NATIONAL INSTITUTE ON DRUG ABUSE EPIDEMIOLOGIC ...

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The 2004 secondary school survey reported lifetime use of downers decreased from 7.1 percent in 2002 to 5.9 percent in 2004. Past-year use decreased from 3.4 percent in 2002 to 2.6 percent in 2004. The 2000 adult survey reported lifetime use of downers at 6.9 percent and past-month use at 0.6 percent; in 1996, lifetime use was 6.2 percent and past-month use was 0.3 percent. The difference in past-year use between 1996 and 2000 (1 percent to 1.8 percent) was statistically significant. About 1 percent of the clients entering treatment in 20043 had a primary problem with barbiturates, sedatives, or tranquilizers. These clients were the most likely to be female; only 36 percent were male. They were also likely to be highly impaired, based on their ASI scores (see exhibit 29). Alprazolam, clonazepam, and diazepam are among the 15 most commonly identified substances according to DPS lab reports, although none of them represent more than 3 percent of all items examined in a year. The proportion of cases that are alprazolam (Xanax) continues to increase (exhibit 19). Alprazolam sells for $3–$5 in Dallas, Fort Worth, and Houston, and for $5–$10 in Tyler. Depending on the dosage unit, diazepam sells for $1–$10 in Dallas, Fort Worth, and Tyler. Club Drugs and Hallucinogens Exhibit 20 shows the demographic characteristics of clients entering TDSHS-funded treatment programs statewide with a problem with a club drug. The row “Primary Drug” shows the percentage of clients citing a primary problem with the club drug shown at the top of the column. The rows under the heading “Other Primary Drug” show the percent of clients who had a primary problem with another drug, such as marijuana, but who had a secondary or tertiary problem with the club drug shown at the top of the column. Note that the treatment data uses a broader category, “Hallucinogens,” that includes lysergic acid diethylamide (LSD), dimethyltryptamine (DMT), STP, mescaline, psilocybin, and peyote. Based on exhibit 20, hallucinogen admissions are the most likely to be male, gamma hydroxybutyrate (GHB) clients are the most likely to be White, phencyclidine (PCP) clients are the most likely to be Black, Rohypnol clients are the youngest, and GHB clients are the oldest. While users of PCP are the most likely to have a primary problem with PCP, users of Rohypnol, ecstasy, and hallucinogens are 268 EPIDEMIOLOGIC TRENDS IN DRUG ABUSE—Texas more likely to have a primary problem with marijuana, rather than with a club drug. Exhibit 21 shows the percent of exhibits identified by DPS laboratories that contained various club drugs. Only the proportion of PCP exhibits has not decreased over time. Dextromethorphan The most popular dextromethorphan (DXM) products are Robitussin-DM, Tussin, and Coricidin Cough and Cold Tablets HBP, which can be purchased over the counter and can produce hallucinogenic effects if taken in large quantities. Coricidin HBP pills are known as “Triple C’s” or “Skittles.” The 2004 Texas school survey reported that 4.3 percent of secondary students indicated they had used DXM. Use increased from 2.5 percent in 7th grade to 5.8 percent in 12th grade. There was no difference by gender, but Whites reported higher lifetime use (6.1 percent) than Native Americans (5.8 percent), Hispanics (3.6 percent), or Blacks (2.4 percent). Poison control centers reported the number of abuse and misuse cases involving dextromethorphan rose from 99 in 1998 to a high of 432 in 2002, and then dropped to 365 in 2003 and 91 in the first half of 2004. Average age was 23.8. The number of cases involving abuse or misuse of Coricidin HBP was 7 in 1998 and rose to 268 in 2002 and then decreased to 189 in 2003. There have been 175 cases in the first half of 2004. Average age in 2004 was 16.2 years, which shows that youths can easily access and misuse this substance. DPS labs examined 2 substances in 1998 that were dextromethorphan, 13 in 1999, 36 in 2000, 18 in 2001, 42 in 2002, 10 in 2003, and 8 in the first half of 2004. Ecstasy (Methylenedioxymethamphetamine or MDMA) The 2004 secondary school survey reported that lifetime ecstasy use dropped from a high of 8.6 percent in 2002 to 5.5 percent in 2004, while past-year use dropped from 3.1 percent to 1.8 percent. The 2000 adult survey reported that 3.1 percent had ever used ecstasy and 1.0 percent had used in the past year. Texas Poison Control Centers reported 23 calls involving misuse or abuse of ecstasy in 1998, 46 in 1999, 119 in 2000, 155 in 2001, 172 in 2002, 284 in Proceedings of the Community Epidemiology Work Group, Vol. II, January 2005
2003, and 169 in the first half of 2004. In 2004, 48 percent were male, and the average age was 20.8. There were 63 admissions for a primary, secondary, or tertiary problem with ecstasy in 1998, 114 in 1999, 199 in 2000, 349 in 2001, 521 in 2002, 502 in 2003, and 289 in the first half of 2004. Approximately 36 percent reported marijuana as their primary problem drug, as compared to 12 percent who reported ecstasy as their primary problem drug. Exhibit 22 shows that ecstasy has spread outside the White club scene and into the Hispanic and Black communities as evidenced by the declining proportion of White clients. In 1999, there were two deaths that involved ecstasy in Texas. There was one death in 2000, five in 2001, five in 2002, and two in 2003. Exhibit 21 shows the substances identified by DPS labs. The labs identified MDMA in 107 exhibits in 1999, 387 in 2000, 814 in 2001, 503 in 2002, 484 in 2003, and 325 in the first half of 2004. Methylenedioxyamphetamine (MDA) was identified in 31 exhibits in 1999, 27 in 2000, 48 in 2001, 90 in 2002, 94 in 2003, and 29 in the first half of 2004. According to the Houston DEA Field Division, ecstasy is more available at clubs, raves, and gyms, and use is increasing in the Galveston, Beaumont, and Fort Hood areas. Logos on the tablets include A&E, Blue Dolphins, Bear, Music Notes, Crescent Moon, Yellow Dolphins, Aladdin Lamp, Yellow Alligator, Yellow Trumpets, Omega, X-5 (aka BMW), JJ, Spade, and Footprints. While most tablets contain MDMA, some have high concentrations of caffeine or methamphetamine. Asian gangs and White males continue to be involved in MDMA distribution. The Dallas DEA Field Division reports that MDMA, which is brought into the Division from Mexico, is heavily adulterated and of poor quality. Use is spreading among Blacks and among older users. Combinations of drugs mentioned in Dallas include “candy flipping” (LSD and MDMA), “hippie flipping” (mushrooms and MDMA), “love flipping” (mescaline and MDMA), “robo flipping” (DXM and MDMA), and “elephant flipping” (PCP and MDMA). The club drug distribution in the Division is dominated by Asian traffickers who are also involved with hydroponic marijuana and methamphetamine. Single dosage units of ecstasy sell for $6–$20 in Dallas, $5–$12.50 in Fort Worth, $12–$25 in Tyler, $4.75–$25 in Houston, $20–$30 in McAllen, $20 in Laredo, and $11–$20 in San Antonio. Multiple dos- EPIDEMIOLOGIC TRENDS IN DRUG ABUSE—Texas age units (1,000 tablets) sell for $5,000–$8,000 in Houston. Gamma Hydroxybutyrate (GHB), Gamma Butyrate Lactone (GBL), 1-4 Butanediol (1,4 BD) The 2000 Texas adult survey reported that 0.4 percent had ever used GHB and 0.1 percent had used in the past year. The number of cases of misuse or abuse of GHB reported to Texas Poison Control Centers was 110 in 1998, 150 in 1999, 120 in 2000, 119 in 2001, 100 in 2002, 66 in 2003, and 54 in the first half of 2004. Average age of the abusers in 2004 was 28, and of the callers whose gender was known, 38 percent were male. Adult and adolescent clients with a primary, secondary, or tertiary problem with GHB, GBL, or 1,4 butanediol (1,4 BD) are seen in treatment. In 1998, 2 were admitted, as compared to 17 in 1999, 12 in 2000, 19 in 2001, 35 in 2002, 31 in 2003, and 21 in the first half of 2004. Clients who used GHB tended to be the oldest of all the club drug users (age 26) and the most likely to be White (91 percent). GHB users were more likely to have used the so-called “hard-core” drugs; 43 percent had a history of injecting drug use. Fifty-two percent had a primary problem with amphetamines or methamphetamines. Because of the sleep-inducing properties of GHB, users will also use methamphetamine so they can stay awake while they are “high” on GHB or they use GHB to “come down” from their use of methamphetamine (exhibit 20). In 1999, there were three deaths that involved GHB, five in 2000, three in 2001, two in 2002, and two in 2003. In 1998, there were 18 items identified by DPS labs as being GHB, in 1999 112 were GHB, 4 were GBL, and 4 were 1,4 BD (exhibit 21). In 2000, 45 were GHB, 7 were GBL, and 4 were 1,4 BD. In 2001, 34 were GHB, 7 were GBL, and 19 were 1,4 BD. In 2002, 81 were GHB, 6 were GBL, and 4 were 1,4 BD. In 2003, 150 were GHB, 5 were GBL, and none were 1,4 BD. In the first half of 2004, 44 were GHB and none were GBL or 1,4 BD (exhibit 21). In 2004, 82 percent of the GHB items were identified in the DPS lab in the Dallas area, which shows use of GHB is centered in this area of the State. In Dallas, the price had increased from $100–$200 per gallon to $250–$500 per gallon. A dose of GHB costs $20 in Dallas and $5–$10 in Lubbock and San Antonio. A 16-ounce bottle costs $100 in San Anto- Proceedings of the Community Epidemiology Work Group, Vol. II, January 2005 269
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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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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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Page 228 and 229: correspond to decreases in total ad
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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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Page 278 and 279: age may be partially due to the fac
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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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