Epidemiologic Trends in Drug Abuse: Proceedings of the Community Epidemiology Work Group: Volume Two: June 2010

2011·8.1 MB·English

by  Community Epidemiology Work Group (CEWG)

NIDA
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NATIONAL INSTITUTE ON DRUG ABUSE

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Proceedings of the Community
Epidemiology Work Group
Volume II
June 2010
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

NATIONAL INSTITUTES OF HEALTH

Division of Epidemiology, Services and Prevention Research

National Institute on Drug Abuse

6001 Executive Boulevard

Bethesda, Maryland 20892
The National Institute on Drug Abuse (NIDA) reports presented and data prepared for the June
acknowledges the contributions made by the repre- 2009 meeting by representatives from 22 areas in
sentatives of the Community Epidemiology Work the United States. This publication also includes
Group (CEWG), who prepare the reports presented reports presented by researchers from Canada,
at the semiannual meetings; representatives from Mexico, and the Netherlands.
other agencies who contribute data and technical All material in this reportis in the public
knowledge. Appreciation is extended also to other domain and may be reproduced or copied without
participating researchers and Federal officials who permission from the Institute or the authors. Cita-
contributed information. This publication was pre- tion of the source is appreciated. The U.S. Gov-
pared by Social Solutions International, Inc., under ernment does not endorse or favor any specific
contract number HHSN- 2712007-000003C from commercial product. Trade or proprietary names
the National Institute on Drug Abuse. appearing in this publication are used only because
This publication, Epidemiologic Trends in they are considered essential in the context of the
Drug Abuse, Volume II, contains the individual studies reported herein.
For more information about the Community Epidemiology Work Group
and other research-based publications and information on drug abuse
and addiction, visit NIDA’s Web site at <http://www.drugabuse.gov>.
This report (available in limited supply) can be obtained by contacting
the NIDA DrugPubs Research Dissemination Center
by phone: 877–NIDA–NIH (877–643–2644)
240–645–0228 (TTY/TDD)
by fax: [phone]
by email: [email protected]
National Institute on Drug Abuse
July 2011
ii
Proceedings of the Community Epidemiology Work Group, June 2010
Contents
Contents
Foreword ..................................................................................................................................................v
Introduction .............................................................................................................................................1
EPIDEMIOLOGY OF DRUG ABUSE: CEWG AREA REPORTS.................................................4
Patterns.and.Trends.of.Drug.Use.in.Atlanta:.2009
Lara DePadilla, Ph.D., and Mary Wolfe, B.S. ...................................................................................5
Patterns.and.Trends.of.Drug.Abuse.in.Baltimore/Maryland/Washington,.DC,..
Metropolitan.Area—Epidemiology.and.Trends:.2002–2009
Erin Artigiani, M.A., Margaret Hsu, M.H.S., Maribeth Rezey, M.S., Cheryl Rinehart, B.A.,
and Eric Wish, Ph.D. ......................................................................................................................19
Greater.Boston.Patterns.and.Trends.in.Drug.Abuse:.2009
Daniel P. Dooley .............................................................................................................................40
Patterns.and.Trends.of.Drug.Abuse.in.Chicago:.2009
Lawrence Ouellet, Ph.D., and Damian J. Denson, M.P.H. .............................................................54
Drug.Abuse.Patterns.and.Trends.in.Cincinnati,.Ohio:.2009
Jan Scaglione, B.S., M.T., Pharm.D., DABAT ................................................................................72
Patterns.and.Trends.in.Drug.Abuse.in.Denver.and.Colorado:.2009
Kristen A. Dixion, M.A., L.P.C. ........................................................................................................87
Drug.Abuse.in.Detroit,.Wayne.County,.and.Michigan:.2009
Cynthia L. Arfken, Ph.D., and Yvonne E. Anthony, Ph.D., M.B.A., M.H.A. ...................................118
Illicit.Drug.Use.in.Honolulu.and.the.State.of.Hawaii:.2009
D. William Wood, M.P.H., Ph.D. ...................................................................................................123
Patterns.and.Trends.in.Drug.Abuse.in.Los.Angeles.County,.California:.2009
Mary-Lynn Brecht, Ph.D. ..............................................................................................................138
Patterns.and.Trends.of.Drug.Abuse.in.Maine:.2009
Marcella H. Sorg, Ph.D., R.N., D-ABFA .......................................................................................150
Drug.Abuse.Trends.in.Miami/Dade.and.Broward.Counties,.Florida:.2009
James N. Hall ...............................................................................................................................159
Drug.Abuse.Patterns.and.Trends,.Minneapolis/St..Paul,.Minnesota:.2009
Carol Falkowski ............................................................................................................................180
Drug.Use.Trends.in.New.York.City:.2009
Rozanne Marel, Ph.D., Robinson B. Smith, M.A., Gregory Rainone, Ph.D., and
Raymond Toledo, Ph.D. ...............................................................................................................196
Drug.Use.in.Philadelphia,.Pennsylvania:.2009
Samuel J. Cutler, Marvin F. Levine, M.S.W., and Roland C. Lamb, M.A . .....................................212
Proceedings of the Community Epidemiology Work Group, June 2010 iii
Contents
Drug Abuse Patterns and Trends in Phoenix and Arizona: 2009

James K. Cunningham, Ph.D. ......................................................................................................228

Patterns and Trends in Drug Abuse in St. Louis, Missouri: 2009

Heidi Israel, Ph.D., R.N., F.N.P., L.C.S.W., and Jim Topolski, Ph.D. ............................................242

Drug Use and Abuse in San Diego County, California: 2009

Robin A. Pollini, Ph.D., M.P.H. .....................................................................................................253

Patterns and Trends of Drug Abuse in the San Francisco Bay Area: 2009

John A. Newmeyer, Ph.D. ............................................................................................................265

Drug Abuse Trends in the Seattle/King County Area: 2009

Caleb Banta-Green, T. Ron Jackson, David Albert, Michael Hanrahan, Mary Taylor,

Steve Freng, John Ohta, Margaret Soukup, Geoff Miller, Robyn Smith, Ann Forbes,

Richard Harruff, Steve Reid, and Eric Finney ..............................................................................272

Substance Abuse Trends in Texas: 2009

Jane C. Maxwell, Ph.D. ................................................................................................................291

INTERNATIONAL REPORTS ............................................................................................................331

Monitoring the Drug Situation in Canada: 2009

Judy Snider, M.Sc. .......................................................................................................................332

Vancouver and British Columbia Drug Use Epidemiology Report: 2009

Jane Buxton, M.B.B.S., M.H.Sc., F.R.C.P.C. ................................................................................342

Substance Use in Mexico—An Epidemiological Update: 2009

Jorge A. Villatoro Velázquez, Ma. Elena Medina-Mora Icaza, Natania Olivia Robles,

Maria de Lourdes Lopez Gutierrez, Filiberto Gaytan Flores, and Michelle Breton Cirett .............357

Drug Abuse Trends in the Netherlands: 2009

Margriet van Laar, Ph.D. ..............................................................................................................368

Drug Use in Europe, Trends and Developments—Update: June 2010

Paul Griffiths, M.Sc. .....................................................................................................................379

The European Union Early Warning System on New Synthetic Drugs—Current Situation and

Future Challenges

Paul Griffiths, M.Sc. .....................................................................................................................381

BZP Use in New Zealand: Patterns of Use, Harms, and Policy Response

Chris Wilkins, Ph.D. .....................................................................................................................382

PARTICIPANT LIST .............................................................................................................................384

Proceedings of the Community Epidemiology Work Group, June 2010 iv
Foreword
Foreword

This publicaTion includes reporTs presenTed Mexico, the Netherlands, New Zealand, and the
and data prepared for the 68th semiannual meeting European Monitoring Centre for Drugs and Drug
of the National Institute on Drug Abuse (NIDA) Addiction (EMCDDA) in Lisbon, Portugal. Other
Community Epidemiology Work Group (CEWG) highlights of the meeting included a welcome from
held in Boston, Massachusetts, on June 9–11, 2010. Rita Nieves, R.N., M.P.H., M.S.W., Director of the
The CEWG is a network of researchers from sen- Addictions Prevention, Treatment, and Recovery
tinel sites throughout the United States. It meets Support Services Bureau in Boston; a greeting
semiannually to provide ongoing community-level and update from Wilson Compton, M.D., M.P.E.,
public health surveillance of drug abuse through Director of the Division of Epidemiology, Ser-
presentation and discussion of quantitative and vices, and Prevention Research at NIDA; presenta-
qualitative data. CEWG representatives access tions by DEA representatives Cassandra Prioleau,
multiple sources of existing data from their local Ph.D., and Artisha Polk, M.P.H., on NFLIS and
areas to report on drug abuse patterns and conse- emerging drugs of concern and drug scheduling
quences in their areas and to provide an alert to issues; an update from the Office of National Drug
potentially emerging new issues. Local area data Control Policy on the Arrestee Drug Abuse Moni-
are supplemented, as possible, with data available toring (ADAM) II data system by M. Fe Caces,
from federally supported projects, such as the Sub- Ph.D.; and an update on the National Drug Intelli-
stance Abuse and Mental Health Services Adminis- gence Center’s SENTRY from Susan Seese, Ph.D.
tration (SAMHSA) Drug Abuse Warning Network A panel session on new drugs included a presen-
(DAWN), Drug Enforcement Administration tation on “Adulterants, Drugs, Coingestants, and
(DEA) National Forensic Laboratory Information Associated HIV Risks” from Edward Boyer, M.D.,
System (NFLIS), and the DEA Heroin Domestic Ph.D., Professor, Department of Emergency Med-
Monitor Program (HDMP). This descriptive and icine at the University of Massachusetts Medical
analytic information is used to inform the health School; a presentation on “Epidemiology, Clinical
and scientific communities and the general public Effects, and Testing Results from a K2 Outbreak”
about the current nature and patterns of drug abuse, by Christopher Rosenbaum, M.D., from the Divi-
emerging trends, and consequences of drug abuse. sion of Medical Toxicology, Department of Emer-
The CEWG convenes twice yearly, in January gency Medicine, University of Massachusetts
and June. For the June meetings, CEWG repre- Medical Center; a presentation on “BZP Use in
sentatives prepare full reports on drug abuse pat- New Zealand: Patterns of Use, Harms, and Policy
terns and trends in their areas. After the meeting, Response” from Chris Wilkins, Ph.D., Centre for
the Proceedings of the Community Epidemiology Social and Health Outcomes Research and Evalua-
Work Group is published in two volumes: a High- tion, Massey University, Auckland, New Zealand;
lights and Executive Summary Report (Volume I), and one by Paul Griffiths, Scientific Coordinator
and this volume that includes the full CEWG area for the EMCDDA in Portugal on the European
reports and international reports. Union’s Early Warning System on new synthetic
The majority of the June 2010 meeting was psychoactive substances, including the current
devoted to the CEWG area reports and presenta- situation and future challenges, using the synthetic
tions. CEWG area representatives presented data cathinone, mephedrone, as a case study. An epi-
on local drug abuse patterns and trends. Presen- demiologic surveillance methods panel session
tations on drug abuse patterns and issues were included the following three presentations: “Use
also provided by guest researchers from Canada, of Arrestee Data to Monitor Drug Abuse,” by Eric
v
Proceedings of the Community Epidemiology Work Group, June 2010
Foreword
Wish, Ph.D., Director of the Center for Substance at each meeting. The information is intended to
Abuse Research at the University of Maryland; alert authorities at the local, State, regional, and
“Using Treatment Admissions Data for Monitor- national levels, and the general public, to current
ing Methamphetamine,” by James Cunningham, conditions and potential problems so that appro-
Ph.D., the CEWG Phoenix area representative; priate and timely action can be taken. Researchers
and “Epidemiologic Surveillance Systems Devel- also use information to develop research hypoth-
opment,” by Caleb Banta-Green, Ph.D., M.P.H., eses that might explain social, behavioral, and bio-
M.S.W., the CEWG area representative from Seat- logical issues related to drug abuse.
tle. Moira P. O’Brien
The information published after each CEWG Division of Epidemiology, Services and
Prevention Research
meeting represents findings from CEWG area rep-
National Institute on Drug Abuse
resentatives across the Nation, which are supple-
National Institutes of Health
mented by national data and by special presentations Department of Health and Human Services
vi
Proceedings of the Community Epidemiology Work Group, June 2010
Section I. Introduction
Introduction

The CEWG Network: Roles, surveillance system to identify and assess cur-
Functions, and Data Sources rent and emerging drug abuse patterns, trends,
and issues, using multiple sources of information.
The 68Th semiannual meeTing of The commu-
Each source provides information about the abuse
nity Epidemiology Work Group (CEWG) was
of particular drugs, drug-using populations, and/
held on June 9–11, 2010, in Boston, Massachu-
or different facets of the behaviors and outcomes
setts. During the meeting, researchers from 22
related to drug abuse. The information obtained
geographically dispersed areas in the United States
from each source is considered a drug abuse indi-
reported on current trends and emerging issues in
cator. Typically, indicators do not provide esti-
their areas. In addition to the information provided
mates of the number (prevalence) of drug abusers
for 18 sentinel areas that have contributed to the
at any given time or the rate at which drug-abusing
network for many years, and two additional areas
populations may be increasing or decreasing in
(Colorado and Broward County, Florida in the
size. However, indicators do help to character-
Miami/Dade Metropolitan Statistical Area), guest
ize drug abuse trends and different types of drug
researchers from Cincinnati and Maine provided
abusers (such as those who have been treated in
data from their respective areas, as did interna-
hospital emergency departments, admitted to drug
tional representatives from Canada, Mexico, the
treatment programs, or died with drugs found in
Netherlands, and the European Monitoring Centre
their bodies). Data on items submitted for foren-
for Drugs and Drug Addiction (EMCDDA) in Lis-
sic chemical analysis serve as indicators of avail-
bon, Portugal, with a presentation on BZP (1-ben-
ability of different substances and engagement of
zylpiperazine) by a New Zealand researcher.
law enforcement at the local level, and data such as
drug price and purity are indicators of availability,
The CEWG Network accessibility, and potency of specific drugs. Drug
abuse indicators are examined over time to monitor
The CEWG is a unique epidemiology network
the nature and extent of drug abuse and associated
that has functioned since 1976 as a drug abuse
Maine
Seattle
Boston
Minneapolis/
St. Paul New York
Detroit
Philadelphia
Baltimore/ 
Chicago Maryland/
Washington, DC
Denver Cincinnati
St. Louis
San Francisco
Los Angeles Phoenix Atlanta
San Diego
Texas
Miami/Ft. Lauderdale
Honolulu
SSeennttiinneell  CCEEWWGG  aarreeaa
Area represented by guest researcher
Proceedings of the Community Epidemiology Work Group, June 2010 1
Section I. Introduction
problems within and across geographic areas. The can alert one another to the emergence of a
CEWG areas on which presentations were made potentially new drug of abuse. The CEWG is
at the June 2010 meeting are depicted in the map uniquely positioned to bring crucial perspectives
above, with one area presentation including data to bear on urgent drug abuse issues in a timely
on Baltimore, Maryland, and Washington, DC. fashion and to illuminate their various facets
within the local context through its semiannual
meetings and post-meeting communications.
CEWG Meetings
The CEWG convenes semiannually; these meet-
ings continue to be a major and distinguishing Data Sources
feature of the workgroup. CEWG representatives
To assess drug abuse patterns and trends, city- and
and guest researchers present information on drug
State-specific data were compiled from a variety
abuse patterns and trends in their areas, and per-
of health and other drug abuse indicator sources.
sonnel from Federal agencies provide updates of
Such sources include: public health agencies;
data sets used by the CEWG. In addition, time
medical and treatment facilities; ethnographic
is set aside for question-and-answer periods and
research; key informant discussions; criminal jus-
discussion sessions. The meetings provide a foun-
tice, correctional, and other law enforcement agen-
dation for continuity in the monitoring and surveil-
cies; surveys; and other sources unique to local
lance of current and emerging drug problems and
areas.
related health and social consequences.
Availability of data varies by area, so report-
Through the meetings, the CEWG accom-
ing varies by area. Examples of data reviewed by
plishes the following:
CEWG representatives to derive drug abuse indi-
• Dissemination of the most up-to-date informa- cators include, but are not limited to, the follow-
tion on drug abuse patterns and trends in each ing:
CEWG area
• Admissions to drug abuse treatment programs
• Identification of changing drug abuse patterns by primary substance of abuse or primary rea-
and trends within and across CEWG areas son for treatment admission reported by clients
at admission
• At the semiannual meetings, CEWG representa-
tives address issues identified in prior meetings • Drug-related emergency department (ED)
and, subsequently, identify drug abuse issues for reports of drugs mentioned in ED records in the
follow-up in the future. In addition to CEWG area Drug Abuse Warning Network (DAWN) Live!
presentations, time at each meeting is devoted to data system, along with weighted estimates from
presentations by invited speakers. These special the DAWN system available for 2004–2008 for
sessions typically focus on the following: this report
• Presentations by researchers in the CEWG host • Seizure, average price, average purity, and
city related data obtained from the Drug Enforce-
ment Agency (DEA) and from State and local
• Updates by Federal personnel on key data sets
law enforcement agencies
used by CEWG representatives
• Drug-related deaths reported by medical exam-
• Drug abuse patterns and trends in other coun-
iner (ME) or local coroner offices or State public
tries
health agencies
• Identification of changing drug abuse patterns is
• Controlled substance transactions reported by
part of the discussions at each CEWG meeting.
the DEA’s Automation of Reports and Consoli-
Through this process, CEWG representatives
dated Orders System (ARCOS)
Proceedings of the Community Epidemiology Work Group, June 2010 2
Section I. Introduction
• Arrestee urinalysis results from the Arrestee Other data sources cited in this report were
Drug Abuse Monitoring (ADAM) II system local data accessed and analyzed by CEWG rep-
resentatives. The sources included: local law
• State and local random samples and other sur-
enforcement (e.g., data on drug arrests); local
veys, such as the Youth Risk Behavior Survey
DEA offices; High Intensity Drug Trafficking Area
(YRBS) and the National Survey on Drug Use
(HIDTA) reports; help lines; local and State sur-
and Health (NSDUH)
veys; and key informants and ethnographers.
• Poison control center data
• Prescription drug monitoring programs
Proceedings of the Community Epidemiology Work Group, June 2010 3