CEWG January 09 Full Report - National Institute on Drug Abuse

Section III. <strong>CEWG</strong> Area Update Briefs and International Presentations
NFLIS data (35 percent), and first in the APPD
(45.8 percent). (It is not tested for in decedents.)
Marijuana use was common by itself or in combination
with cocaine, alcohol, and phencyclidine
(PCP), among others. Treatment admission
trends have been stable since 2001 with respect
to gender (ranging from 78 to 82 percent male).
The percentage of African Americans entering
treatment increased from 68 to 75 percent from
2006 to mid-2008, while proportions of Asians/
others declined to very low levels. The proportions
by age group for treatment admissions have
remained stable from early 2005 through mid­
2008: with clients under age 21 constituting from
9 to 9.4 percent; age 21–30, from 44 to 46.2 percent;
age 31–40, from 27 to 26.7 percent; and age
41 and over, from 19 to 17.7 percent. Alcohol in
combination with other drugs declined from second
rank to third in deaths with drugs detected
(present in 21.6 percent of decedents in the first
half of 2008). It was most commonly reported as
used along with or after cocaine, heroin, and/or
marijuana. Alcohol was also the second most frequently
mentioned drug in treatment admissions
data (remaining stable at 22.1 percent) and seventh
in the APPD study (5.4 percent). The proportion
of African Americans entering treatment has
changed from 49 percent in 2002 to 70 percent in
the first half of 2008. Concomitantly, percentages
of Whites have decreased from 41 to 26 percent
during this period. Deaths with the presence of
alcohol in combination decreased from a high of
386 in 2006, to 264 in 2007, to 107 in the first half
of 2008. The street-level purity of heroin declined
from 2000 (73 percent) to 2004 (52 percent) and
increased to 56.3 percent in 2007. The price per
milligram pure has been fluctuating from $0.71
in 2004, to $0.58 in 2005, $0.63 in 2006, and
$0.71 in 2007; however, the standard bag price
remained $10 and contained one “hit.” In the first
half of 2008, heroin ranked fourth in treatment
admissions (17.9 percent), moving from third
to second in deaths with the presence of drugs
(25.8 percent); it was third in the NFLIS data,
and fifth in the APPD data (within the category
“total opioids,” at 13.2 percent). At the beginning
of the period of declining heroin purity in 2001,
Whites comprised 54 percent of treatment admissions
and had increased to over 68 percent by
mid-2008. Proportions of African Americans
declined from 42 percent in 2001 to 23 percent by
mid-2008. As the purity levels bottomed out, the
21–30 age group entered treatment in increasing
proportions (from 22 percent in 2001 to 42 percent
in 2005), and as the purity leveled off in 2006,
so did this population entering treatment. Deaths
with the presence of heroin closely matched the
purity trends from 2001 through mid-2008, with
the exception of the period of the fentanyl outbreak
from spring 2006 to spring 2007. Heroin
was most commonly reported as used in combination
with cocaine, alprazolam, alcohol, and/or
oxycodone. In the first half of 2008, 88 percent of
females and 85 percent of males reported injection
as their preferred route of administration. Within
the other opioids category, use was characterized
as at medium levels with mixed indicator results,
depending on the drug. Codeine and oxycodone
remained low in treatment admissions, but relatively
high in the Philadelphia Medical Examiner’s
(ME’s) toxicology reports. However, six “other
opioids” were in the top 15 drugs in the NFLIS
report for the first half of 2008—oxycodone (4th),
codeine (7th), hydrocodone (8th), methadone
(10th), buprenorphine (14th), and propoxyphene
(15th). Benzodiazepine use, while lower than
use of drugs discussed above, remained a drug
used in combination with other drugs according
to trend data. Indications of abuse appeared to
be increasing in the first half of 2008. Benzodiazepines
ranked third in the mortality data. Alprazolam
is clearly the benzodiazepine of choice,
ranking seventh in the ME’s toxicology reports
and fifth in the NFLIS data. Alprazolam is most
commonly used in combination with heroin and/
or oxycodone. PCP is primarily smoked in combination
with marijuana in blunts. Indicators reflect
medium levels of use, and indicators were either
stable or declined in the first half of 2008, with
the exception of the APPD study, where 12 percent
of the (positive) tests were positive for PCP
in the full calendar year 2008. The most common
Proceedings of the Community Epidemiology Work Group, <strong>January</strong> 20<strong>09</strong> 59