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data from the Drug Abuse Warning Network (DAWN), Office of Applied Studies (OAS), Substance Abuse and Mental Health Services Administration (SAMHSA). Because of a redesign of DAWN, the most recent estimates available are from 2002. Limited unweighted data on ED reports for 2004 were available for this report, but because of data collection differences, these cannot be used in conjunction with the older data to measure trends. Data sources for this report are detailed below: • Population and demographic data, including population estimates for 1990–2003 and income and poverty estimates for 2000 for Maryland counties, were derived from U.S. Bureau of the Census data (electronic access: last accessed June 13, 2004). • Treatment admissions data were provided by the Maryland Alcohol and Drug Abuse Administration, Department of Health and Mental Hygiene, for 1994 through the first half of 2004. Data are presented for the PMSA as a whole, as well as separately for Baltimore City and the suburban counties. Included are those programs receiving both public and private funding. All clients are reported, regardless of individual source of funding. Significant omissions are the Baltimore City and Fort Howard Veterans’ Administration Medical Centers, which do not report to the State data collection system. Treatment data in this report exclude admissions for abuse of alcohol alone (about 16 percent of all treatment admissions). Admissions with primary abuse of alcohol and secondary/tertiary abuse of drugs (about 12 percent of all admissions) are included. • Emergency department (ED) drug mentions data were provided by DAWN, OAS, SAMHSA, for the Baltimore PMSA for 1994 through 2002. The 1994–2002 data provided weighted estimates and rates per 100,000 population, which are reported in this paper. In addition, unweighted data on selected drugs were derived from DAWN Live!, a restricted-access online query system administered by OAS. The data for the first half of 2004 are, as noted above, not comparable to DAWN data for 2002 and prior years, and cannot be used for comparison with future data. The new DAWN sample includes all 21 eligible hospitals in the Baltimore metropolitan area, with 24 EDs in the sample. (Some hospitals have more than one ED.) The data accessed from DAWN Live! (updated by OAS on December 13, 2004) were incomplete. Over the 6-month period, between 21 20 EPIDEMIOLOGIC TRENDS IN DRUG ABUSE—Baltimore Metropolitan Area and 23 of the EDs reported to DAWN each month, with most reporting data that were basically complete (90 percent or greater). This paper includes drug reports on drug-related visits involving stimulants and the so-called “club drugs.” Drug reports exceed the number of visits since a patient may report use of multiple drugs (up to six plus alcohol). The unweighted data from DAWN Live! Cannot be used as estimates for the Baltimore area, nor can they be used for comparison with future data. Only weighted DAWN data released by SAMHSA can be used for trend analysis. A full description of the DAWN system can be found at . • Mortality data were provided by DAWN, OAS, SAMHSA, for the Baltimore PMSA for 1997 through 2002. • Illicit drug prices were provided by the National Drug Intelligence Center, Narcotics Digest Weekly 3(52), December 28, 2004, for July– December 2004. • Data on drug seizures were provided by the National Forensic Laboratory Information System (NFLIS). DRUG ABUSE PATTERNS AND TRENDS Polydrug use in general appears to be the norm in the Baltimore PMSA. Three-quarters of drug-related treatment admissions in the first half of 2004 reported problems with at least one substance other than their primary substance. In 2002, the average ED episode involved 1.8 substances, and the average drug-related death involved 3.1 substances; 89 percent of the drug-related deaths involved multiple substances. Cocaine/Crack Cocaine indicators (treatment admission rates, rates of ED mentions, and cocaine-involved deaths) all began to increase in 2001 (exhibit 1). The rate of cocaine-related ED mentions (257 per 100,000 population for 2002) represented a significant increase over the previous year. Deaths associated with cocaine increased from 248 in 2001 to 299 in 2002. The cocaine treatment admission rate increased from 164 per 100,000 population age 12 and older in 2001 to 221 per 100,000 in 2003 (exhibit 2). The rate is projected to decline slightly, to 217 per 100,000 in 2004. Smoked cocaine (crack) represented 73 percent of the treatment admissions for primary cocaine use in the Baltimore PMSA in the first half of 2004 (exhibit 2). Proceedings of the Community Epidemiology Work Group, Vol. II, January 2005
The population in treatment for cocaine smoking has aged (exhibit 3). About three-quarters (74 percent) were age 35 or older in the first half of 2004, an increase from 59 percent in 2000. The median age at admission to treatment was 39, compared with 36 in 2000. Almost one-half (45 percent) of those in treatment for smoking cocaine were women, and more than two-thirds (69 percent) were African-American. The majority (63 percent) of the crack smokers had been in treatment before, and most (70 percent) were referred through sources other than the criminal justice system. Daily crack use was reported by 45 percent, and use of other drugs in addition to crack was reported by more than two-thirds (69 percent). Alcohol was the most common secondary drug (used by 45 percent), followed by marijuana (22 percent) and heroin used intranasally (15 percent). Only 4 percent of crack smokers reported heroin injection. Primary use of cocaine represented 14 percent of treatment admissions in the first half of 2004, well behind the 51 percent of admissions represented by primary use of heroin (exhibit 2). Despite the apparent dominance of heroin in the Baltimore PMSA, testing of some 40,000 items in fiscal year (FY) 2004 by the National Forensics Laboratory found that 43 percent were cocaine and 27 percent were heroin. This apparent discrepancy may be explained by the use of cocaine as a secondary substance. Cocaine was reported as a secondary substance by 37 percent of treatment admissions in the first half of 2004 (exhibit 2), meaning that 51 percent of treatment admissions reported cocaine abuse as a primary or secondary problem. Exhibit 4 compares the characteristics of treatment admissions for primary and secondary cocaine use according to the route of administration of cocaine. Cocaine smoking was the most prevalent among both primary and secondary users, followed by injection and intranasal use. Differences between primary and secondary users were generally small, although secondary users were consistently less likely to be entering treatment for the first time than primary users. User characteristics were more pronounced between routes of administration. Cocaine smokers were more likely to be female (50 percent of cocaine smokers, compared to 38 percent of injectors and 31 percent of intranasal users), African-American (70 percent, 55 percent, and 47 percent, respectively), and age 35 and older (72 percent, 64 percent, and 56 percent, respectively). Cocaine smokers were less likely to be age 25 and younger (7 percent, compared with 15 percent of injectors and 22 percent of intranasal users). Cocaine smokers and injectors were more likely to be treated in the city (69 percent and 72 percent, respectively, compared to 48 percent of the intranasal users). EPIDEMIOLOGIC TRENDS IN DRUG ABUSE—Baltimore Metropolitan Area Exhibit 5 compares the number of cocaine treatment admissions (primary, secondary, or tertiary use) in the first half of 2004 by route of administration, age, and race. For all three routes of administration, the younger users tended to be White rather than African-American. Thirty-eight percent of the cocaine smokers reported cocaine smoking as their primary problem (exhibit 4). Secondary cocaine smokers generally shared the characteristics of primary smokers (see above and exhibit 3). They were somewhat more likely to be female (54 percent of secondary smokers, compared to 45 percent of primary smokers), and more likely to be treated in Baltimore City (71 percent and 67 percent, respectively). Cocaine smokers were likely to use heroin intranasally. Fifty-two percent of the secondary cocaine smokers reported intranasal heroin use as their primary substance problem, while 15 percent of the primary cocaine smokers reported intranasal heroin use as a secondary problem. Other primary problems reported by secondary cocaine smokers were alcohol (21 percent) and heroin injection (20 percent). Cocaine injection was strongly linked to heroin injection (exhibit 4). Only 7 percent of the cocaine injectors reported cocaine injection as their primary substance problem, and 59 percent of these reported secondary heroin injection. Among the secondary cocaine injectors, 92 percent reported that their use was secondary to heroin injection. Secondary cocaine injectors were less likely to report daily use than primary cocaine injectors (51 percent and 63 percent, respectively). Cocaine injectors were likely to be male (62 percent), African-American (55 percent), older (64 percent were age 35 and older), and treated in Baltimore City (72 percent). Twenty-three percent of the primary intranasal cocaine users reported intranasal cocaine as their primary substance problem (exhibit 4). Intranasal cocaine users were likely to use heroin intranasally. Forty-two percent of the secondary intranasal cocaine users reported intranasal heroin use as their primary substance problem, while 11 percent of the primary intranasal cocaine users reported intranasal heroin use as a secondary problem. Other primary problems reported by secondary intranasal cocaine users were alcohol (27 percent) and heroin injection (14 percent). Intranasal cocaine users were likely to be male (69 percent), White (51 percent), older (56 percent were age 35 and older), and treated in the suburban counties (52 percent). Primary intranasal cocaine users were more likely than secondary users to be White (55 percent and 49 percent, respectively) and younger (8 percent were younger Proceedings of the Community Epidemiology Work Group, Vol. II, January 2005 21
Page 1 and 2: NATIONAL INSTITUTE ON DRUG ABUSE EP
Page 3: Foreword This publication includes
Page 6 and 7: EPIDEMIOLOGIC TRENDS IN DRUG ABUSE
Page 8 and 9: 2 EPIDEMIOLOGIC TRENDS IN DRUG ABUS
Page 11: Epidemiology of Drug Abuse: CEWG Ar
Page 14 and 15: • The city of Atlanta has become
Page 16 and 17: In the first 6 months of 2004, trea
Page 18 and 19: eports (exhibit 2), while African-A
Page 20 and 21: population) than in 2002 (17.2 per
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Page 28 and 29: than age 18, compared to 4 percent
Page 30 and 31: More often than not, marijuana use
Page 32 and 33: Solomon, L.; Flynn, C.; Muck, K.; e
Page 44 and 45: • Logan International Airport and
Page 46 and 47: In 2002, heroin/morphine was indica
Page 48 and 49: The FY 2004 racial distribution for
Page 58 and 59: • Emergency department (ED) drug
Page 60 and 61: monly mentioned secondary drug amon
Page 62 and 63: Between 2001 and 2003, the Illinois
Page 64 and 65: In the NIHU Study, 20 percent of pa
Page 66 and 67: Ecstasy remained available in most
Page 72 and 73: 66 and analyzed by the Division of
Page 74 and 75: 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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76 EPIDEMIOLOGIC TRENDS IN DRUG ABU
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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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EPIDEMIOLOGIC TRENDS IN DRUG ABUSE
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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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the deaths, while Whites constitute
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2000 reported that the average hero
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for this drug, making olanzapine th
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ADHS/DBHS reported that more than o
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Marijuana is widely available in Ar
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212 2004. Data from 2000-2002 DAWN
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purity dropped to 14.4 percent in 2
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No recent GHB incidents or deaths w
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correspond to decreases in total ad
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228 reports in drug-related visits;
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Marijuana Arrests for marijuana-rel
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positivity. UHS staff believe, on t
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236 are not estimates for the repor
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were evident. Excluding missing dat
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The characteristics of other opiate
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June 2004 (exhibit 6c). A minority
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Deaths involving depressants were a
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imipramine) are an older class of m
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The term “lag” refers to the pe
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costs $1,200-$1,500, compared with
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ties. In the DFW area, Mexican mari
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The 2004 secondary school survey re
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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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