CEWG January 09 Full Report - National Institute on Drug Abuse

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Section III. <strong>CEWG</strong> Area Update Briefs and International Presentations drug-use history (e.g., decedent had history of heroin abuse). While such information cannot be used to specify heroin as a cause of death in the absence of 6-monoacetylmorphine, it does indicate that heroin is the likely “parent drug.” The combination of heroin and cocaine (typically called a “speedball”) was found among 4.7, 5.3, and 2.6 percent of Denver drug-related decedents in 2005, 2006, and 2007, respectively. Again, it is likely that the combination of heroin with other drugs among Denver drug decedents was a much higher percentage than indicated for the same reason as described above. Heroin lagged far behind cocaine, cannabis, and methamphetamine among drugs submitted for testing by local law enforcement in the first half of 2008 in Denver, Arapahoe, and Jefferson Counties. Only small quantities of heroin were seized in Colorado, ranging from 2.5 to 4.6 kilograms from 2003 to 2007. Other opiates ranked fifth in both statewide and greater Denver treatment admissions (excluding alcohol), accounting for 6.7 and 6.2 percent of admissions, respectively, in the first half of 2008. Statewide, other opiate admissions accounted for 4.8 and 5.1 percent, respectively, during the first half of 2006 and 2007. In greater Denver, opiate admissions fluctuated from 5.1 percent in the second half of 2006, to 4.5 percent in the second half of 2007, to 6.2 percent in the first half of 2008. With 1,081 ED reports, other opiates (excluding alcohol) ranked third behind cocaine and marijuana, and represented 23 percent of the unweighted DAWN Live! reports. For the first half of 2008, oxycodone and hydrocodone accounted for approximately two-thirds of all unweighted narcotic analgesic ED visits. Other opiates were among the most common drugs found in Denver drug-related decedents from 2005 to 2007. Morphine was involved in 35.3, 37.9, and 22.8 percent of Denver drug-related deaths in 2005, 2006, and 2007, respectively. Codeine was involved in 21.2 percent of Denver drug-related deaths in 2005, 21.3 percent in 2006, and 9.5 percent in 2007. However, based on the prior discussion of the short half-life of the marker for heroin deaths (6-monoacetylmorphine) and the fact that codeine and morphine are heroin metabolites, it is likely that a substantial proportion of morphine and codeine deaths are really heroin-related deaths. Oxycodone accounted for only 7.1 percent of Denver drug-related deaths in 2005, but increased to 20.1 percent by 2007. Likewise, oxycodone in combination with any other drug as a cause of Denver drug mortality was virtually nonexistent in 2005 and 2006, but increased to 10.1 percent of decedent drug combinations in 2007. Taken together, oxycodone, hydrocodone, morphine, codeine, and hydromorphone accounted for 2.8, 2.5, and 1.6 percent of drugs submitted for testing by local law enforcement in the first half of 2008 in Denver, Arapahoe, and Jefferson counties, respectively. Interestingly, Denver combined adult and juvenile arrests for sale and possession of opium have declined by 31 percent from 2000 to 2007, while those for synthetic narcotics increased by 88 percent during the same time period. HIV/AIDS Update: Cumulative acquired immunodeficiency syndrome (AIDS) data through September 2008 indicated decreasing cases related to injection drug use. Data Sources: Treatment data were provided by the Colorado Department of Human Services, Division of Behavioral Health (DBH). Data from client admissions to all DBH-licensed treatment providers from <strong>January</strong>–June 2008 were included in the data set. Unweighted ED DAWN Live! data from the Offce of Applied Studies, Substance Abuse and Mental Health Services Administration were available to report drug mentions in ED visits occurring from <strong>January</strong>–June 2008. No comparisons with earlier time periods or discussions of trends can be done with unweighted data. Eligible hospitals in the Denver area totaled 15; hospitals in the DAWN sample numbered 15, with the number of EDs in the sample totaling 17 (some hospitals have more than one ED). During this 6-month period, nine EDs reported data each month. The completeness of data reported by participating EDs varied by month. Data in this report reflect cases that were received by DAWN as of December 8, Proceedings of the Community Epidemiology Work Group, <strong>January</strong> 20<strong>09</strong> 45
EpidEmiologic TrEnds in drug AbusE: HigHligHTs And ExEcuTivE summAry 2008. Unweighted DAWN data are reported for the Denver area only. Forensic laboratory data were provided by the Denver Police Department Crime Lab (for CY 2008 through 08/31/2008) and the <strong>National</strong> Forensic Laboratory Information System, Drug Enforcement Administration, for the first half of CY 2008 (<strong>January</strong>–June). While the NFLIS data are described, they cannot be compared with earlier data to establish trends, as a new methodology renders them not comparable. Hospital discharge data were obtained from the Colorado Department of Public Health and Environment, and from the Colorado Hospital Association. These data represent CY 2007. Death data were obtained for CYs 2005 through 2007 from the Denver Offce of the Medical Examiner. Poison call data were obtained from the Rocky Mountain Poison Control Center and represent CY 2007. Information on drug seizure quantities was obtained from the standard Drug Enforcement Administration report, State Facts: Colorado 2008. Data were for CY 2007. CY 2008 data is scheduled to be published in February 20<strong>09</strong>. Drug price and purity data came from the <strong>National</strong> Drug Intelligence Center’s intelligence bulletin, “<strong>National</strong> Illicit Drug Prices,” published in March 2008, and cover drug prices collected in June 2007. Intelligence and qualitative data were obtained from a questionnaire developed by the Denver Offce of Drug Strategy and sent in September 2008 to law enforcement, treatment, research, public health, and street outreach agencies. AIDS data were obtained from the Colorado Department of Public Health and Environment (HIV/STD Surveillance Program Disease Control and Environmental Epidemiology). Drug Abuse Patterns and Trends in Detroit, Wayne County, and Michigan— Update: <strong>January</strong> 20<strong>09</strong> Cynthia L. Arfken, Ph.D., and Yvonne E. Anthony, Ph.D., M.B.A., M.H.A. For inquiries concerning this report, please contact Cynthia L. Arfken, Ph.D., Associate Professor, Wayne State University, 2761 East Jefferson Avenue, Detroit, MI 48207, Phone: 313–993–3490, Fax: 313–993–1370, E-mail: carfken@med.wayne.edu. Overview of Findings: Cocaine and heroin were the two major drugs of abuse in the Detroit/ Wayne County area in 2008, and marijuana was widespread. Updated Drug Trends and Emerging Patterns: Cocaine primary treatment admissions accounted for 24.1 percent of Detroit publiclyfunded admissions in fiscal year (FY) 2008; 91.6 percent of these admissions were for crack cocaine. Of the crack cocaine admissions, 54 percent were male; 88.7 percent were African American; and 84.9 percent were older than 35. Of the powder cocaine admissions, 54.1 percent were male; 83 percent were African American; and 68.6 percent were older than 35. Cocaine accounted for 25.6 percent of Wayne County drug items identified by forensic laboratories in the <strong>National</strong> Forensic Laboratory Information System (NFLIS) in first half of 2008, a decrease from 34.4 percent in 2007. In the first half of 2008, the Wayne County Medical Examiner (ME) reported 138 deaths involving cocaine, the highest number for all drugs, but lower than the preceding year. In FY 2008, heroin primary treatment admissions represented 31.7 percent of the publicly-funded admissions; 61.5 percent were male (an increase of 4.8 percent from FY 2007); 84.3 percent were African American; and 90.4 percent were older than 35. White clients had a younger mean age and were more likely to inject heroin than African-American clients: 39.1 years versus 49.7 years, and 77 percent versus 37.1 percent. Heroin items analyzed by forensic laboratories accounted for 7.4 percent of the total drug items. For 2008 compared with 2007, the Wayne County ME reported an increase in the number of deaths with heroin detected— projected to be 182, compared with 167 in 2007. The Drug Enforcement Administration (DEA) through the Heroin Domestic Monitor Program (HDMP) reported an increase in purity and cost for both South American heroin and Southwest 46 Proceedings of the Community Epidemiology Work Group, <strong>January</strong> 20<strong>09</strong>
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CEWG January 09 Full Report - National Institute on Drug Abuse

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