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 first half of 2008. Data on drug items identified in forensic laboratories from drug samples submitted for analysis were obtained from NFLIS, DEA, for <strong>January</strong>–June 2008. Drug testing results for law enforcement seizures in King County were reported by the county where the drug was seized. Unweighted ED drug reports data were obtained from DAWN Live!, Offce of Applied Studies, Substance Abuse and Mental Health Services Administration, for the first half 2008. Data were accessed December 22, 2008. Data completeness for the first half of 2008 (for 25 eligible EDs) was as follows: 11 to 12 of the EDs reported basically complete data (90 percent or greater) each month, and 13 to 15 reported no data. Drug treatment data were provided by Washington State Department of Social and Health Services, Division of Alcohol and Substance Abuse, Treatment <strong>Report</strong> and Generation Tool from 1999–June 2008. Treatment modalities included outpatient, intensive inpatient, recovery house, long-term residential, and opiate substitution admissions. Department of Corrections and private-pay admissions are included. Methamphetamine incident data were provided by the Washington State Department of Ecology for 1990–June 2008. Drug Abuse Patterns and Trends in St. Louis—Update: <strong>January</strong> 20<strong>09</strong> Heidi Israel, Ph.D., M.S.N., LCSW For inquiries concerning this report, please contact Heidi Israel, Ph.D., M.S.N., LCSW, Assistant Professor, Orthopaedic Surgery, Saint Louis University School of Medicine, 3635 Vista, FDT 7 N, St. Louis, MO 63110, Phone: 314–577–8851, Fax: 314–268– 5121, E-mail: israelha@slu.edu. Overview of Findings: Many of the indicators for the major substances of abuse have remained relatively stable or were mixed through the first half of 2008. Alcohol and all drug categories have shown some increase in treatment admissions, but deaths and arrests appear more stable. Anecdotal information indicates that heroin use and availability may have increased as well as treatment admissions. While cocaine indicators have increased in treatment admissions data, death data for St. Louis City and County appear to have stabilized during both 6-month reporting periods (death data were reported for the second half of 2007 and the first half of 2008). Prescription narcotic analgesics were also reported to be available in the more rural areas of the St. Louis Metropolitan Statistical Area (MSA). Indicators for both cocaine and the opiates will need continued monitoring to determine if there have been changes in these markets or in the user populations. Methamphetamine indicators have been stable in the last 6 months. Updated Drug Abuse Trends and Emerging Patterns: Alcohol was the primary drug of abuse for those entering publicly-funded treatment programs in Missouri. Treatment admissions increased from 2006 to 2007 and again in 2008, and alcohol was frequently indicated as a secondary drug of abuse. The Youth Risk Behavioral Surveillance System (YRBS) survey indicated no change in lifetime use of alcohol and cigarettes in 2007, compared with 2005. Cocaine indicators, in general, were stable over the past 12 months. YRBS current cocaine use indicators were stable in 2007, compared with 2005, while treatment admissions and deaths increased in the last 6 months of 2008. Cocaine continues to be St. Louis City’s primary drug problem, and timelier multiple indicator data are needed to develop a better picture of the cocaine situation in the region. It is believed that Mexican-controlled distribution chains may be increasing in urban areas of St. Louis and possibly organizing networks that control distribution of multiple drugs. <strong>National</strong> Drug Intelligence Center (NDIC) reports showed an increase in street prices for crack/cocaine in 2007. The heroin market in the St. Louis Region has grown and become more complex over the past few reporting periods. From 2006 to 2007, treatment admissions increased by 11.2 percent, and increased another 44 percent in the first half of 2008. YRBS lifetime use was stable from 2005 to 2007, at 2.7 percent (95-percent Confidence Proceedings of the Community Epidemiology Work Group, <strong>January</strong> 20<strong>09</strong> 67
EpidEmiologic TrEnds in drug AbusE: HigHligHTs And ExEcuTivE summAry Interval, or CI:1.5,5.1) in 2005 and 2.3 percent (CI:1.6,3.4) in 2007. Two types of heroin were available—Mexican black tar coming to the region from the Southwest and more recently, South American (SA) heroin. Increased involvement of Mexican dealers has complicated the market. Heroin Domestic Monitor Program (HDMP) analyses in 2007 reflected this growing, competitive heroin market in the St. Louis area, with decreasing purity in black tar heroin and increasing purity in the SA heroin. South American and Mexican black tar were represented in the samples, with more white samples than black tar samples. Indicators for opiates have increased for both heroin and other opiates. This increase is consistent with reported availability for heroin and reports from rural law enforcement about increased usage. The available indicators for other opiates remained stable for this reporting period, after a significant increase in reports between 2006 and 2007 in the St. Louis area. While the actual number of admissions was relatively low, there is still reason for concern, as anecdotal information has indicated that abuse of narcotic analgesics has been on the rise in this region, along with concern about rural use of prescription narcotics. Marijuana was considered stable or possibly growing slightly in the region. While treatment admissions dropped 7.3 percent from 2006 to 2007, they rose again in the first half of 2008. However, these admissions may be in response to criminal justice demands. The percentage of current users in the YRBS shows no change since the 2005 survey. Cannabis was the most frequently cited substance identified in the 2007 and <strong>January</strong>–June 2008 <strong>National</strong> Forensic Laboratory Information System (NFLIS) reports for the St. Louis MSA. Methamphetamine indicators appeared to be decreasing in for the St. Louis region. Treatment admissions have risen by 30 percent since the second half of 2007. YRBS data suggest that lifetime methamphetamine use among students has decreased, from 6.4 percent (CI:4.4,9.1) in 2005 to 3.7 percent (CI:2.9,4.7) in 2007. While it is believed that the bulk of the available methamphetamine is being imported from Mexico, reports of “ice” from Mexico are not well-substantiated. One indication that the methamphetamine problem is not disappearing is the large number of positive toxicology screens among the Department of Corrections population in 2007 and the anecdotal reports from rural health clinics about patients who are current or former methamphetamine users. The pseudoephedrine control legislation has led to more creative ways of networking for the local “cooks” to gain access to the chemicals needed to make methamphetamine. Further analysis and monitoring are needed. Interestingly, the eastern half of the State remained relatively active in clandestine laboratory operations; 108 clandestine laboratories were reported in a rural county of the MSA in the first half of 2008 (Jefferson County). However, clandestine laboratory incidents in the St. Louis MSA were down from 868 in 2005 to 503 in 2007. Statewide, 770 clandestine laboratories were reported in the first half of 2008. Prescription drug abuse has been growing, particularly in the rural areas. However, it has been diffcult to access data to substantiate this trend. There have been multiple reports from key informants about increases in prescription drug use and in the continued use of MDMA in select populations. HIV/AIDS Update: Data available from the St Louis City Health Department and the Missouri Department of Health and Senior Services for 2007 indicate that the risk factor of injection drug use does not play a major role in the transmission of human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) in the St. Louis area. However, the men who have sex with men (MSM) population and heterosexual contact in minority populations are more prominent risk factors. The role of alcohol and other drug use among these populations is a key factor. Emerging Patterns: Indicators for many substances appeared to be stable. However, the number of cocaine-related deaths and the increase in a number of opiate abuse indicators are cause for concern and continued monitoring. A synthesis of all data sources leads to the conclusion that the heroin problem in St. Louis is becoming larger and more complex, with the market becoming 68 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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