow range in 1997–2000, but then they dropped in 2001 and 2002 to a level 29 percent below the 1997–2000 average (exhibit 3). The combined count of hydrocodone and oxycodone in the unweighted DAWN Live! ED reports in 2004 was less than 8 percent that of heroin. For hydrocodone, whose count was more than twice that of oxycodone, 57 percent of the reports represented male patients, 71 percent represented Whites, and 63 percent represented patients older than 35. Proceedings of the Community Epidemiology Work Group, Vol. II, January 2005 229
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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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Benloton, X-man, 911, Lean Back, Se
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DAWN ME mentions for marijuana-invo
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ecstasy. MDMA ED mentions may be st
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Page 270 and 271: costs $1,200-$1,500, compared with
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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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