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EPIDEMIOLOGIC TRENDS IN DRUG ABUSE—Texas Substance Abuse Trends in Texas, January 2005 Jane Carlisle Maxwell, Ph.D. 1 ABSTRACT Cocaine continues to be readily available, and the price for a kilogram has decreased. It is the primary illicit drug for which Texans enter treatment. It remains a problem on the border with Mexico, as documented in the school survey. Use of crack cocaine, which is at an endemic level, continues to move beyond Black users to White and Hispanic users. Alcohol is the primary drug of abuse in Texas in terms of dependence, deaths, and treatment admissions. Heroin addicts entering treatment are primarily injectors. In Texas, hydrocodone is a much larger problem than oxycodone or methadone. Codeine cough syrup, ‘Lean,’ continues to be abused. Treatment data show that marijuana clients admitted with criminal justice problems are less impaired than those who are not referred from the criminal justice system. ‘Ice,’ which is smoked methamphetamine, is a growing problem and the price has dropped dramatically. Xanax and Soma continue as widely abused pharmaceutical drugs. Club drug users differ in their sociodemographic characteristics, just as the properties of these drugs differ. Ecstasy use is moving out of the White club scene. Ketamine continues as a problem. GHB, GBL, and similar precursor drugs remain a problem, particularly in the Dallas/Fort Worth Metroplex area. Although indicators are down, Rohypnol remains a problem along the Texas- Mexico border. PCP indicators are continuing to rise and dextromethorphan is a problem with adolescents. Inhalants remain a problem with different types of users. The number of AIDS cases of females and persons of color is growing. The proportion of cases due to the heterosexual mode of transmission now exceeds the proportion of cases due to injecting drug use. Forty-one percent of persons testing positive for hepatitis C were exposed through injecting drug use. INTRODUCTION Area Description The population of Texas in 2004 is 22,158,126, with 51 percent White, 12 percent Black, 34 percent Hispanic, and 3 percent “Other.” Illicit drugs continue to enter from Mexico through cities such as El Paso, Laredo, McAllen, and Brownsville, as well as through 260 smaller towns along the border. The drugs then move northward for distribution through Dallas/Fort Worth and Houston. In addition, drugs move eastward from San Diego through Lubbock and from El Paso to Amarillo and Dallas/Fort Worth. A major problem is that Mexican pharmacies sell many controlled substances to U.S. citizens who then bring them into the States. Both private and express mail companies are used to traffic narcotics and smuggle money. Seaports are used to import heroin and cocaine via commercial cargo vessels. The international airports in Houston and Dallas/Fort Worth are major ports for the distribution of drugs into and out of the State. Data Sources Substance Abuse Trends in Texas is an ongoing series which is published every 6 months as a report for the Community Epidemiology Work Group meetings sponsored by the National Institute on Drug Abuse (NIDA). This report updates the June 2004 report. Complete 2004 data will be published in the June 2005 report. To compare the January 2005 report with earlier periods, please access http://www.utexas.edu/research/cswr/gcattc/drugtren ds.html. The information on each drug is discussed in the following order of sources: • Student substance use data came from the Texas School Survey of Substance Abuse: Grades 7-12, 2004 and the Texas School Survey of Substance Abuse: Grades 4-6, 2004, which are published by the Texas Department of State Health Services (TDSHS), formerly the Texas Commission on Alcohol and Drug Abuse. • Adult substance use data came from TDSHS’s 2000 Texas Survey of Substance Use Among Adults. • Use by Texans ages 12 and older data came from the Substance Abuse and Mental Health Services Administration (SAMHSA) State Estimates of Substance Use from the 2002 National Survey on Drug Use and Health. 1 The author is affiliated with The University of Texas at Austin, Center for Social Work Research, Austin, Texas. Proceedings of the Community Epidemiology Work Group, Vol. II, January 2005
• Poison Control Center data came from the Texas Poison Center Network, TDSHS, for 1998 through June 2004. Analysis was provided by Mathias Forrester, epidemiologist with the Texas Poison Center Network, and by the author. In addition, findings from three papers authored by Forester, “Carisoprodol Abuse in Texas, 1998- 2003,” “Flunitrazepam Abuse and Malicious Use in Texas, 1998-2003,” and “Oxycodone Abuse in Texas, 1998-2003,” were used in this report. • Treatment data were provided by TDSHS’s client data system provided information on clients at admission to treatment in TDSHS-funded facilities from the first quarter of 1983 through June 30, 2004. For most drugs, the characteristics of clients entering with a primary problem with the drug are discussed, but in the case of emerging club drugs, information is provided on any client with a primary, secondary, or tertiary problem with that drug. Analysis was by the author. • Overdose death data on statewide on drug overdose deaths came from death certificates from the Bureau of Vital Statistics, TDSHS; analysis was by the author. Findings are also presented from Maxwell, J. C.; Pullum, T.W.; and Tannert, K. “Deaths of Clients in Methadone Treatment in Texas: 1994-2002,” Drug and Alcohol Dependence, 78(1); 73-82, 2005. • Drug and alcohol arrests data come from the Uniform Crime Reports of the Texas Department of Public Safety (DPS). • Information on drugs identified by laboratory tests are from the Texas Department of Public Safety, which submitted results from toxicological analyses of substances submitted in law enforcement operations for 1998 through June 30, 2004, to the National Forensic Laboratory Information System (NFLIS) of the Drug Enforcement Administration (DEA). Analysis was by the author. • Price, purity, trafficking, distribution, and supply information was provided by fourth quarter 2004 reports on trends in trafficking from the Dallas, El Paso, and Houston Field Divisions of the DEA. • Reports by users and street outreach workers drug trends for September through November 2004 were reported to TDSHS by street outreach workers. EPIDEMIOLOGIC TRENDS IN DRUG ABUSE—Texas • Acquired immunodeficiency syndrome (AIDS) data were provided by TDSHS for annual and year-to-date periods through June 2004. • Hepatitis C (HCV) data were provided by TDSHS on HCV counseling and testing for the period January 2003 to December 31, 2003. DRUG ABUSE TRENDS Cocaine/Crack The Texas School Survey of Substance Abuse: Grades 7-12, 2004 reported that lifetime use of powder and crack cocaine had dropped from a high of 9.3 percent in 1998 to 7.9 percent in 2004, while past-month use dropped from 3.5 percent in 1998 to 3.2 percent in 2004. Some 7.0 percent of students in nonborder counties had ever used powder or crack cocaine, and 2.5 had used it in the past month. In comparison, students in schools on the Texas border reported higher levels of cocaine use: 13.3 percent lifetime and 5.8 percent past-month use (exhibit 1). The 2000 Texas Survey of Substance Use Among Adults reported 11.8 percent of Texas adults had ever used powder cocaine. Some 1.9 percent had used it in the past year. In 2002, the National Survey on Drug Use and Health estimated that 2.4 percent of Texans ages 12 and older had used cocaine in the past year. Estimates by age group were 2.6 percent of those age 12–17, 6.7 percent of those 18–25, and 1.5 percent of those 26 and older. Texas Poison Control Center calls involving the use of cocaine increased from 503 in 1998 to a high of 1,194 in 2002 before dropping to 979 in 2003. This trend is changing in 2004, where in the first half of the year, 720 cases had already been reported. Cocaine (crack and powder) represented 26 percent of all admissions to TDSHS-funded treatment programs in the first half of 2004. With 18 percent of all admissions, crack cocaine is the primary illicit drug abused by clients admitted to publicly funded treatment programs in Texas (exhibit 29). Abusers of powder cocaine were 8 percent of all admissions to treatment. Cocaine inhalers were the youngest and most likely to be Hispanic and involved in the criminal justice or legal systems. Cocaine injectors were older than inhalers but younger than crack smokers and were most likely to be White (exhibit 2). Proceedings of the Community Epidemiology Work Group, Vol. II, January 2005 261
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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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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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Page 216 and 217: EPIDEMIOLOGIC TRENDS IN DRUG ABUSE
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Page 252 and 253: imipramine) are an older class of m
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Page 270 and 271: costs $1,200-$1,500, compared with
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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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