HomeMy WebLinkAboutCOM 0683.039 1998-2000Stephen K. Yamashiro
Mayor
August 21, 2000
Cauut -of Rtfun-l"
POLICE DEPARTMENT
349 Kapiolani Street • Hilo, Hawaii 96720-3998
(808)935-3311 • Fax(808)961-2702
Chairman James Y. Arakaki and
Members of the Hawaii County Council
Hawaii County Council
25 Aupuni Street
Hilo, Hawaii 96720
Dear Council Chairman Arakaki and Members:
SUBJECT: STATISTICS ON DRUG ABUSE IN THE KONA AREA
t.'
Wayne G. Carvalho
Police Chief
James S. Correa
Deputy Police Chief
I -paw
County Coundl
This letter is to inform you of the results of the Police Department's
attempts to determine the validity of statistics reported by Council
Member Curtis Tyler at the March 29, 2000, County Council budget
hearing. Council Member Curtis Tyler commented, "Kona is reported to
be on a per capita basis No. 2 in the nation for the abuse of ice and
No. 7 in the nation for the abuse, I think they used 'use,' but I call
it 'abuse' of heroin."
Council Member Tyler informed us that he received the statistics from
Roslyn Cohen, Head Psychiatric Nurse, Kona Community Hospital.
On June 29, 2000, we contacted Roslyn Cohen about the source of
statistics on Kona drug use, which she provided to Council Member
Tyler. Cohen stated that she obtained the statistics from Dr. Kevin
Kunz, who informed her that the statistics were compiled by the
National Institute of Drug Abuse and presented in the 1997 Community
Epidemiology Work Group report.
We went through the report, but could find no mention of the amount of
drug use in Kona.
On August 4, 2000, Cohen told us that after reviewing the reports
again, she realized that she did not provide accurate information to
Council Member Tyler as we had earlier suspected. She stated that
although Kona is mentioned as being an area of high drug abuse, it is
not as high as she initially reported.
NOTE: Attachment is on File in Clerk's Office.
lo�� •CA
Comm. No. CA—
File No.,_,&N
Ref. To:
Ref. Date A� �'
Council Chairman Arakaki and Members
August 21, 2000
Page 2
Enclosed is the National Institute on Drug Abuse, Community
Epidemiology Work Group December 1997 report which we recently
received from Cohen. She refers to pages 45 and 72 which indicate
heroin and ice purity/price charts.
If you or any council member would like to discuss statistics or the
drug problem facing Hawaii County, please contact Lieutenant Henry
Tavares of our Area I Vice Section at (808)961-2253, or Lieutenant
Robert Hickcox of our Area II Vice Section at (808)326-4205. Mahalo.
Sincerely,
y •IWJWW{/�
WAY G. CARVALHO
POL CHIEF
HT: if
Enclosure
cc: Mayor Stephen K. Yamashiro
DEMIOLOGIC
TRENDS IN
DRUG ABUSE
volume I:
Highlights and
,
Executive Summary 1
Community
Epidemiology
Work Group
December 1997 li
COMMUNITY EPIDEMIOLOGY WORK GROUP
DECEMBER 1997
VOLUME I: HIGHLIGHTS
AND EXECUTIVE SUMMARY
NATIONAL INSTITUTES OF HEALTH
Division of Epidemiology and Prevention Research
National Institute on Drug Abuse
5600 Fishers Lane
Rockville, Maryland 20857
" 1.
All material in this volume is in the public
domain and may be reproduced or copied
without permission from the Institute or the
authors. Citation of the source is
appreciated. The U.S. Government does not
endorse or favor any specific commercial
product. Trade or proprietary names
appearing in this publication are used only
because they are considered essential in the
context of the studies reported herein.
The data in Volume I (this volume) of this
publication were extracted from 20 city abuse
indicator trend reports whose full edited text
appears in Volume II. Volume II
also contains the full edited text of reports on
specialized topics.
The National Institute on Drug Abuse
(NIDA) acknowledges the contributions
made by the members of the Community
Epidemiology Work Group (CEWG) who
voluntarily have invested their time and
resources in preparing the reports presented
at the meetings.
This publication was developed by Johnson,
Bassin & Shaw, Inc., under subcontract to
the CDM Group, Inc., contract number
NO1DA-65054, for the National Institute on
Drug Abuse.
Please visit the CEWG home page at http: //www.
cdmgroup. com/cewg/pubs. htm, or the NIDA home
page at http://www.nida.nih.gov, in order to: (1)
request Volume II of this issue (available in
limited supply), or (2) view Volumes I and II of
previous issues.
National Institute on Drug Abuse
NIH Publication No. 98-4297
Printed May 1998
ii CEWG December 1997
The Community Epidemiology Work Group
(CEWG) is a network of researchers from
major metropolitan areas of the United
States and from selected foreign countries.
The CEWG meets semiannually with the
primary objective of providing ongoing
community -level public health surveillance of
drug use and abuse, principally through
collection and analysis of epidemiologic and
ethnographic research data. Through this
program, the CEWG provides current
descriptive and analytical information
regarding the nature and patterns of drug
abuse, emerging trends, and characteristics
of vulnerable populations.
The 43rd meeting of the CEWG was held in
Scottsdale, Arizona, on December 9-12,
1997. It provided an assessment of drug
abuse and related issues in 20 metropolitan
areas of the United States and in other
countries, including Australia, Canada,
China, India, Mexico, South Africa, and
Thailand. These national presentations
highlighted the many similarities in patterns
and trends between countries and the rapid
spread of emergent drugs of abuse across
geographic borders. They also underscored
the need to continue developing an effective
program of international drug abuse
surveillance and information exchange.
The Scottsdale/Phoenix location afforded the
opportunity to consider drug -abuse -related
issues of special concern to the local
community. These opportunities included a
visit to Indian Rehabilitation, Inc., where
Dede Devine, the facility director, reported
on the scope of drug abuse among the Native
CEWG December 1997
American population and on the program's
history and current operations. In addition,
oral presentations were made on the unique
approaches implemented by programs that
provide drug abuse treatment service to
populations in the area. These approaches
include treatment rooted in Native American
and Hispanic traditional healing, such as
those used by the Curandero and Roadman
and those applied in the Talking Circle and
Sweat Lodge. These alternative therapies
were described and conducted by Juan Paz,
Wayne Juste, Sergio Maldonado, and
Minerva Blacksmith. Presentations also
were made on traditional medicine and
indigenous approaches to treatment in Asia
and Africa.
This CEWG meeting affirmed, once again,
the encompassing nature of drug abuse and
its impact on all aspects of society, both
national and global. The meeting also made
it clear that the problems and consequences
of drug use and abuse are essentially a local
community matter. While drug abuse has
national and international implications, it
emerges as a local phenomenon and has its
greatest impact on the immediate community
life. It is addressed by local health and law
enforcement agencies, and its final resolution
is increasingly being recognized as residing in
the hands of the community itself.
Nicholas J. Kozel
Associate Director
Division of Epidemiology and
Prevention Research
National Institute on Drag Abuse
Page
FOREWORD ................................ iii
LIST OF REPORTS IN VOLUME II ............. vi
INTRODUCTION ............................. I
HIGHLIGHTS
Drug Highlights ............................... 3
Regional Highlights ............................ 8
City Highlights ............................... 12
EXECUTIVE SUMMARY
Cocaine and Crack ............................ 15
Heroin...................................... 32
Opiates Other Than Heroin ...................... 48
Marijuana ................................... 51
Stimulants ................................... 64
Depressants .................................. 75
Hallucinogens ................................ 79
Other Drugs ................................. 84
AIDS Among Injecting Drug Users ................ 85
CEWG December 1997
LIST OF REPORTS IN VOLUME II
Atlanta: Metropolitan Atlanta Drug Abuse
Trends
Claire Sterk and Kristen Springer
Baltimore: Drug Use in the Baltimore
Metropolitan Area: Epidemiology and
Trends
Leigh A. Henderson
Boston: Drug Use Trends in Greater Boston
and Massachusetts
Thomas W. Clark, Elsa A. Elliott,
and Milly Krakow
Chicago: Patterns and Trends of Drug
Abuse in Chicago
Wayne Wiebel and Lorna Thorpe
Denver: Drug Use Trends in Denver and
Colorado
Lee Hoffer and Bruce Mendelson
Honolulu: Illicit Drug Use in Honolulu and
the State of Hawaii
D. William Wood
Los Angeles: Update on Illicit Drug Use
in Los Angeles County
Valerie Hq. Finan and M. Douglas Anglin
Miami: Drug Use in Miami -Dade County,
Florida
James N. Hall
Minneapolis/St. Paul: Drug Abuse Trends
in the Minneapolis/St. Paul Metropolitan
Area
Carol L. Falkowski
Newark: Drug Abuse in Newark: The
Continuing Epidemic
Abdelrahman L Abdelrahman , John F.
French, and Richard J. Schadl
New Orleans: Drug Abuse Indicators in
New Orleans
Gail Thornton -Collins
New York: Current Drug Use Trends in
New York City
Blanche Frank and John Galea
Philadelphia: Drug Use in Philadelphia,
Pennsylvania
Samuel J. Cutler and Mark R. Bencivengo
Phoenix: Drug Abuse Trends in Phoenix
and Arizona
Ilene L. Dodd
St. Louis: Drug Trends in St. Louis
Heidi Israel and Jim Topolski
San Diego: Indicators of Drug Abuse in San
Diego County
Michael Ann Haight
San Francisco: Patterns and Trends of Drug
Abuse in the San Francisco Bay Area
John A. Newmeyer
Seattle: Recent Drug Abuse Trends in the
Seattle -King County Area
T. Ron Jackson, Arnold F. Wrede, L.
David Murphy, Charlton Clay, Michael
Hanrahan, James McGough, Donald T.
Reay, and Michael Gorman
V1 CEWG December 1997
Texas: Substance Abuse Trends in Texas
Jane C. Maxwell
Australia: The Use of Ketamine and Other
Party Drugs in Sydney, Australia
Paul Dillon
Canada (Abstract): National Action Plan on
HIV, AIDS, and Injection Drug Use in
Canada
Pamela Fralick
China: Research and Application of
Traditional Chinese Medicine in Drug Abuse
Zheng Jiwang and Lu Sunan
India: Iyengar Yoga in the Treatment of
Drug Addiction and AIDS
Snehal Mehta
Mexico: Update of the Epidemiological
Surveillance System of Addictions (SISVEA)
in Mexico
Roberto Tapia-Conyer, Patricia Cravioto,
Pablo Kuri, Arturo Revuelta, and Blanca
de la Rosa
South Africa: Indigenous Approaches to the
Treatment of Substance Abuse in South
Africa
Neo Morojele
List of Participants
Contents
Washington, DC: Drug Abuse Patterns and
Trends in the Nation's Capital
Marcia Meth
Thailand: Indigenous Drug Treatment in
Thailand
Peter Loverde
Special Report: Traditional Native American
Approaches to Substance Abuse Treatment
Dede Devine, Wayne Justee, Sergio
Maldonado, and Minerva Blacksmith
Special Report: Culturally Specific
Approaches to Treatment: The Curandero As
Healer
Juan Paz
Special Report. (Abstract): Indicators of
Substance Abuse in New Mexico
Jane Martin
Special Report (Abstract): HIV Risk, Drug
Use, and Drug Treatment Among Native
Americans
Sally Stevens
CEWG December 1997 vii
EPIDEMIOLOGIC TRENDS IN DRUG ABUSE
INTRODUCTION TO VOLUME I
The 43rd meeting of the Community Epidemiology Work Group (CEWG) was held on December
9-12, 1997, in Scottsdale/Phoenix, Arizona. During this meeting, 20 CEWG representatives
reported on current drug trends and patterns in U.S. cities. The following highlights and
executive summary are based on these reports.
To assess drug abuse patterns and trends,
city- and State -specific data gathered from a
variety of health and other drug abuse
indicator sources are used. Such sources
include public health agencies, medical and
treatment facilities, criminal justice and
correctional offices, law enforcement
agencies, surveys, and other sources unique
to local areas, including:
• Primary substance of abuse reported by
clients at admission to treatment programs
• Arrestee urinalysis results based on data
collected by the Arrestee Drug Abuse
Monitoring (ADAM) system, formerly
known as the Drug Use Forecasting
(DUF) program, of the National Institute
of Justice
• Drug-related deaths reported by medical •
examiner (ME)/local coroner offices or
State public health agencies
• Drug-related emergency department.
(ED) mentions (estimated mentions and
estimated rates per 100,000 population)
reported to the Drug Abuse Warning
Network (DAWN) of the Substance Abuse
and Mental Health Services
Administration (SAMHSA) (Note: men-
tions differ from episodes—each ED
episode may involve one or more
mentions of specific drugs.)
Seizure, price, purity, prescription/
distribution, and arrest data obtained
from the Drug Enforcement Administra-
tion (DEA) and from State and local law
enforcement agencies
Additionally, these quantitative data
are enhanced with information
obtained through field reports, focus
groups, interviews, and other quali-
tative methodologies. Such
observations are interspersed
throughout the discussions of
indicator data; these excerpts and
extracts are set off in indented bold
italics.
The executive summary is organized by indicators do not differentiate between
specific drug of abuse. Please note, cocaine hydrochloride and crack. Finally,
however, that multiple -drug abuse is local comparisons are limited, especially for
the normative pattern among a broad range of the following indicators:
substance abusers. Furthermore, most health
CEWG December 1997 1
Introduction
• Deaths—Definitions associated with drug
deaths vary. Common reporting terms
include "drug-related," "drug-induced,"
"drug -involved," and "drug detec-
tions"—these terms have different
meanings in different areas of the country
DAWN data—The ED estimates for both
1995 and 1996 are preliminary. Final
estimates may be higher or lower because
of nonresponse adjustment and other
factors.
Treatment admissions—Many variables
affect treatment admission numbers,
including program emphasis, slot
capacity, data collection methods, and
reporting periods. Furthermore, while
most areas report citywide data, Texas
and Hawaii report statewide data.
• Arrest/seizure data—The number of
arrests/seizures and quantity of drugs
confiscated often reflect enforcement
policy rather than levels of abuse.
The following methods were applied to
facilitate local area comparisons:
• All ED data are based on April 1997
DAWN files. These data reflect weighted
estimates of the number of mentions based
on a sample of hospital emergency
departments.
All ED trend data cover the period
1991-96. Unless otherwise specified,
comparisons are based on 1994 versus
1996. Increases or decreases are noted
only when they meet standards of
precision at p < 0.05.
• Unless otherwise specified, all percentages
for treatment program admissions are
calculated based on admissions excluding
alcohol -only but including alcohol -in -
combination.
• Shaded boxes within tables reflect
increases (or, if noted, decreases) of 5
percentage points or more since the
previous reporting period.
Row percentages in tables do not always
add up to 100 percent: sometimes
because of rounding, sometimes because
of large numbers in the "unknown" or
"other" categories.
• Arrestee urinalysis data for 1997 are
unpublished preliminary data obtained
from ADAM. Comparisons are based on
the first half of 1996 versus the first half
of 1997.
Heroin prices per milligram pure for 1997
are based on unpublished data obtained
from sources at the DEA Domestic
Monitor Program, Intelligence Division,
Domestic Unit.
Cumulative totals of acquired immuno-
deficiency syndrome (AIDS) cases for the
total United States are based on the HIV/
AIDS Surveillance Report, Volume 9,
Number 1, Midyear 1997, from the
Centers for Disease Control and
Prevention (CDC).
Local areas vary in their reporting periods.
Many indicators reflect fiscal periods that
may differ between local areas. In addition,
the timeliness of data varies, particularly for
death and treatment indicators.
Some indicator data are unavailable in certain
areas. The symbol "--" in tables refers to
data not reported.
2 CEWG December 1997
DRUG HIGHLIGHTS
In the 6 months since the last CEWG reporting period, marijuana indicators have continued
to escalate across the country. "Club drugs" have increasingly appeared on the drug scene
in several areas. Cocaine indicators have continued to level or decline, except for some
isolated potentially emerging problems (as in Miami). Heroin indicators have varied by city:
some are level, some show increases (especially the Northeast), and some are mixed. And
most methamphetamine indicators have increased, but only in the West.
Crack cocaine continues to dominate the in 11 of the 16 CEWG cities in the Arrestee
Nation's illicit drug problem, although
indicator data show leveling off in many
urban areas: cocaine -related deaths were
stable or down in 6 of the 10 areas where
such information was reported; emergency
department (ED) mentions per 100,000
population increased significantly* in only 3
of the 20 CEWG cities in the Drug Abuse
Warning Network (DAWN); the percentage
of treatment admissions for primary cocaine
problems declined slightly or remained stable
in 13 of the 15 areas where data were
available; the percentage of cocaine -positive
male arrestees declined or remained stable"
Heroin now overshadows cocaine in some
indicators. It was the top-ranking ED
mention in four cities (Newark, San Diego,
San Francisco, and Seattle), and it was the
most common primary drug of abuse among
treatment admissions in eight areas: Arizona
(tied with stimulants), Baltimore, Boston,
Los Angeles, Newark, New York City, San
Francisco, and Seattle. Furthermore, the
Drug Abuse Monitoring (ADAM) system;
and prices remained stable or declined
slightly in most areas. Supplies remain
abundant in nearly every city. Cocaine
continues to be frequently used in
combination with other drugs in some cities,
including with heroin and marijuana in
Atlanta and Philadelphia, and with
methamphetamine in Denver. Demographic
data continue to show most cocaine users as
older, inner-city crack addicts; only in Miami
were any new using populations reported
this period.
rate of ED mentions per 100,000 population
increased significantly* in eight cities:
Dallas, Detroit, Miami, New Orleans,
Newark, Philadelphia, Phoenix, and
Washington, DC. As a percentage of ED
mentions, heroin increased or remained
stable in all CEWG areas. Available
mortality figures showed mixed trends in
eight areas: they increased in four, declined
*DAWN comparisons are for 1994 versus 1996 (preliminary estimates); the\, are included only when they are reliable at
p<0.05.
ADAM comparisons are for first half of 1996 versus first half of 1997.
CEWG December 1997 3
Highligh is
in two, and remained stable in two. Similarly,
treatment trends are mixed during this
reporting period: the percentage of
admissions for primary heroin abuse
increased in four areas (Boston, Seattle,
Chicago, and Minneapolis/St. Paul) and
declined in another four areas (Denver,
Hawaii, Los Angeles, and San Diego). In six
CEWG cities, considerable percentages (>_ 10
percent) of arrestees, both male and female,
tested heroin -positive in ADAM program.
These percentages increased in five cities,
declined in four, and remained stable in the
others." Higher quality, lower priced heroin
is available throughout the CEWG areas.
Prices declined in 10 cities in 1996, while
rising in 6; purity levels rose in 9 cities while
declining in 8.
Injecting remains the most common route of
heroin administration—particularly in the
West, but also in some eastern (Atlanta,
Boston, and Philadelphia) and midwestern
Continuing the upward trend ongoing in
many cities since 1992, marijuana ED rates
increased significantly" in nine CEWG cities.
Treatment indicators also reflect this
upswing: primary marijuana abuse as a
percentage of treatment admissions increased
slightly to moderately in at least 10 reporting
areas since their previous reporting periods.
Marijuana is now the top-ranking primary
drug in at least four areas, and it accounts
(Minneapolis/St. Paul and St. Louis) cities.
However, injecting is declining dramatically
among treatment admissions in some cities,
particularly Minneapolis/St. Paul and
Philadelphia. Snorting predominates in
Chicago, Detroit, Newark, and New York
City, and it nearly equals injecting among
Baltimore treatment admissions. Smoking is
increasing among admissions in Atlanta,
Denver, Hawaii, San Diego, and San
Francisco. Younger heroin users tend to
snort or smoke the drug. Overall, heroin
users tend to be males older than 35, but in
some cities qualitative and quantitative
data—including mortality data in
Miami—indicate increases among those age
18-25. Those age 17 and younger still
account for relatively few heroin ED
mentions, but in Dallas they constituted 6
percent, their representation among heroin
treatment admissions remains relatively low
but still noteworthy: 4 percent in
Minneapolis/St. Paul, and 2 percent in both
San Francisco and Texas.
for substantial proportions (>_20 percent) of
nonalcohol admissions in at least three
others. Among adult male arrestees,
marijuana now exceeds cocaine as the most
frequently detected drug in eight of the
CEWG cities in ADAM; moreover, in each
of the seven CEWG cities where ADAM
tests juvenile males, the percentage of
positive urinalyses is much higher for
juveniles than for adults. Treatment
DAWN comparisons are for 1994 versus 1996 (preliminary estimates), they are included only when they are reliable at
p<0.05.
ADAM comparisons are for first half of 1996 versus first half of 1997.
4 CEWG December 1997
demographics have similarly become
increasingly youth dominated: the s 17 age
group now accounts for the largest
percentages of marijuana admissions in at
least nine areas. That age group also
accounted for 20 percent or more of
marijuana ED mentions in seven of the
CEWG cities in 1996. All age groups,
however, are substantially represented in all
indicators, both qualitative and quantitative.
Ethnographic research and local surveys
increasingly support the hypothesis that the
resurgence in quantitative indicators of
marijuana use, especially among youth, may
be partially due to changing attitudes and
perception about both marijuana and
Except for ED mentions, methamphetamine
indicators—mortality, treatment, and
arrestee urinalysis—and ethnographic
research show increases in the West, where
the problem has been historically centered.
Recent ADAM data show increases** in all
the western CEWG cities. San Diego and
Phoenix lead the CEWG cities in the
percentage of arrestees testing
methamphetamine -positive. San Diego
mortality and treatment figures also show
increases, as do treatment figures in Denver,
Los Angeles, and San Francisco. Meth-
amphetamine is the most common primary
drug among treatment admissions in San
Diego and Hawaii, and it equals heroin as the
number -one drug in Arizona. By contrast,
High/igh is
cocaine. Increasing availability of more
potent marijuana is another factor.
Youth often consume marijuana with malt
liquor. Joints or blunts are also combined
with other substances: dipped in PCP in
Chicago, Philadelphia ("love boats" or "dust
blunts"), St. Louis, and Texas; containing
crack or cocaine hydrochloride in Chicago
("3750s"); laced with heroin in one San
Francisco neighborhood; dipped in codeine
cough syrup in Houston ("candyblunts"); and
dipped in embalming fluid in Houston ("dip,"
"fry," "fry sticks," "amp," and
"water -water").
ED rates declined significantly by 20-40
percent` throughout the West: in Dallas,
Denver, San Diego, San Francisco, and
Seattle (they also declined in Los Angeles
and Phoenix, but not significantly). They
also declined* in Philadelphia, but the
numbers are much lower there. The only
city with a significant increase* was
Minneapolis/St. Paul, but the numbers are
sharply lower than in the West.
Smoking has recently overtaken inhalation as
the primary route of administration in San
Diego and Los Angeles. "Ice" smoking also
predominates in Hawaii, and it is increasing
in Denver and San Francisco. Injecting,
however, still predominates in Denver, San
*DAWN comparisons are for 1994 versus 1996 (preliminary estimates); they are included only when they are reliable at
p<0.05.
**ADAM comparisons are for first half of 1996 versus first half of 1997.
CEWG December 1997 5
Highligh is
Francisco, and Texas. Denver drug dealers
sometimes cut crack or heroin with
methamphetamine. Elsewhere in the
country, methamphetamine appears in
indicators in Minneapolis/St. Paul and in the
rural areas surrounding St. Louis; availability
is reported in Atlanta and New Orleans; and
it is associated with the club or rave scenes
in Boston, Baltimore, Miami, and New York
City.
Methylenedioxymethamphetamine (MDMA
or "ecstasy") availability is reported in 12
CEWG areas, primarily as a club drug at
raves and dance parties. Methylphenidate
(Ritalin) abuse among school -aged
adolescents is reported in Boston and
Washington, DC, and it is the drug of choice
for some stimulant users in Chicago.
Gamma-hydroxybutyrate (GHB) has been
involved in poison control cases in Boston,
Miami, and Texas, and has been suspected in
deaths in Miami; it is also part of the club
scene in Baltimore, Honolulu, New York
City, and areas of New Jersey, in Atlanta, it
has become popular as a synthetic steroid.
Another club drug, ketamine ("Special K" or
"vitamin K"), is available in Boston (where
youth both smoke and inject it), Honolulu,
Miami, Minneapolis/St. Paul (where
adolescents and young adults snort it and
sometimes sprinkle it on tobacco or
marijuana), New York City (where recent
legislation has classified it as a controlled
substance), and Washington, DC.
Flunitrazepam (Rohypnol) availability has
dried up in Miami following State and
Federal legislation; in Texas, however, it
Seizures of khat, a flowering evergreen shrub
also known as "qat" or "Somali tea,"
continue to be reported in Minneapolis/St.
Paul.
The growing use of marketing terms such as
"all natural" or "all herbs" for some
ephedrine -based products is a major concern
in some areas. Products such as "herbal
ecstasy" are widely available at convenience
stores and truck stops in many CEWG areas.
In Minneapolis/St. Paul, adolescent girls
reportedly combine ephedrine -based
products with substances such as
methamphetamine and nicotine gum in an
effort to control their weight. In Arizona,
the DEA seized more than 1,000,000
pseudoephedrine tablets from one individual.
continues to be reported by treatment
admissions, especially youth, in border areas.
It continues to be reported in "date rape"
incidents in Atlanta, Minnesota (where large
quantities have been seized), and the
Washington, DC, area; and it is used as a
club drug in Atlanta and Honolulu. It has
received media attention in some cities, such
as San Diego and Seattle, but is not a
widespread problem there. Clonazepam
(marketed as Klonopin in the United States
and Rivotril in Mexico), is sold and abused in
place of flunitrazepam in Miami; on the
Texas -Mexico border, juveniles widely use it
in combination with beer, just as they had
used flunitrazepam before the import ban.
Opiate addicts use it to enhance methadone
effects in Atlanta, Boston, and Minneapolis/
St. Paul (where availability has declined).
6 CEWG December 1997
Lysergic acid diethylamide (LSD) remains
widely available in many CEWG cities, and
prices are falling; however, indicators show
declines in most areas. Rates of LSD -related
ED mentions declined in every CEWG area
(significantly in five) except San Diego and
New Orleans. Similarly, phencyclidine
(PCP) -related ED mentions declined` in six
CEWG cities, but increased* slightly in three.
Primary hallucinogen users generally
continue to constitute small percentages of
Highlights
total treatment admissions. Most
hallucinogen users are young, suburban, and
middle class. In numerous areas, such as
such as Chicago, Philadelphia, St. Louis, and
Texas, PCP is frequently used in combination
with other drugs, primarily marijuana. In
Boston and Seattle, LSD and other
hallucinogens are often associated with both
club drugs and the rave scene.
DAWN comparisons are for 1994 verstis 1996 (preliminary estimates); they are included only when they are reliable at
p<0.05.
CEWG December 1997 7
K-1
Sa Francis o
Los gele
San Diego i
CENTRAL
Cocaine still predominates, indicators mixed (T in New Orleans)
Heroin indicators T, but_purity mixed
All marijuana indicators, especially treatment and THC levels
Meth indicatorsT in Minneapolis/St. Paul and St. Louis
WEST
Cocaine indicators mixed
Heroin remains dominant problem
in many cities, most inject
Marijuana indicators stable after
recent increases
Methamphetamine use rebounding
after earlier, slight decline
Fewer mentions of club drugs
troit l Boston
r
New York
ewark
Philadelphia
Baltimore
Washington, DC
Miami
EAST
Cocaine and heroin both dominate indicators
Cocaine indicators mixed, generally
Heroin indicators T or level;
snorting common; young initiates
Marijuana indicators sharply T
Club drugs T (especially GHB)
NEWARK
Nation's #2 cocaine and heroin ED rates
Cocaine admissions stable
Heroin #1 ED and treatment drug; indicatorsT
most snort; prices I ,,,purityT
Marijuana admissions
PHILADELPHIA
Cocaine #1 in indicators (mixed)
Heroin mortality T, new younger users;
snorting T ; prices I - purity
Marijuana indicators f; #1 ADAM drug
Marijuana/PCP combinations
Boston
ew York
Newark
Philadelphia
Baltimore
Washington, DC
BOSTON
Cocaine indicators mixed
Heroin #1 treatment drug (T); new younger
users, some inject; purityT
Marijuana admissions T
NEW YORK CITY
Cocaine #1 ED drug, indicators mixed
Heroin #1 treatment drug; most snort; new
younger users; prices. ; purityT
Marijuana indicators T
Club drugs T (GHB, MDMA, ketamine)
BALTIMORE
Nation's #1 cocaine and heroin ED rates
Cocaine #1 ED drug, but admissions I
Heroin #1 treatment drug; injecting=snorting
Marijuana indicators sharply T
111 WASHINGTON, DC
Atlanta Cocaine #1 ED drug but 1, ADAM T
Heroin purityT
Marijuana ED rate 1; #1 ADAM drug
ATLANTA \ MIAMI
Cocaine still #1 in indicators; admissions Cocaine #1 in indicators (mixed); signs of adolescent
Heroin smoking T; new younger users; cocaine initiates
price and purity I Heroin mortality T, new younger users
Marijuana admissions Miami Indoor hydroponic marijuana
GHB and flunitrazepam used as club drugs GHB replaces flunitrazepam, involved in emergencies;
club drugsT (ketamine, meth, MDMA, GHB)
0
O
MINNEAPOLIS/ST. PAUL
Cocaine dominates law enforcement
efforts, but indicators mixed
Heroin indicators slightlyT
Marijuana #1 treatment drug (T);
flavored MJ
Treatment for meth T sharply
Ketamine detected
ST. LOUIS
Cocaine #1 ED and treatment drug
Heroin T in almost every indicator
Marijuana #1 ADAM drug
MJ/PCP combinations
Meth becoming major problem in
rural areas
s
St.
DETROIT
Cocaine #1 ED drug
Heroin ED rates T , but purity I; most snort
Marijuana indicators T; #1 ADAM drug
Detroit
CHICAGO
Cocaine #1 ED drug
St. o Heroin indicators T;
all types available; most snort
Marijuana #1 treatment drug;
indicators sharply T; Nation's
highest MJ -positive rate
MJ/PCP, MJ/crack combinations
Methylphenidate still readily available
NEW ORLEANS
Cocaine #1 problem; indicatorsT
Heroin ED rates
Nation's highest ED marijuana rate
Homegrown MJ remains a problem
MJ/PCP combinations
a
SEATTLE
Heroin indicators stable at elevated levels
Cocaine indicators I
Marijuana indicators continuer
Heroin and marijuana both #1 treatment drugs
SAN FRANCISCO
Cocaine indicators continue .�
Heroin remains #1 in indicators;
purity T ; prices 1; smoking T
MJ/heroin combinations
Reports of GHB, ketamine
PCP re-emerging; highest ED rate in DAWN
LOS ANGELES LOS w ales
Methamphetamine indicators T
Heroin remains dominant drug San Diego Ph enix
but treatment I
Cocaine indicators mixed
SAN DIEGO
Methamphetamine #1 in treatment;
indicators Tafter earlier decline
Cocaine indicators mixed
Q Heroin #1 in ED; deaths sharply;
other measures mixed; smoking T
Marijuana indicators T, #1 ADAM drug
HONOLULU
Methamphetamine remains #1 drug; indicators T;
meth tx admissions=alcohol admissions
Marijuana remains #2 drug
Heroin and cocaine indicators 1; heroin smoking T
DENVER
Cocaine indicators mixed but elevated
Methaphetamine problem T;
meth/cocaine combinations
Heroin indicators mixed; smoking T;
young adult users T ; prices I ; purity T
Marijuana #1 treatment problem, but
indicators stable
DALLAS
Cocaine remains #1 but indicators.
Heroin, methamphetamine indicatorsT
Club drug use continues (GHB, MDMA)
Marijuana indicators mixed,
#1 ADAM drug
Dallas
PHOENIX
Cocaine indicators T
cocaine -positive juvenile arrestees T
Methamphetamine indicators
but seizures and arrests T
Marijuana remains widespread
J
N
CEWG CITY HIGHLIGHTS: KEY ABUSED DRUGS, DECEMBER 1997
:"Atl 'tA < ..:
ED rate 230.2; 57 % of TXs;
ED rate 16.9; 4 l of TXs;
ED rate 60.9; 15 % of TXs;
Flunitrazepam linked to "date rapes", used by high
['
$90-$100/g (1); crack
$1.11 /mg (1); 41.7% pure (1)
sinsemilla $200-$250/oz
school students; methadone
diverted'$10-
20/rock
commercial $100_$125/oz
hydromorphone readily available, nexus" available;
combined with malt liquor
GHB used as steroid; clonazepam + methadone
B2kI tY O V., ;
#1 CEWG ED rate of 361.9
#1 CEWG ED rate 346 42% of
ED rate 51.6 i 15 % of TXs
(),
PCP ED rate 4.3 1 GHB &
(), methamphetamine in
Ca>
(1); 20 % of TXs; crack $10/hit
TXs; $.99/mg; 26.1 % pure
"poor quality"; $95/oz
clubs
ffti>r:< `:::
ED rate 102.8 (1); 34% of
ED rate 68.3; 55 % of TXs;
ED rate 54.3; 6 % of TXs;
GHB in poison control cases; MDMA availability T;
TXs; $80-$100/g ( ); crack
$.96/mg; 63.9% pure (1)
sinsemilla $200-$300/oz
mushrooms available; college students use ketamine;
$10-$20/g
commercial $75-$300/oz
alprazolam & clonazepam + heroin, crack, &
$700-$3,000/lb; combined with
methadone; IDUs use ketamine, methamphetamine,
PCP
other club drugs
Ca>
ED rate 210.7; 19 % of TXs;
ED rate 105.9; 20% of TXs;
ED rate 57.9 (1); 22 % of TXs;
PCP ED rate 1; methadone diverted; depressant TX
$50-$150/g ( ); crack
$.93/mg (1); 33 % pure (1)
"High quality" $110-$200/oz,
admissions T; injection of amitriptylene tablets;
$10-$20/rock ()
commercial $60-$70/oz;
methylphenidate abuse among stimulant users
.:IliettgEt.;.j'
ED rate 242.2
ED rate 74.7 (?); $1.74/mg (1);
combined with malt liquor,
26.2 % pure 1)
PCP, crack, cocaine HCl
Dallas: <':.
ED rate 60.9; 40% of TXs;
ED rate 15.9 (i ); 14 % of TXs;
ED rate 22.9 (1); 18 % of TXs;
GHB mentioned in poison control cases; inhalant
$20-$100/g (1); crack
$4.9Q./mg (1); 8.9 %pure (?)
Mexican $450-$ 800/lb
TX admissions 1; first cohort of flunitrazepam users
$60-$100/g (!)
Domestic (higher THC)
entered treatment; clonazepam (Rivotril) substituted
$700-$3,000/lb; combined with
for flunitrazepam; methamphetamine ED rates 1
PCP
66 deaths in 1996; ED rate 55.2
ED rate 23.4 (1); 10% of TXs;
ED rate 19.2 (1); 37% of TXs;
Methamphetamine treatment admissions 13 % (I);
(1); 32% of TXs; $80-$100/g
$.60/mg (1); 29.6 % pure (1)
sinsemilla $1, 500-$3,200/lb
"Ice" smoking 1; methamphetamine ED rate 1;
(1)
commercial $800-$1,200/lb
amphetamine ED rate 1
.:IliettgEt.;.j'
ED rate 242.2
ED rate 74.7 (?); $1.74/mg (1);
ED rate of 98.6 (? )
26.2 % pure 1)
..... tlt >` .
Deaths 1 (13 in 1H97); 15% of
Deaths (22 in 1H97); 6% of
23% of TXs;
Depressant -related deaths 1 (16 in 1H97);
TXs; $100-$120/g ( ); crack
TXs; $200-$500/g; 67% pure
"low quality" $250-$500/oz
::low
methamphetamine #1 drug among TX admissions;
g g
_
$20 $100/ rock ()
quality" $350-$700/oz
Ice" smoking common
I aS '>....;..
301 deaths through 11/96• ED
g
ED rate 37.4. 51 % of TXs;
ED rate 24.9; 5 % of TXs
PCP ED rate 1; methamphetamine TX admissions
::::;;:;;:::;;:;:
rate 65.8; 15 % of TXs
$1.45/m (1); 25.2% pure (1)
7% (1)
............................. .
111ii>'>.>:.,..>;.
Deaths 29 through 9/97 •
( g ),
Deaths 1 30 through 9/ 7
( g 9 ), ED
1
ED rate 53 (), 12% of TXs;
Flunitrazepam now Schedule I, GHB Schedule II;
1
ED rate 162.8 , 46 % of
()
rate 21 (1); 4 % of TXs
()
sinsemilla 250 600/oz
$ $
GHB in poison control cases, suspected in deaths;
P P
TXs- 40- 60/
TX crack
, $ $ g O
1
2.23/m pure 7.6 o pure
$ %
g P O P
commercial 65 - 180/oz
$ $
flunitraze a availability 1
m ailabilit MDMA hotline
P Y
$5-$20/bag oinitiates
un
( ),in
Y gq
uiries 1 methamphetamine in club scene;
p heroin
addicts use benzodiazepines; clonazepam sold as
Deaths 1 (27 in 1H97); ED rate Deaths - (12 in 1H97); ED rate ED rate 22.1; 21 % of TXs; Khat seizures continue; psilocybin mushrooms,
25.0; 15% of TXs; $100/g 5; 4% of TXs; $350-$500/g $200-$300/oz ketamine in club scene; clonazepam + methadone;
crack $10-$20/rock combined with ketamine students carry liquid LSD
Nevi > 'k : , '::.
ED rate 253.5; 13 % of TXs;
ED rate 312.7 (1); 77 % of
ED rate 34.2; 4 % of Txs
Alprazolam ED rate 12.8 (1); clonazepam ED rate
crack $3-$20/vial (�)
TXs; $.95/mg (1); 64.1 % pure
$10/1.0-1.Sg
I slightly; diazepam rate 1; MDMA in State
(1)
>.><°
ED rate 205.8 1 • 33 % of
O,
ED rate 27.4 1 • 8 % of TXs;#1
O,P
CEWG ED rate of 107.3
Diazepam ED rate 12.3 1 alprazolam ED rate
O� P
f}i'i'
TXs; $80-$150/g (�); crack
$1.98/mg (1); 32.4% pure ()
(1);
12.8 (1); hydromorphone and methamphetaine
$5-$25/rock ()
25 % of TX; $125-$160/oz
available; LSD widely available and used by young
people
evv`Yerk<;'»:<:
ED rate 231.0; 37 % of TXs;
ED rate 120.2; 40% of TXs;
ED rate 37.7; 14 % of TXs;
PCP ED rate 1; ketamine named controlled
$25-$30/
$.56/m (1); 60.3% pure (1)
$70-$80/oz
substance; methamphetamine and GHB in club scene
' .P.:I ila ietvfda. Deaths
1 (152 in 1H97); ED
Deaths 1(178 in 11497); ED rate
ED rate 65.4 (1); 17 % of TXs;
#1 CEWG ED rate for alprazolam (16.9); diazepam
rate 198.9; 56% of TXs; crack
77.7 (1); 20% of TXs; $.25/mg
combined with PCP, cocaine
ED rate 1; male teens continue to "huff" toluene;
$5/"ca
(1); 76.4% pure 1
HCl
P[itieiix`'
Deaths 1 (15 in 11197); ED rate
Deaths 1(25 in 1 H97); ED rate
ED rate 29.6 (1); 6 % of TXs;
Barbiturate -related deaths 1 (15 in 1 H97);
66.4 (1); 12% of TXs;
31.2 (1); 14 % of TXs; $.61 /mg
$75-$100/oz
amphetamine ED mentions 1; diazepam ED rate
$80-$100/g O
(1); 22.5 % pure (1)
13.0; hydromorphone readily available;
methamphetamine TX admissions 1
Sf Ltiuii5:r`;::'':
Deaths 1 (34 in 1H97); ED rate
Deaths 1(16 in 1H97); ED rate
ED rate 39; 19% of TXs;
Methamphetamine available in rural areas;
78.9; 41 % of TXs; $38-$100/g
21.8; 11 % of TXs; $2.48/mg
sinsemilla $1,000-$2,000/lb
alprazolam ED rate 12.5; clonazepam ED rate 1;
crack $25/rock ()
(1); 18% pure (i)
imported $2,000 $4,000/lb
MDA and MDMA sporadically available
combined with PCP
iq.IN4>: «:.:.
Deaths 1 (32 in 11497); ED rate
Deaths 1 (86 in 11497); ED rate
ED rate 24.8; 10% of TXs;
Methamphetamine deaths 1 (30 in 1H97), ED rate
35.6; 15 % of TXs; $60-$90/g
37.7; 16 % of TXs;
sinsemilla $200-$400/oz
1; "Ice" smoking predominates; LSD ED rate 1
;crack $20/0.2
$50-$200/ ; 48.5% pure 1
2-3% THC $50-$75/oz
slightly
Deaths f; ED rate 162.9 (1);
ED rate 223.9; 53 % of TXs;
ED rate 29.8; 2% of TXs;
Commercial STP and other octane enhancers used as
Ftaneiscp:? :; ':'':
19% of TXs
$.75/mg (1); 26.9% pure (1)
sinsemilla $200-$600/oz
inhalants; ketamine use by young, gay men; "Ice"
commercial $40-$100/oz
smoking I; methamphetamine TX admissions I, ED
combined with heroin
rates 1; #1 CEWG ED rate for diazepam 16.1)
Deaths 1 (45 through 9/97); ED
Deaths 1 (78 through 9/97); ED
ED rate 46.8; 32% of TXs;
Depressant -related deaths i (23 in 11497);
rate 112.3; 24% of TXs; crack
rate 127.6; 32% of TXs;
sinsemilla $2,000-$8,000/lb
methamphetamine ED rate 1 (10.1); clonazepam an-
$20-$40/rock
$.81/mg ( ); 17.8% pure (1)
commercial $350-$2,500/lb
diazepam ED rates 1; methadone diverted; LSD,
psilocybin mushrooms in rave scene
>..WasEi<ii gE ri '
ED rate 89.1 (1); $80-$150/g
ED rate 39.8 (1); $1.09/mg (1);
ED rate 50.8 (1)
Flunitrazepam linked to sexual assaults; PCP ED
crack $80-$150/g (1)
21.8% pure (1)
sinsemilla $150-$500/oz
rate 1 (81 %); ketamine available; methylphenidate
commercial $150-$250/oz
arrests amon 'unior high school students
- P a g e 1 4-
L e f t B l a n k
a
EXECUTIVE SUMMARY
Boston: "Although crack may still be Boston's number -one illicit drug of abuse,
heroin is now a widely available alternative. "
New York City: "Field researchers report few "new" (crack) users. "
MORTALITY DATA
Cocaine mortality figures increased in four
cities, remained stable in two cities, and
decreased in four cities where 1996 or part -
year 1997 data were available.
In Phoenix, the number of cocaine -related
deaths in the first half of 1997 almost
equaled that for all of 1996 (16 in 1996 and
15 through June 1997). The number of
cocaine deaths was also up, but only
slightly, in Philadelphia, from 144 in the
second half of 1996 to 152 in the first half
of 1997; the percentage of cocaine deaths
among total deaths, however, remained
stable at 49 percent. Cocaine was detected
in 32 of the 123 accidental overdose deaths
in San Diego during the first half of 1997,
a slight increase over 1996. In San
Francisco County, cocaine ME mentions
increased 28 percent between FY 1995 and
FY 1996.
Stable trends are projected for Miami,
where 29 cocaine -induced deaths were
reported in the first three quarters of 1997,
compared with 36 in all of 1996. Sim-
ilarly, cocaine -related deaths appear stable
in St. Paul (Ramsey County), with 5 such
deaths through June 1997 and 10 in 1996.
However, in Minneapolis (Hennepin
County), cocaine -related deaths appear to
CEWG December 1997
be decreasing slightly: 27 deaths were
reported in the first half of 1997 compared
with 64 in 1996.
Cocaine -related deaths were also down
slightly in Honolulu, with 13 cases in the
first half of 1997 and 18 in the second half
of 1996, although long-term trends are
stable. In St. Louis, there were 34
cocaine -related deaths in the first half of
1997 and 93 in 1996, a projected sharp
decrease. Cocaine -overdose deaths in
Seattle are also projected to decline slightly
(74 in 1996 and 45 in 1997 through
September).
Infant deaths attributed to maternal cocaine
abuse during pregnancy remained relatively
unchanged in Minneapolis, with four cases
during the first half of 1997. In New York
BEYOND THE CITY LIMITS...
Atlanta: "The epidemiologic indicators show
that the crack epidemic is leveling off in the
urban areas. However, ethnographic
information and 1996 DAWN data show an
increase among residents in metropolitan
counties outside the city ofAtlanta and in the
southern and eastern parts of the State. ...several
kev individuals have started bringing crack back
to the rural areas when delivering marijuana in
the city. "
15
Executive Summary., Cocaine
City, the number of births to women
who admitted using cocaine during
pregnancy has been steadily declining,
from a peak of 3,168 in 1989 to 1,005 in
1996, a 68 -percent decline over 7 years.
EMERGENCY DEPARTMENT
DATA
Preliminary estimates for 1996 show cocaine
emergency department (ED) mentions
(including crack) continued to constitute a
sizable proportion of total drug mentions
(including alcohol -in -combination): cocaine
accounted for 20 percent or more of drug
mentions in 9 of the 20 CEWG cities in the
Drug Abuse Warning Network (DAWN)
(exhibit 1). These percentages fluctuated
only slightly from 1994, with the exception
of St. Louis, where the proportion of cocaine
ED mentions declined by 4 percentage
points.
Exhibit 1. Percentages of total ED mentions composed of cocaine, heroin, marijuana,
methamphetamine, and "other" by metropolitan area, ranked by cocaine, 1996*
New York City
Miami
Baltimore
Atlanta
Chicago
Detroit
Philadelphia
Newark
New Orleans
Washington, DC
St. Louis
Boston
San Francisco
Los Angeles
Dallas
Seattle
Denver
Phoenix
San Diego
Minneapolis/St. Paul
N = 57,803
N = 9,434
N = 26,198
N = 20,069
N = 40,762
N = 37,739
N = 35,155
N = 18,185
N = 11,014
N = 18,448
N = 10,838
N = 22,338
N = 15,452
N = 33,571
N = 9,244
N = 13,546
N = 6,239
N = 12,151
N = 9,251
N = 7,939
10 20 30 40 50 60 70 80 90 100
Percentage of Total ED Mentions
Cocaine Methamphetamine
Heroin [] Other (includes
l
acohol-in-combination
Marijuana )
*Preliminary estimates
SOURCE: SAMHSA, Drug Abuse Warning Network, April 1997 files
16 CEWG December 1997
V.
Cocaine was once again the most frequently
mentioned illicit drug in the majority of
cities; heroin, however, became the most
mentioned drug in four cities (Newark, San
Diego, San Francisco, and Seattle). New
York City and Miami again had the highest
percentages of cocaine ED mentions (32 and
31 percent, respectively), as in 1993-95.
Baltimore
Newark
Detroit
New York City
Atlanta
Chicago
New Orleans
Philadelphia
San Francisco
Miami
Seattle
Boston
Washington, DC
St. Louis
Phoenix
Los Angeles
Dallas
Denver
San Diego
Minneapolis/St. Paul
400-
300-
200-
100-
0
00-300-200-100-0
Executive Summary: Cocaine
The highest rate of cocaine mentions per
100,000 population occurred in Baltimore,
as it has for the past 4 years, despite a 10 -
percent decline between 1994 and 1996
(exhibits 2 and 3). Newark remained
second, while Detroit jumped to third (with a
24 -percent increase, although not
Exhibit 2. Estimated rate of cocaine/crack ED mentions
per 100,000 population by metropolitan area, 1996"
162.9
162.8
� 112.3
� 102.8
� 89.1
� 78.9
66.4
65.8
60.9
M 55.2
35.6
1 253.5
242.2
231.0
230.2
■ 210.7
1205.8
198.9
0 50 100 150 200 250 300 350
ED Mentions per 100,000 Population
*Preliminary estimates
SOURCE: SAMHSA, Drug Abuse Warning Network, April 1997 files
Exhibit 3. Annual trends in cocaine/crack ED mentions
per 100,000 population in four top-ranking cities, 1991-96*
ED Mentionsper 100,000 Population
361.9
400
- -- Baltimore
=X _Newark
Detroit
New York Citty
1991 1992 1993 1994 1995* 1996*
Year
*Preliminary estimates
SOURCE: SAMHSA, Drug Abuse Warning Network, April 1997 files
CEWG December 1997 17
C
Executive Summary: Cocaine
significant), and New York remained fourth.
Minneapolis/St. Paul continued to have the
lowest rate, despite the largest increase (40
percent) in the rate of cocaine mentions
between 1995 and 1996.
Nationwide, cocaine ED rates increased
significantly (p<0.05) between 1994 and
1996 in only three cities and decreased in
five cities. New Orleans had the largest
increase (26 percent—although overall drug
mentions increased 14 percent), but the 1996
rate is still well below the rates of the early
1990s (exhibit 4). Other notable 1994-96
increases occurred in Phoenix (22 percent)
and Miami (8 percent). Significant decreases
occurred in Denver (36 percent), Wash-
ington, DC (33 percent), Boston (23
percent), and San Francisco (20 percent).
350
300
250
200
150
100
50
w ivienuons per iuu.uuu
TREATMENT DATA
BEYOND THE CITY LIMITS...
St. Louis: "Cocaine use varies by area. Cocaine
is the primary drug of choice identified in inner-
city treatment programs; alcohol, however,
remains the primary drug in both the outlying
rural areas and statewide. "
Cocaine (including crack) as a primary drug
of abuse now accounts for the highest
percentage of admissions (excluding alcohol -
only but including alcohol -in -combination) in
only 6 of the 19 areas where such data were
available (Atlanta, Miami, New Orleans,
Philadelphia, St. Louis, and Texas)—a major
Exhibit 4. Annual trends in cocaine/crack ED mentions
per 100,000 population in selected cities, 1991-96*
—� -- Chicago
—— Miami
1991 1992 1993 1994
Year
*Preliminary estimates
SOURCE: SAMHSA, Drug Abuse Warning Network, April 1997 files
--�-- New Orleans
--+ Boston
1995* 1996'
18 CEWG December 1997
shift from only 2 years ago, when twice as
many city treatment systems were dominated
by cocaine (exhibit 5). Heroin now dom-
inates the treatment percentages in more
cities than cocaine (Newark, Boston, San
Francisco, Los Angeles, Baltimore, New
York City, Seattle, and Arizona); marijuana
ranks highest in Denver, Chicago, and
Minneapolis/St. Paul; and stimulants account
for the highest percentage in San Diego and
Hawaii.
Executive Summary: Cocaine
Since the previous reporting period, the
percentages for cocaine have declined in 11
of the 15 areas where data were available:
sharply in Chicago (9 percentage points) and
Atlanta (7 percentage points); moderately in
Seattle (5 percentage points), St. Louis (4
percentage points), and Baltimore and
Boston (3 percentage points each); and only
slightly in New York City, San Diego,
Hawaii (2 percentage points each), Texas,
and San Francisco (1 point each). The only
Exhibit 5. Primary drugs of abuse as percentages of treatment admissionsa
in reporting CEWG areas
NOTE: The shaded areas indicate the top-ranking primary drug of abuse in each area.
aTotal admissions number excludes alcohol -only but includes alcohol -in -combination; reporting periods are
January—June 1997, except for the following: July 1995—June 1996 in San Francisco; calendar year 1996 in
Baltimore, Newark, and New York City; July 1996—March 1997 in Miami; January—April 1997 in Denver; July
1996—June 1997 in Chicago and Hawaii; July—September 1997 in Los Angeles; and October 1996—September 1997
in Texas.
bincludes Harris, Bexar, and Dallas Counties
°Alcohol -only is not excluded.
CEWG December 1997
19
Executive Summary: Cocaine
increases were noted in Philadelphia and
New Orleans (9 and 6 percentage points,
respectively). The proportion of cocaine
admissions remained stable in Newark and
Denver.
EXPLANATION FOR A DECLINE?
Newark: "Cocaine admissions have leveled off
and even decreased in Newark and some other
areas across the State, due in part to the effect of
managed care on admissions to hospital-based
detoxification programs. "
DEMOGRAPHICS
New York City: 'Another difference
between cocaine hydrochloride (HCV
and other major illicit drugs is that a
large number of white, middle-class
individuals are involved in selling.
Typically, many of these people are
small-time sellers who seek to offset
the cost of their own habit by
peddling the drug to a limited number
of friends and acquaintances. "
Atlanta: 'According to ethnographic
sources, the availability of cocaine HCl
has caused an increase in intranasal
cocaine use, specifically among
middle-class suburban residents. "
Age
Indicator data continue to show most
cocaine users as an aging pool of hard-core
users; however, younger users in certain
areas, such as Miami, may be emerging as a
potentially new using population.
In all cities where mortality demographics
were available, the average age of decedents
was higher than 35. For example, in Seattle,
cocaine overdose decedents had a mean age
20
of 40 (with an age range of 26-57), an
increase from the 1996 average of 36.8. The
average age of cocaine -induced deaths in
Miami during 1997 was similar at 41 years,
with a range of 28-63. In St. Paul
(Hennepin County), the average age of
cocaine decedents (excluding infants) was
38.5 years. The majority (66 percent) of San
Diego cocaine overdose decedents were age
36 or older.
Emergency department data also point to an
aging cohort of users among cocaine
mentions (exhibit 6). The 35+ age group
accounts for the largest proportion of
cocaine mentions in 13 of the 20 CEWG
cities in DAWN, while the 26-34 age group
constitute the largest proportion in 4 cities,
and the remaining 2 cities have an equal
proportion in each group.
In addition, the percentage of cocaine ED
mentions in the 35+ age group increased by
5 or more percentage points in 13 of 20
cities between 1994 and 1996 (exhibit 6).
Notably, no other age groups in any city had
a 5 -point or greater percentage increase. In
fact, in Atlanta, Boston, Dallas, Detroit,
Miami, New Orleans, St. Louis, San Diego,
and Washington, DC, the 26-34 group
declined by 5 or more points; and in Denver,
Newark, and Philadelphia, the 18-25 group
had similar decreases.
Like mortality and ED data, treatment
demographics continue to reflect an aging
group of cocaine users (exhibit 7). More
than 80 percent of primary cocaine admis-
sions in every reporting area continue to be
in the 26-34 or 35+ age groups. Trend data
also point to an aging cohort of cocaine
admissions: the proportion of primary
cocaine admissions age 35+ increased by 5
CEWG December 1997
Executive Summarv: Cocaine
Exhibit 6. Percentage of cocaine/ Exhibit 7. Percentage of primary cocaine
crack ED mentions by male representation, admissions in reporting CEWG areas by
age group, and area, 1996° male representation and by the two oldest age
arouos"
.....
.
.:::::....:....:.::::::::::::::::::
. . .....................
5....
6
Atlanta
70
2
12
b36
44
Baltimore
63
< 1
11
39
49
Boston
58
1
16
b43
40
Chicago
b62
1
14
38
58
Dallas
42
5
18
b38
39
Denver
63
3
b19
40:::::.
$
Detroit
66
< 1
7
b32
&Q
Los Angeles
67
3
18
36
43
Miami
69
1
13
b35
44
Minneapolis/
St. Paul
63
3
21
38
:3$
Newark
63
< 1
b13
43
42
New Orleans
69
2
19
b35
43
New York
Cit
72
< 1
8
39
`: 52
Philadelphia
67
1
b13
39
:'46
Phoenix
73
1
27
41
29
St. Louis
63
1
13
b34
51
San Diego
b61
3
12
b26
59
San
Francisco
67
1
10
32
56
Seattle 1
641
2
18
35
44
Washington,
DC
61
2
11
b43
44
NOTE: Shaded areas reflect percentages that have
increased by 5 percentage since the reporting
period 1 year earlier.
'Total admissions number excludes alcohol -only but
includes alcohol -in -combination; reporting periods are
January -June 1997, except for the following: July
1995 -June 1996 in San Francisco; calendar year
1996 in Baltimore, Newark, and New York City;
January -April 1 997 in Denver; July 1996 -June
NOTE: Shaded areas reflect percentages that have 1997 in Chicago and Hawaii; July -September 1997
increased by _>5 percentage points since 1994. in Los Angeles; and October 1996 -September 1997
in Texas.
'Preliminary estimates "Age category is 26+.
"Percentage has declined by �!5 percentage points since 'Age categories are 26-35 and 36+.
1994.
SOURCE: SAMHSA, Drug Abuse Warning Network,
April 1997 files
CEWG December 1997 21
.
.:::::....:....:.::::::::::::::::::
. . .....................
Atlanta
62
45
44
Baltimore
59
44>[
Boston
62
-
--
Chicago
50
46
40
Denver
62
89b
Hawaii
58
41
42
Los Angeles
53
43
39
Minneapolis/
64
431><:;:;:::
St. Paul
Newark
54
55
35
New York City'
62
55
34
Philadelphia
60
-
--
St. Louis
55
48
44
San Diego
54
42
50'::;
San Francisco
61457.
49
Texas
55:::.....11
41
€<4Cf:
NOTE: Shaded areas reflect percentages that have
increased by 5 percentage since the reporting
period 1 year earlier.
'Total admissions number excludes alcohol -only but
includes alcohol -in -combination; reporting periods are
January -June 1997, except for the following: July
1995 -June 1996 in San Francisco; calendar year
1996 in Baltimore, Newark, and New York City;
January -April 1 997 in Denver; July 1996 -June
NOTE: Shaded areas reflect percentages that have 1997 in Chicago and Hawaii; July -September 1997
increased by _>5 percentage points since 1994. in Los Angeles; and October 1996 -September 1997
in Texas.
'Preliminary estimates "Age category is 26+.
"Percentage has declined by �!5 percentage points since 'Age categories are 26-35 and 36+.
1994.
SOURCE: SAMHSA, Drug Abuse Warning Network,
April 1997 files
CEWG December 1997 21
Executive Summary. Cocaine
or more percentage points in Baltimore,
Minneapolis/St. Paul, San Diego, and Texas.
The 26-34 age group increased by more than
5 percentage points only in San Francisco.
In Boston, longer term trend data vividly
show primary cocaine clients as an aging
population: those age 30 or older increased
from 49 percent in FY 1993 to 66 percent in
FY 1997.
Miami. "Anecdotal reports indicate
that some adolescents may be
initiating cocaine use in combination
with other drugs. "
New York City: Most users at
copping locations appear to be
between 20 and 40 years of age. "
San Francisco: "Ethnographic
observers report that there is not
much recruitment of new users of
crack cocaine. Users tend to be older
(thirdes and forties) and to be using
less frequently. "
As previously mentioned, a potentially new
cocaine -using population may be emerging in
the Miami area: younger cocaine users
started appearing among 1996 and 1997
local Poison Information Center cocaine
mentions. Cocaine mentions among youth
age 14-20 accounted for 17 percent of the
1996 episodes, but increased to 30 percent
of the 1997 cases. Among 1996 DAWN
cocaine ED mentions in Miami, only 1
percent were age 12-17. However, the rate
of such mentions for this age group (32.2 per
100,000 population) was more than three
times the national rate of 9.1 per 100,000 for
this same age group. Further monitoring of
this situation must continue in the next
several reporting periods to avoid the
emergence of a new outbreak.
Gender
Males continue to dominate cocaine
overdose deaths: they far outnumber females
in all cities with demographic data. In
Miami, for example, 26 of the 29 cocaine -
induced decedents were males (90 percent).
Likewise, in San Diego and Seattle, males
constituted 84 and 82 percent of cocaine
overdose deaths, respectively.
Males also continue to outnumber females as
a percentage of cocaine ED mentions in all
CEWG cities in DAWN (exhibit 6). The
gender gap is widest in Phoenix, followed by
New York City and Atlanta; it remains
narrowest in Boston. Between 1994 and
1996, the percentage of males increased by 5
or more points only in Dallas, while it
declined similarly in Chicago and San Diego.
EXPLANATION FOR THE GENDER GAP?
Males predominate in all the cocaine
indicators—except for arrestee urinalysis.
WHY?
Perhaps:
• Women avoid treatment because of
inadequate child care and limited number of
treatment slots.
• Women avoid ED care because they fear
losing child custody.
• Police tend to rearrest prostitutes, and street
prostitutes are often involved with drugs.
Similarly, among cocaine admissions, males
outnumber females in all reporting areas
except Chicago, where males and females are
evenly divided (exhibit 7). Following
Chicago, the narrowest gender gaps
22 CEWG December 1997
Executive Summary., Cocaine
Exhibit 8. Percentage positive for cocaine among male and female booked arrestees,
first half 1997 (ranked by males)
New Orleans
Atlanta
Chicago'
New York City
Miami`
St. Louis
Los Angeles
Denver
Philadelphia
Houston
Washington, DC
Phoenix
Dallas
San Antonio
San Diego
Detroit
27
9
- 66
NOMMEMEMIL52
-� 61
48
48
45
MONEL-44
- 55
MMM -L4
52
42 148
37_ _ 59
35
34
34
43
36
34
-- J 33
22 - -
- - -- 49
0 10 20 30 40 50 60
Percent Positive
'Females are not tested at these sites.
SOURCE: National Institute of Justice, Arrestee Drug Abuse Monitoring system,
preliminary data, November 1997 files
occurred in Los Angeles, Newark, and San
Diego. The proportion of males increased by
6 percentage points in Texas, the only area
reporting such a large change.
Only in one indicator do women pre-
dominate: according to preliminary first-
half -1997 Arrestee Drug Abuse Monitoring
(ADAM) data, cocaine -positive findings
were higher among female arrestees than
among males in most CEWG cities (exhibit
8). The only exceptions occurred in
Houston, New York City, and San Antonio,
where male arrestees tested positive at
higher percentages than females.
Race/Ethnicity
Unlike ED and treatment data, cocaine
mortality racial/ethnic distributions were
primarily dominated by whites. In Seattle,
whites constituted 60 percent of cocaine
CEWG December 1997 23
■
Males
Females
70
80
'Females are not tested at these sites.
SOURCE: National Institute of Justice, Arrestee Drug Abuse Monitoring system,
preliminary data, November 1997 files
occurred in Los Angeles, Newark, and San
Diego. The proportion of males increased by
6 percentage points in Texas, the only area
reporting such a large change.
Only in one indicator do women pre-
dominate: according to preliminary first-
half -1997 Arrestee Drug Abuse Monitoring
(ADAM) data, cocaine -positive findings
were higher among female arrestees than
among males in most CEWG cities (exhibit
8). The only exceptions occurred in
Houston, New York City, and San Antonio,
where male arrestees tested positive at
higher percentages than females.
Race/Ethnicity
Unlike ED and treatment data, cocaine
mortality racial/ethnic distributions were
primarily dominated by whites. In Seattle,
whites constituted 60 percent of cocaine
CEWG December 1997 23
Executive Summary: Cocaine
overdose deaths, although African-
Americans continued to be overrepresented
(33 percent). Similarly, in San Diego,
cocaine overdose decedents were predomi-
nantly whites (59 percent), followed by
African-Americans (22 percent) and
Hispanics (13 percent). Among the cocaine -
induced deaths in Miami, 16 were non -
Hispanic whites (55 percent), 10 were
African-Americans (34 percent), and 2 were
Hispanics (7 percent). In Los Angeles,
however, African-Americans were the modal
group, accounting for 38 percent of the 1996
cocaine -related decedents, while whites
made up 34 percent of such deaths, a sharp
and significant increase from earlier years.
Only in Minneapolis were African-Americans
the majority group among decedents,
comprising 60 percent of cocaine deaths in
the first half of 1997.
African-Americans constitute the majority of
cocaine ED mentions in 11 of the 20 CEWG
cities in DAWN, and they are the modal
group in another 2 cities (exhibit 9). Whites
continue to account for the majority of
cocaine mentions in Boston, and they are the
modal group in Dallas, Denver,
Minneapolis/St. Paul, Phoenix, San Diego,
and Seattle. The largest Hispanic
representation continues to occur in Los
Angeles, followed by Phoenix, New York
City, Chicago, Dallas, and San Diego.
The most notable increases among cocaine
ED mentions between 1994 and 1996
occurred among African-Americans in San
Diego (from 24 to 32 percent), whites in
Washington, DC (from 23 to 28 percent),
and Hispanics in Chicago (from 10 to 15
percent). During the same period, the
percentage of African-Americans among
Exhibit 9. Proportions of cocaine/crack ED
mentions by race/ethnicity and area, 1996°
................. . ..d=
Atlanta
b68
11
< 1
Baltimore
79
18
< 1
Boston
21
58
6
Chicago
65
15
Dallas
b38
41
15
Denver
b13
b24
114
Detroit
79
17
< 1
Los Angeles
37
28
31
Miami
b51
36
11
Minneapolis
35
b40
4
Newark
66
18
8
New Orleans
72
26
< 1
New York
Cit
52
13
20
Philadelphia
64
30
5
Phoenix
18
44
28
St. Louis
74
24
...
San Diego
....... .... ....
3`2
36
615
San
Francisco
b33
24
7
Seattle
b13
b27
2
Washington,
DC
662
>
NOTES: "..." Denotes estimate does not meet
standard of precision; shaded areas reflect
percentages that have increased by _>5 percentage
points since 1994; percentages in several cities are
on the low side because of unusually high "race
unknown" category or missing data.
*Preliminary estimates
bPercentage has declined by_5 percentage points
since 1994.
SOURCE: SAMHSA, Drug Abuse Warning
Network, April 1997 files
24 CEWG December 1997
Exhibit 10. Percentage of primary cocaine
admissions by race/ethnicity in reporting CEWG
areas°
'Total admissions number excludes alcohol -only but
includes alcohol -in -combination; reporting periods are
January -June 1997, except for the following: July
1995 -June 1996 in San Francisco; calendar year 1996
in Baltimore, Newark, and New York City; January -April
1997 in Denver; July 1996 -June 1997 in Chicago and
Hawaii; and October 1996 -September 1997 in Texas.
bPercentage has declined by _>5 points since the
reporting period 1 year earlier.
'Hawaiians constitute 37 percent.
cocaine ED mentions declined sharply (10+
percentage points) in San Francisco, Seattle,
Washington, DC, and Dallas, and less so in
Atlanta (7 percentage points). The
percentage of whites declined notably in
Denver (15 points), Minneapolis/St. Paul (11
points), and Seattle (10 points). In Denver
and San Diego, the proportion of Hispanics
declined (7 percentage points each).
Executive Summary: Cocaine
African-Americans continue to constitute the
majority of cocaine treatment admissions in
every reporting area except Denver (where
whitesr the em
oda)P)
r
a
ou Hawaii
(where
where
Hawaiians are the modal group), and Texas
(where African-Americans are the modal
group) (exhibit 10). The percentage of
African-Americans, however, has decreased
sharply in several areas, including Atlanta,
Chicago, San Diego, and Texas. In Boston,
longer term trends show a striking decrease:
55 percent of primary cocaine admissions in
FY 1997 were African-American, down from
65 percent in FY 1993.
New York City continues to have the largest
Hispanic representation among cocaine
admissions, followed by Texas, Boston, and
San Diego, which all increased slightly.
USE PATTERNS
Route of Administration
Atlanta: "Injection mentions have
increased as cocaine HCI has become
more available on the drug market.
Users have reported to ethnographers,
outreach workers, and drug treatment
staff that they have shifted from
smoking crack to injecting cocaine,
often in combination with heroin. "
Boston: "Ina significant new
development, outreach and needle
exchange workers in Boston and in
western Massachusetts reported that
some cocaine and speedball (cocaine
and heroin) injectors are dissolving
crack cocaine for injection, a practice
initially driven by shortages of cocaine
HCl.
'However, it seems a growing
proportion of cocaine injectors may be
CEWG December 1997 25
.....
:>::.........
Hts anus
Atlanta
b71
28
< 1
Baltimore
62
37
1
Boston
55
32
10
Chicago
b67
25
5
Denver
34
46
--
Hawaii°
9
25 1
4
Minneapolis/
56
36
4
St. Paul
Newark
85
5
10
New York City
65
16
18
St. Louis
83
16
1
San Diego
b62
25
10
San Francisco
74
13 1
8
Texas
b45
38
16
'Total admissions number excludes alcohol -only but
includes alcohol -in -combination; reporting periods are
January -June 1997, except for the following: July
1995 -June 1996 in San Francisco; calendar year 1996
in Baltimore, Newark, and New York City; January -April
1997 in Denver; July 1996 -June 1997 in Chicago and
Hawaii; and October 1996 -September 1997 in Texas.
bPercentage has declined by _>5 points since the
reporting period 1 year earlier.
'Hawaiians constitute 37 percent.
cocaine ED mentions declined sharply (10+
percentage points) in San Francisco, Seattle,
Washington, DC, and Dallas, and less so in
Atlanta (7 percentage points). The
percentage of whites declined notably in
Denver (15 points), Minneapolis/St. Paul (11
points), and Seattle (10 points). In Denver
and San Diego, the proportion of Hispanics
declined (7 percentage points each).
Executive Summary: Cocaine
African-Americans continue to constitute the
majority of cocaine treatment admissions in
every reporting area except Denver (where
whitesr the em
oda)P)
r
a
ou Hawaii
(where
where
Hawaiians are the modal group), and Texas
(where African-Americans are the modal
group) (exhibit 10). The percentage of
African-Americans, however, has decreased
sharply in several areas, including Atlanta,
Chicago, San Diego, and Texas. In Boston,
longer term trends show a striking decrease:
55 percent of primary cocaine admissions in
FY 1997 were African-American, down from
65 percent in FY 1993.
New York City continues to have the largest
Hispanic representation among cocaine
admissions, followed by Texas, Boston, and
San Diego, which all increased slightly.
USE PATTERNS
Route of Administration
Atlanta: "Injection mentions have
increased as cocaine HCI has become
more available on the drug market.
Users have reported to ethnographers,
outreach workers, and drug treatment
staff that they have shifted from
smoking crack to injecting cocaine,
often in combination with heroin. "
Boston: "Ina significant new
development, outreach and needle
exchange workers in Boston and in
western Massachusetts reported that
some cocaine and speedball (cocaine
and heroin) injectors are dissolving
crack cocaine for injection, a practice
initially driven by shortages of cocaine
HCl.
'However, it seems a growing
proportion of cocaine injectors may be
CEWG December 1997 25
Executive Summary: Cocaine
choosing crack over HCI, even when
both are available, perhaps due to
crack's lower price and higher average
purity. Some of the materials used in
the process of dissolving crack (such
as lemon juice and vinegar) can add
significantly to the risks of injection. "
Smoking, typically crack, remains the
dominant route of administration among
primary cocaine treatment admissions in
every CEWG reporting area (exhibit 11).
However, in Chicago, intranasal use of
cocaine increased sharply (from 8 to 18
percent), while smoking has concurrently
decreased. Less dramatically, intranasal use
has increased in Philadelphia (from 10 to 14
percent), although smoking continues to
overshadow other modes of cocaine use.
Intranasal use has also reportedly increased
among middle-class suburban residents in
Atlanta.
Multisubstance Use
As in previous years, alcohol and marijuana
remain the most frequently reported sec-
ondary and tertiary drugs of abuse among
primary cocaine treatment admissions in
every reporting area except Texas, where
heroin is the most common secondary drug
of abuse, and San Francisco, where heroin is
the most common tertiary drug of abuse.
Cocaine is also commonly cited as a sec-
ondary and tertiary drug among admissions
for other primary drugs of abuse. For
example, while heroin clearly exceeds
cocaine as the primary drug of abuse among
treatment admissions in Baltimore, cocaine
was the most pervasive illicit drug in the
treatment system: cocaine use was reported
by 57 percent of all drug treatment admis-
sions, although the number of primary
Exhibit 11. Route of administration
among cocaine treatment admissions, by
percentage, in reporting CEWG areas*
'Total admissions number excludes alcohol -only but
includes alcohol -in -combination; reporting periods are
January -June 1997, except for the following: July
1995 -June 1996 in San Francisco; calendar year
1996 in Baltimore, Newark, and New York City;
January -April 1997 in Denver; July 1996 -June
1997 in Chicago and Hawaii; and October
1996 -September 1997 in Texas.
cocaine admissions was less than half that for
heroin. Likewise, in Newark, cocaine
remains a major problem as a secondary drug
of abuse, substantially more than as a
primary drug: during 1996, 42 percent of all
heroin admissions reported a concomitant
cocaine problem.
Denver: "According to field reports,
crack is often used with metham-
phetamine, and it appears some crack
users have 'crossed over' to
methamphetamine use. "
26 CEWG December 1997
>Ir`ect
Atlanta
58
6
1
Baltimore
76
14
8
Boston
76
16
4
Chicago
77
18
2
Denver
66
--
Hawaii
87
9
3
Minneapolis/
St. Paul
85
13
2
Newark
77
20
4
New York
City
74
24
1
Philadelphia
83
14
2
St. Louis
92
3
2
San Diego
86
8
5
San
Francisco
91
4
1
Seattle
80
Texas
72
14
13
'Total admissions number excludes alcohol -only but
includes alcohol -in -combination; reporting periods are
January -June 1997, except for the following: July
1995 -June 1996 in San Francisco; calendar year
1996 in Baltimore, Newark, and New York City;
January -April 1997 in Denver; July 1996 -June
1997 in Chicago and Hawaii; and October
1996 -September 1997 in Texas.
cocaine admissions was less than half that for
heroin. Likewise, in Newark, cocaine
remains a major problem as a secondary drug
of abuse, substantially more than as a
primary drug: during 1996, 42 percent of all
heroin admissions reported a concomitant
cocaine problem.
Denver: "According to field reports,
crack is often used with metham-
phetamine, and it appears some crack
users have 'crossed over' to
methamphetamine use. "
26 CEWG December 1997
Use of crack in combination with other
substances is frequently reported in several
areas. In Miami, hotline callers and school
counselors continue to report that marijuana
and crack are commonly combined in "geek
joints." Similar combinations were reported
in Chicago, including "diablito," "primo," or
"3750" (crack with marijuana) and
"bazooka" or "primo' (crack with tobacco).
In Philadelphia, crack users continue to
report frequent use of 40 -ounce bottles of
malt liquor or other drugs, including
alprazolam (Xanax), diazepam, or marijuana;
less frequently, heroin or phencyclidine
(PCP) is used with crack. And, for the first
time, focus group conversations in
Philadelphia revealed the use of brand names
for crack.
Cocaine HCl combinations have also been
identified. In Philadelphia, buyers of cocaine
HCl are more likely to use it for injecting
with heroin than for snorting. Cocaine HCl
also continues to be used with marijuana in
blunts in that city. In Atlanta, a combination
of cocaine and heroin is smoked, while the
use of cocaine with alcohol and marijuana
remains common.
LAW ENFORCEMENT DATA
Arrestee Data
Cocaine and marijuana each rank as the most
frequently detected drug among adult male
arrestees in seven cities, according to
preliminary first -half -1997 ADAM data.
Cocaine, however, remains the most
frequently detected drug among female
arrestees in all cities except San Diego,
where methamphetamine was the most
commonly detected drug.
Executive Summary: Cocaine
Several striking declines occurred among
ADAM cocaine -positive adult male arrestees
in CEWG cities between the first halves of
1996 and 1997: Miami and Philadelphia,
down 9 percentage points each; and
Chicago, Houston, and San Diego, down 5
percentage points each. Among female
arrestees, large declines were noted in
Philadelphia (18 points) and Phoenix (9
points).
Despite these declines, notable increases
occurred among male arrestees in
Washington, DC (5 points), Denver, and
New York (3 points each). Among cocaine -
positive female arrestees, marked increases
were also reported in Washington, DC (from
33 to 43 percent) and San Diego (from 24 to
33 percent).
Cocaine -positive levels among juveniles
increased in San Antonio (from 11 to 16
percent), Phoenix (from 10 to 16 percent),
and Denver (from 4 to 7 percent), and
remained stable in other reporting areas.
Cocaine continues to be involved in the
majority of drug-related arrests in several
areas, including Boston, Honolulu, and St.
Louis. While cocaine still accounts for 50
percent of all controlled substance arrests in
Boston, that figure is 3 percentage points
lower than in the preceding year and well
below the all-time high of 66 percent in
1992. In New York City, cocaine arrests
have remained level since 1994 at around
38,000 annually, with 82 percent of cocaine
arrests involving crack. In Honolulu, the
number of cocaine cases declined sharply
between the first and second halves of 1996
(from 786 to 532) but then increased slightly
in the first half of 1997 (to 545).
CEWG December 1997 27
Executive Summary: Cocaine
Crime and Violence
Homicides, one indicator of the violence
associated with cocaine, continued to decline
in Minneapolis. Homicides were involved in
6 of the cocaine -related deaths in Hennepin
County in the first half of 1997, compared
with 17 in 1996 and 23 in 1995. Despite this
decline, overt drug dealing continued to
erode the quality of life and livability of some
Minneapolis neighborhoods. To heighten
public awareness and raise the visibility of
this persistent problem in a central city
neighborhood, one concerned group of
residents created "Minneapolis Crack Tours"
of the area. The Block Club/Citizen's
Coalition widely publicized the tours in local
media and planned to create an Internet Web
site where people can take a so-called
"virtual crack tour," watching drug deals on
their computer screen as they are taking
place.
Because of the violence associated with
crack cocaine, there is a tendency to assume
crack use is more common among prison
inmates than cocaine HCl use. However,
according to a recent Texas Commission on
Alcohol and Drug Abuse (TCADA) analysis
of county -level data on probationers and
prison inmates, this assumption is question-
able. Between 1993 and 1995, past -month
use of cocaine HCl and crack were similar in
many instances. For Dallas and San
Antonio, past -month use of cocaine HCl was
higher than past -month use of crack, for
these cities and for Houston, lifetime use was
higher for cocaine HCl than for crack.
Availability, Price, and Purity
Chicago: "The (crack and HCV
drought was confirmed by users,
outreach workers, and the police.
Most sources perceived the lack of
cocaine and rock availability to be a
concerted effort on the part of cocaine
dealers to reinvigorate the price of
cocaine. "
Denver: "Ethnographic reports
indicate that within the last 4 years,
cocaine HCl has become less available
to the street user. Reports continue
that users frequently unrock' crack in
order to inject it. Even when working
for crack dealers, users often cannot
acquire HCl. "
Boston: "Anecdotal police reports
indicate that cocaine is still
widespread in the Boston area,
despite a possible decline in
popularity. "
BEYOND THE CITY LIMITS...
Boston: "Crack is the predominant form of
cocaine in the inner city, while cocaine HCl
seems more prevalent in outlying communities. "
Both crack and HCl were widely available in
most cities, including Atlanta, Boston,
Miami, Newark (but with the caveat that
many crack users cook their own crack from
cocaine HCl), New Orleans, Phoenix, and St.
Louis. Additionally, crack was easily
obtainable in Philadelphia (despite a reported
decline in purity); cocaine HCl, however,
was not as readily available in small
28 CEWG December 1997
quantities as crack. In Chicago, crack's
dominance in inner-city street cocaine
markets has clearly diminished HCl
availability in many areas of the city.
New York City: "Cocaine HCl users
continue to flock to uptown
Manhattan and Washington Heights,
which are dominated by Dominican
drug sellers. The belief is that cocaine
purchased here is of better quality and
less expensive. "
Philadelphia: "Focus groups of former
drug users recently admitted to
treatment indicated that in fall 1997,
the perceived quality of crack was not
as potent as it had been in the last
half of 1996 and early 1997.
Similarly composed groups over the
last few years also indicated a decline
in quality. "
As shown in exhibits 12 and 13, crack and
HCl prices remained stable or decreased
during the last reporting period in most
cities. Compared with 6 months earlier, the
price of cocaine HCl and crack in Texas
decreased slightly while purity remained
high. Likewise, cocaine HCl prices declined
slightly in Atlanta; crack prices were level
but purity increased. In New Orleans, HCl
prices have remained consistent for the past
4 years; crack prices also remain stable, with
purity high. Cocaine HCl prices remained
low in St. Louis, while purity stayed high,
crack prices and purity were also stable.
Similarly, crack and cocaine prices remained
relatively stable in Seattle. Cocaine HCl
prices were stable in Washington, DC,
between 1996 and 1997, while crack prices
remained stable at the gram level but
declined for larger quantities, including
Executive Summary: Cocaine
Exhibit 12. Crack prices and purity in
reporting CEWG areas
Via
« .... <<
R6e�lUni�<`>>
:..:...:..::.;:.:.::..
...
t 1.
:.
Atlanta
75
$10-$20/rock
$50-$75/g
$850-$1,300/oz
$18,000-$22,000/k
Baltimore
--
$10/hit
$150/
Boston
70-90
$10-$20/
Chicago
$10-$20/rock
Honolulu
$5-$15/dose
$20-$100/rock
$30-$400/0.25oz
$100-$2,600/oz
Miami
--
$5-$20/ba
Minneapolis/
$10-$20/rock
St. Paul
Newark
--
$3-$20/vial
New Orleans
60-70
$5-$25/rock
Philadelphia
-
$5/"ca "
St. Louis
50-90
$25/rock
$40-$100/
San Diego
20-40
$10/0.1
Seattle
--
$20-$40/rock
Texas
up to 60
up to $100/rock
$60-$100/g
$500-$ 1,1 00/oz
Washington,
45-97
$80-$150/g
DC
$750-$1,500/oz
$20,000-$30,000/k
SOURCE: CEWG city reports, December 1997
ounces and kilograms. Prices and purity of
crack remained stable in Boston. Despite
dramatic price fluctuations in Chicago during
1997, current cocaine prices have stabilized
at previous levels, average purity is up
slightly. Cocaine prices also remain
unchanged in Phoenix and Honolulu.
CEWG December 1997 29
Executive Summary: Cocaine
Atlanta
Boston
Chicago
Denver
Honolulu
Miami
Minneapolis/
St. Paul
New Orleans
New York City
Phoenix
St. Louis
San Diego
Texas
Washington, DC
Exhibit 13. Cocaine hydrochloride prices in reporting CEWG areas
$90-$100
$80-$100 (35-60% pure)
$50-$150
$80-$100
$100-$120 (20-50% pure)
$40-$60
$100
$80-$150
$25-$30
$80-$100
$38-$100 (65-90% pure)
$60-$90 (20-40% pure)
$ 20-$100 (40% pure)
$80-$150
SOURCE: CEWG city reports, December 1997
Seizures
BEYOND THE CITY LIMITS ...
$900-$1,200
$800-$1,100 (60-92% pure)
$2,000
$800-$1,400
$1,100-$1,500
$700-$1,200
$1,000-$1,200
Chicago: "The amount of cocaine seized in other
areas of the State, especially in rural counties,
has increased greatly. "
$800-$1,200
$500-$750
$600-$1,000
$400-$1,200 (50-85% pure)
$750-$1,500
Cocaine seizures continued to increase in
several cities. In Boston, seizures for 1997
were running about 10 percent above those
for 1996. There, the State police lab
reported that crack seizures outnumber those
for cocaine HCl, although HCl seizures seem
to involve larger quantities. Cocaine seizures
by local law enforcement agencies in
Minneapolis/St. Paul also continued to
increase. Likewise, in Newark during the
first 10 months of 1997, cocaine seizures
$22,000-$28,000
$22,000-$30,000 (80-95°x6 pure)
$13,250-$20,000
$26,500-$52,000 (>90% pure)
$16,000-$20,000
$18,000-$24,000
$18,000-$25,000
$14,000-$21,000
$10,000-$22,000 (75-95% pure)
$20,000430,000
already exceeded 6,500, a sharp increase
over the average number of seizures during
the previous 6 years. Seizures for cocaine in
St. Louis far outnumber those for other drug
types. The one reported exception to the
overall increasing trend was in Washington,
DC, where cocaine seizures by local police
have been declining dramatically over the last
3 years (from 43.9 kilograms in 1995 to 33.4
in 1996 to 13.9 through November 1997, a
68 -percent decline between 1995 and 1997).
Trafficking and Distribution
According to the DEA, Atlanta continues to
serve as a major transshipment and distribu-
tion point for both HCl and crack. The
majority of domestically distributed cocaine
arrives from areas in California, Florida, New
York, Texas, and Washington, DC. Sources
30 CEWG December 1997
for cocaine in Boston remain primarily New
York, Puerto Rico, and the southwestern
border, with Colombian and Dominican
nationals still the major traffickers. DEA
intelligence information has also reportedly
identified Chicago as a major node of crack
cocaine distribution in the Nation.
New York City: "The Street Studies
Unit reports an apparent leveling in
crack selling activity. In some major
crack copping locations, there are
fewer buyers, in other locations, there
are fewer hours of selling. "
Hispanic organizations continue to traffic the
majority of cocaine HCl in the Seattle area,
multiple ethnic youth gangs, however,
distribute crack in that city and its adjacent
counties. Street gangs dominate crack
distribution networks in Denver. In St.
Louis, most cocaine arrives as HCl and is
processed locally into crack, rather than
entering the area in crack form.
An increasing number of crack dealers in
Atlanta also sell heroin and marijuana, both
Executive Summary: Cocaine
of which are suggested as a means to reduce
the misery of coming down from a crack
high. In New York City, some dealers have
switched from selling crack to selling heroin.
Those who do sell crack have had problems
with loiterers who tend to attract police
attention. As a result, crack dealers continue
to use a variety of schemes to screen and
attract customers one at a time, and to use
communication devices such as walkie-
talkies and beepers. Lookouts often monitor
police radio frequencies and observe possible
police presence from rooftops. In contrast,
cocaine HCl is more likely to be purchased
though a house connection or at clubs or
bars than on the street.
Because the sentences for crack cocaine
violations are relatively stiff compared with
those for HCl and other drug offenses,
middle -level dealers in Atlanta are recruiting
more youth to sell crack or carry small
amounts of the drug and deliver it to them on
request. Noncrack-using teens also remain
involved in crack street sales in Newark.
CEWG December 1997 31
Miami: "Significant changes in the most recent data on local heroin consequences
suggest that Miami -Dade County's emerging heroin problem is now an expanding
epidemic spreading to new and younger populations. "
Boston: "Heroin use has risen among younger populations, driven by its easy
obtainability, low price, and high purity. "
MORTALITY DATA
Early 1997 mortality figures show possible
increases in four cities, stable levels in two
cities, and declines in two cities.
Heroin mortality figures increased in four of
the eight areas where partial 1997 data were
available: Miami, Philadelphia, St. Louis, and
San Diego. Through June 1997, 178 heroin -
related mortalities were reported in
Philadelphia, compared with 290 for all of
1996. These figures represent that city's
highest mortality levels of the 1990s. In San
Diego, heroin was detected in 69 percent of
124 accidental overdose deaths during the
first half of 1997. If this trend continues, it
will represent a sharp increase from the 146
heroin overdose deaths in 1996. Similarly,
heroin -related mortalities appear to be
increasing in Miami (30 in first three quarters
1997, 31 in 1996) and St. Louis (12 in first
half 1995, 14 in first half 1996, 16 in first
half 1997).
Heroin -related mortality figures appear level
in two reporting cities. In Honolulu, heroin
was detected in 22 deaths in the first halves
of both 1996 and 1997. Similarly, figures in
Minneapolis appear to be stable, with 23
heroin -related deaths in 1996 and 12 in the
first half of 1997.
After increasing between 1994 and 1996 (to
a peak of 77), the number of morphine -
related deaths in Phoenix may be declining
(25 in the first half of 1997). In Seattle,
heroin was detected in 78 drug -caused
deaths during the first three quarters of
1997, an apparent decline from 135 deaths
during 1996.
BEYOND THE CITY LIMITS...
Texas: "In Plano, an affluent suburb... outside
Dallas, 16 oi,erdose deaths were reported to date
in 1997, compared with 3 in 1996 "
EMERGENCY DEPARTMENT
DATA
Heroin remained the top-ranking illicit drug
ED mention in Newark and San Francisco
(accounting for 30 percent and 23 percent,
respectively, of those cities' total drug
mentions), and it moved to the top spot in
both San Diego (9.5 percent) and Seattle (18
percent). Heroin also accounted for large
percentages of ED mentions in Baltimore (30
percent), New York City (17 percent),
Chicago (15 percent), Boston (11 percent),
and Philadelphia (10 percent) (exhibit 1). All
of these percentages have increased since
1994 except in New York City, where the
percentages remained unchanged.
Baltimore and Newark led the Nation, by far,
in estimated rates of heroin ED mentions per
100,000 population during 1996 (exhibit 14).
32 CEWG December 1997
They were followed by San Francisco and
Seattle. Minneapolis/St. Paul had the lowest
rate, as it did for cocaine.
Of the four top cities, only Newark showed a
substantial rate increase (p<0.05) between
1994 and 1996: 19 percent (exhibit 15). The
smaller increases noted in Baltimore (2
percent) and Seattle (13 percent) did not
meet the statistical standard of precision.
Across the Nation, 1994-96 rates increased
significantly in eight cities: New Orleans (60
percent), Dallas (57 percent), Detroit (45
percent), Minneapolis/St. Paul (44 percent),
Philadelphia (44 percent), Phoenix (26
Baltimore
Newark
San Francisco
Seattle
New York City
Chicago
Philadelphia
Detroit
Boston
Washington, DC
San Diego
Los Angeles
Phoenix
New Orleans
Denver
St. Louis
Miami
Atlanta
Dallas
Minneapolis/St. Paul
All of United States
Executive Summary- Heroin
percent), Newark (19 percent), and
Washington, DC (16 percent). Denver was
the only city where the estimated rate of
heroin ED mentions per 100,000 population
declined significantly (29 percent) (exhibit
16).
TREATMENT DATA
Heroin is the top-ranking illicit drug of abuse
(excluding alcohol -only, but including
alcohol -in -combination) among treatment
admissions in seven areas: Newark, Boston,
San Francisco, Los Angeles, Baltimore, New
York City, and Seattle (exhibit 17). It is tied
with stimulants in Arizona (alcohol -only is
Exhibit 14. Estimated rate of heroin/morphine ED mentions
per 100,000 population by metropolitan area, 1996*
50 100 150 200 250 300 350
ED Mentions per 100,000 Population
*Preliminary estimates
SOURCE: SAMHSA, Drug Abuse Warning Network, April 1997 files
CEWG December 1997 33
Executive Summary., Heroin
Exhibit 15. Annual trends in heroin/morphine ED mentions
per 100,000 population in four top-ranking cities, 1991-96*
400
350
300
250
200
150
100
50
0
90
80
70
60
50
40
30
20
10
0
to Mennons per i uu,uuu ro uiation
Baltimore --0 San Francisco
—X Newark 0 — Seattle
1991 1992 1993 1994 1995*
Year
*Preliminary estimates
SOURCE: SAMHSA, Drug Abuse Warning Network, April 1997 files
Exhibit 16. Annual trends in heroin/morphine ED mentions
per 100,000 population in four selected cities, 1991-96*
to Mentions per i uu,uuu i
Philadelphia
XM Detroit
m
-� New Orleans
Denver
1991 1992 1993 1994
Year
*Preliminary estimates
SOURCE: SAMHSA, Drug Abuse Warning Network, April 1997 files
1996*
1995* 1996*
34 CEWG December 1997
A
not excluded). In Boston, past -month heroin
use among treatment clients now nearly
equals that of cocaine. In Denver, the
proportion (and number) of new heroin users
entering treatment has increased in the past
few years, from 8.9 percent in 1994 to 17.5
percent in 1996.
BEYOND THE CITY LIMITS...
Newark: `7n Ocean County, 50 miles south of
Newark, treatment admissions have nearly
tripled, from 250 in 1992 to 717 in 1996."
Since the previous reporting period, the
percentage of admissions rose in four cities:
most notably in Boston (16 percentage
points) and Seattle (16 points), and to a
lesser extent Chicago (9 percentage points)
and Minneapolis/St. Paul (2 points). By
contrast, admissions appear to have declined
in four cities: Hawaii (9 points), Los
Angeles (4 points), Denver, and San Diego
Executive Summary. Heroin
(2 percentage points each). Admissions
percentages remained stable in the other
reporting areas.
USE PATTERNS
Route of Administration
New York City. "The Street Studies
Unit confirms the continued decline in
injecting as a mode of heroin use....
In casual conversation, some of these
(teenagers and young adults) indicate
their preference for using heroin
intranasally and their aversion to
injecting. In fact, they report sniffing
heroin for many months without
progressing to needle use. "
St. Louis: "Young users report a
'fear' of needles as a reason for
alternative methods of administration,
but further investigation of this issue
is warranted because the purity level
of the heroin is reported to be less
than 20 percent. "
Exhibit 17. Heroin as a proportion of primary drugs of abuse
among treatment admissions (excluding alcohol -only) in six CEWG cities
77% 55% 53%
4
Newark Boston San Francisco
1/96-12/96 1/97-6/97 7/95-6/96
51% 42.5% "0/0
Los Angeles Baltimore New York City
1/97-6/97 1/96-12/96 1/96-12/96
Heroin Cocaine Marijuana Other
CEWG December 1997 35
Executive Summary: Heroin
Injecting remains the most common route of
heroin administration—particularly in the
West, but also in some eastern (Atlanta,
Boston, and )
Philadel hia and midwestern
Philadelphia)
(Minneapolis/St. Paul and St. Louis) cities
(exhibit 18). However, the percentage of
heroin admissions who report injecting as the
primary route of administration is stable or
declining in all CEWG areas. Since the last
reporting period, that percentage has
declined particularly in Minneapolis/St. Paul
(22 percentage points), Atlanta (13 points),
and Philadelphia (5 points).
Injectors tend to be older, experienced users,
however, younger injectors are beginning to
appear in some cities. In Boston, for
example, injection among younger users is
beginning to be more widely reported,
suggesting that progression from snorting to
injection may be occuring.
Intranasal use is the most common route of
administration in Chicago, Detroit, Newark,
and New York City, and it is a close second
in Baltimore. Since the previous reporting
period, the percentage of intranasal users
among heroin admissions has increased in six
cities (Atlanta, Chicago, Minneapolis/St.
Paul, New York City, Philadelphia, and
Texas). It remained stable elsewhere. The
increase was particularly dramatic in
Minneapolis/St. Paul: from 27 to 45 percent
between the first halves of 1996 and 1997.
Although smoking has traditionally been a
minority route of heroin administration
among treatment admissions, the numbers
are increasing in several CEWG cities.
Hawaii has the highest percentage of
smokers, followed closely by San Diego and
San Francisco. Furthermore, the percentage
Exhibit 18. Route of administration among
heroin treatment admissions, by percentage,
in reporting CEWG areas*
;:area
t.. h ein
Atlanta
5
15
b62
Baltimore
2
47
48
Boston
31
64
Chicago
4
......................
Detroit
51
43
Hawaii
9
< 1
90
Minneapolis/
St. Paul
4
.....................
.....................
.....................
A;<><>
b51
Newark
0.6
77.1
22.1
New York
Cit a
1
57
41
Philadelphia
3
4?>>«<
......................
'61
St. Louis
3
36
b57
San Diego
7
3
87
San
Francisco
6
6
87
Seattle
1
93
Texas
1
6
92
NOTE: Shaded areas reflect percentages that have
increased by -5 points since the previous reporting
period.
'Reporting periods are January -June 1997 in
Atlanta, Minneapolis/St. Paul, Philadelphia, St.
Louis, and San Diego; July 1996 -June 1997 in
Boston, Chicago, and Hawaii; calendar year 1996
in Baltimore, Detroit, Newark, New York City, and
Seattle; July 1995 -June 1996 in San Francisco;
and October 1996 -September 1997 in Texas.
'Indicates percentages that have declined by 2!5
points since the previous reporting period.
of smokers is increasing in Atlanta and
Denver.
The mode of heroin administration is often
related to demographic characteristics. For
example, in San Francisco, a substantial
population of younger whites smoke heroin
36 CEWG December 1997
while many younger African-Americans
snort it from eyedrop squeeze bottles. In the
majority of the reporting CEWG cities,
injectors tend to be older users; in New York
City they tend to be white; and in
Philadelphia the proportion of injectors is
higher among male than among female
admissions. However, preliminary first -half -
1997 data suggest noteworthy shifting in
Philadelphia: injecting has declined among
males; concomitantly, among females,
injecting and intranasal use have increased.
The route of administration often influences
progression of addiction. In Texas, for
example, inhalers enter treatment more than
twice as quickly as injecting users. This
finding conflicts with street rumors that
sniffing or inhaling is not addictive. These
rumors are again disproved in St. Louis,
where 21 percent of current treatment
admissions are younger than 25 years and 39
percent of that group report smoking or
sniffing as the primary method of use.
EXPLANATION?
Boston: ".Since new users can snort or smoke the
drug, thus avoiding the possibility of needle -
borne HIV infection, the perceived risk of heroin
use seems to have dropped. "
The route of administration can also be
related to the incidence of multisubstance
abuse. For example, nearly 80 percent of
heroin injectors entering treatment in
Baltimore reported a secondary drug of
abuse, compared with 68 percent of those
who reported intranasal heroin use.
Executive Summary: Heroin
BEYOND THE CITY LIMITS...
"Baltimore City has had a stable admission rate
for heroin injection. However, the rate in the
surrounding counties increased by 22 percent
from 1994 to 1995 before stabilizing in 1996 "
Multisubstance Use
Heroin -related mortalities often involve other
drugs as well. In San Diego, for example,
heroin was the sole drug detected in just 29
of the 86 heroin -related deaths. Cocaine was
present in 43 percent of the heroin -related
deaths in Miami and 35 percent of those in
Seattle. Of the 12 opiate -related deaths in
Minneapolis/St. Paul during the first half of
1997, 4 involved methadone and 4 involved
cocaine.
Cocaine remains the most common
secondary drug of abuse among heroin
treatment admissions in every reporting area
except Minneapolis/St. Paul, where alcohol
was more frequently noted. Alcohol was
the most common tertiary drug, followed by
cocaine (Atlanta and Hawaii, where cocaine
was most common as both a secondary and
tertiary drug), and marijuana (San
Francisco).
DEMOGRAPHICS
Newark: "...police report continuing
increases in white suburban users
coming into the city to buy heroin. Of
those users, more than half are
females. Stories of white suburban
teens now dominate the media drug
scene. "'
CEWG December 1997 37
Executive Summary: Heroin
Age
Philadelphia: "For the third
consecutive half year, focus group
participants reported that new users
entering the prevalence pool are likely
to be in their teens and either male or
female; however, they are not
necessarily as likely to be white as in
the autumn of 1996 "
New York City: "... street researchers
find an increasing number of young
people in their late teens and early
twenties at these (copping) locations. "
Mortality figures are still largely confined to
older heroin users. In San Diego, for
example, 69 percent of heroin decedents
were age 35 or older. Most heroin -related
deaths in St. Louis involved older, long -tern
users. In Miami, however, the average age
of heroin decedents declined from 41.2 in
1996 to 34.7 in 1997, and heroin contributed
to the deaths of 6 people younger than 25 in
the first 8 months of 1997 (20 percent of all
heroin decedents). Conversely, the
percentage of heroin decedents age 25 or
younger decreased slightly in Philadelphia
during the same reporting period.
Among heroin ED mentions and treatment
admissions for primary heroin abuse, the 35+
group still accounts for the highest
percentages in every city except Newark,
where the 26-34 group predominates in ED
mentions and is tied with the 35+ group in
the percentage of treatment admissions
(exhibits 19 and 20). Heroin ED mentions in
the 12-17 age group are a relatively recent
phenomenon: in 1994, they were reported in
6 cities; in 1996, they were reported in 12.
Exhibit 19. Percentage of heroin/morphine ED
mentions by male representation, age group, and
area, 1996'
NOTES: "..." Denotes estimate did not meet standard of
precision. Shaded areas reflect percentages that have
increased by >5 points since 1994.
"Preliminary estimates
bPercentage has declined by > 5 points since 1994.
SOURCE: SAMHSA, Drug Abuse Warning Network, April
1997 files
38 CEWG December 1997
4
18 2. ..i.
...
Atlanta
76
[[{I<»»3.'ti
b54
Baltimore
62
< 1
10
36
54
Boston
64
< 1
15
37
.................
48
.................
.................
Chicago
61
<1
................................
b14
.................
35
.................
.................
Dallas
' 66
.................................
.................................
::>><`>6>>r
...............
` `4>
.............
23
b45
Denver
67
12
b 241
62
................
.................
Detroit
66
< 1
6
.................
.................
.................
b16
.................
.................
'>
Los Angeles
68
10
27
63
Miami
7i
i3'
35
b53
Minneapolis/
St. Paul
''63
12
32
52
.................
Newark
62
b < 1
b17
44
New
Orleans
85
<27
21
b49
New York
City
76
< 1
7
26
b57
Philadelphia
71
2
16
30
52
Phoenix
77
14
39
47
St. Louis
''64
3
121
18
67
..............
................
.................
San Diego
67
1
6
.................
26
...............
.................
Sari
Francisco
''64
< 1
10
23
67
Seattle
63
< 1
14
28
57
Washington,
DC
67
6
23
68
NOTES: "..." Denotes estimate did not meet standard of
precision. Shaded areas reflect percentages that have
increased by >5 points since 1994.
"Preliminary estimates
bPercentage has declined by > 5 points since 1994.
SOURCE: SAMHSA, Drug Abuse Warning Network, April
1997 files
38 CEWG December 1997
4
0
Exhibit 20. Percentage of primary heroin
admissions in reporting CEWG areas by male
representation and age group"
,,,ki: ••::•: ••K.?:•:•::L::
}tiff:•ii:
::. •}rii::�:?•i\ ,•.
;
401
Atlanta
b64
`'?`9''
??
b59
Baltimore
56
1
15
39
45
Boston°
68
27
45
27
Chicago
59
< 1
14
38
48
Detroit
61
3
13
84
Hawaii
66
9
21
1 70
Los An elesd
b55
25
43
26
Minneapolis/
4
b 18
...:
40
St. Paul
fi5
Newark
57
<1
13
43
43
New York
70
1
8
39
53
Cit
St. Louis
71
1
20
27
52
San Diego
63
2
13
31
54
San
66
<1
9
>>
b67
Francisco
..................
Seattle
57
928
b62
Texas 1
63
2
'<:':'
22
59
NOTES: "..." Denotes estimate did not meet standard of
precision. Shaded areas reflect percentages that have
increased by 2:5 points since the previous reporting
period. Percentages do not always add to 100 percent,
due to rounding.
"Reporting periods are Jan. -June 1997 in Atlanta,
Minneapolis/St. Paul, St. Louis, and San Diego;
April -June 1997 in Los Angeles; July 1996 -June 1997 in
Boston, Chicago and Hawaii; calendar year 1996 in
Baltimore, Detroit, New York City, and Seattle; July
1995 -June 1996 in San Francisco; and October
1996 -September 1997 in Texas.
'Denotes percentages that have decreased by Z5 points
since the previous reporting period.
Ages are <19, 19-29, 30-39, and 40+.
°Ages are 25-34, 35-44, and 45-54.
In Dallas, for example, 1996 was the first
time the adolescent age group was involved
in any heroin ED mentions.
CEWG December 1997
Executive Summary: Heroin
In some cities, heroin ED trends between
1994 and 1996 highlight the existence of two
distinct cohorts. The percentage of patients
in the18-25 oun er increased in
Y g ( )grou P
� cities
eight (Boston, Dallas Detroit, , Los
Angeles, New Orleans, Phoenix, St. Louis,
and Seattle). Similarly, the percentage of
patients in the older (35+) group increased in
six cities(Chicago, Los Angeles, Phil-
adelphia, St. Louis, San Diego, San
Francisco). But, by contrast, the percentage
of those in the intermediary (26-34) group
declined in nine cities (Dallas, Detroit, Los
Angeles, Minneapolis/St. Paul, Philadelphia,
St. Louis, San Diego, San Francisco, and
Seattle), while increasing in only Atlanta and
Miami.
Unlike the ED data, the treatment data do
not reflect a clear cohort distinction. Just as
ED mentions increased for the 18-25 age
group, so did the percentage of treatment
admissions (increases were detected in six
cities, decreases in two). Similarly,
treatment admissions for the 17 -and -younger
group increased in four cities. However,
while the ED mentions for those age 26-34
declined in most areas, treatment admissions
for the group varied—increasing in three
cities and decreasing in three cities.
Likewise, treatment admissions for the 35+
age group did not correspond with the
increasing ED trends. Rather, treatment
admissions for this older group declined in
six cities while increasing in only two.
Throughout the CEWG areas, large shifts
occurred in the age distribution of treatment
admissions since the previous reporting
period. In Minneapolis, for example, the
18-25 group declined dramatically (10
39
Executive Summary: Heroin
percentage points) among heroin admissions,
while the 26-34 group concomitantly
increased (by 12 points). Other notable
shifts occurred in Atlanta (18-25 up 6.5
points, 26-34 up 4.5 points; 35+ down by 11
points); San Francisco (18-25 up 3.5 points,
26-34 up 7.2 points, 35+ down 10.8 points),
and Baltimore (18-25 down 3.3 points,
26-34 stable, 35+ up 4 points).
Arrestee urinalysis figures, like mortality
figures, are still largely confined to older
heroin users. According to ADAM, only 1
percent or less of juvenile arrestees tested
positive at all CEWG sites, except for
Phoenix and San Diego, where 1.5-2 percent
tested positive. Between the first halves of
1996 and 1997, the percentage of juvenile
arrestees with a positive heroin screen
decreased by 4 percentage points in San
Antonio.
BEYOND THE CITY LIMITS...
Boston: "Needle exchange workers in the
Cambridge site reported visits by increasingly
younger, mostly white male heroin injectors from
working or middle-class backgrounds... many
come from outlying areas where needle
exchanges are not available. "
Gender
Males predominate in heroin mortality
figures in all areas where such data are
available: Minneapolis/St. Paul (100
percent), San Diego (88 percent), Miami (83
percent), and Philadelphia (81 percent).
Males also outnumber females as a percen-
tage of heroin ED mentions in all the CEWG
cities in DAWN (exhibit 19), but the gap
may be closing a bit. Between 1994 and
1996, the percentage of males among ED
mentions declined in 12 cities. The biggest
declines occurred in St. Louis (9 percentage
points) and Minneapolis/St. Paul (7 percent-
age points). During the same reporting
period, the percentage of males among
heroin ED mentions rose in Miami (by 7
percentage points), San Diego (2 points),
and Washington, DC (3 points). The gender
gap remains widest in New Orleans and
narrowest in Chicago.
Similarly, among primary heroin treatment
admissions, males account for the majority in
all reporting areas (exhibit 20). In a few
cities, however, the gender gap for treatment
is narrower than that for ED mentions:
women account for 45 percent of treatment
admissions in Los Angeles and 43 percent in
Newark. Since the previous reporting
period, the percentage of male treatment
admissions has increased in two cities and
declined in two cities. The increase occurred
in St. Louis (4 percentage points) and Texas
(3 points), while the declines were reported
in Los Angeles (17 percentage points) and
Atlanta (13 points).
Women continue to show up more
prominently in the ADAM data than in the
other indicators. Opiate -positive findings
during the first half of 1997 were higher
among female arrestees than among their
male counterparts in most CEWG cities.
The exceptions were Houston and New
Orleans, where male arrestees tested positive
at higher percentages than females, and
Atlanta, Phoenix, St. Louis, and San
Antonio, where the percentages were nearly
equal.
40 CEWG December 1997
4
N
4
1
a
M
Race/Ethnicity
New York City: "White users are
frequently observed entering minority
neighborhoods in order to obtain a
supply of heroin. "
Heroin decedents were predominantly white
in areas reporting mortality figures: San
Francisco (79 percent), San Diego (72
percent), and Philadelphia (72.5 percent).
Heroin ED patients, however, showed mixed
racial demographics (exhibit 21). In 1996,
whites were the largest racial/ethnic group in
10 of the 20 CEWG cities in DAWN,
African-Americans were the largest group in
9 of the cities, and Hispanics were the modal
group in Los Angeles. The most notable
shifts between 1994 and 1996 occurred in
New Orleans, Phoenix, and St. Louis, where
the percentage of African-Americans
increased considerably; in Minneapolis/St.
Paul and Los Angeles, where the percentage
of whites increased; and in San Diego, where
the percentage of Hispanics declined.
Among primary heroin treatment admissions,
whites comprised the largest group in seven
areas; African-Americans were the largest
group in eight; and Hispanics were the
largest group in Los Angeles and New York
City (exhibit 22). Several notable proportion
shifts occurred (>5 percentage points) since
the previous reporting period: Atlanta
(whites increased by 8 percentage points,
while African-Americans declined by 8
percentage points); Minneapolis/St. Paul
(African-Americans increased by 18
percentage points, whites declined by 19
percentage points); San Francisco (African-
Americans declined by 5 percentage points,
Hispanics increased by 5 percentage points);
CEWG December 1997
MWA
Executive Summary: Heroin
and Texas (whites increased by 6 percentage
points).
The racial/ethnic breakdowns of deaths,
treatment admissions, and arrests in San
Diego varied widely. Whites constituted 72
percent of the deaths, but only 54 percent of
the treatment admissions and 43 percent of
heroin -positive screens in the ADAM
program. Hispanics, meanwhile, were
represented in 22 percent of the deaths, 33
percent of the treatment admissions and 43
percent heroin -positive screens. Finally,
blacks constituted 5 percent of the deaths, 8
percent of the treatment admissions, and 14
percent of the heroin -positive screens.
LAW ENFORCEMENT DATA
Arrestee Data
Opiate use among adult male arrestees is
increasing slightly at the ADAM sites.
Opiate -positive screens of 10 percent or
higher were reported at seven CEWG cities
in the first half of 1997 (up from five during
the first half of 1996): Chicago (with the
highest rate of 22 percent), followed by New
York City, Houston, Philadelphia, San
Antonio, and St. Louis. Among female
arrestees, six CEWG sites had rates of 10
percent or higher: Atlanta, Los Angeles,
New York City, Philadelphia, San Diego,
and Washington, DC.
Compared with the first half of 1996, opiate -
positive findings remained relatively stable
among arrestees during the first half of 1997.
The largest shifts among males were a 6 -
point percentage increase in Houston and a
nearly 4 -point decline in Detroit. Few large
increases were reported among females,
41
Executive Summary: Heroin
Exhibit 21. Proportions of heroin/morphine
ED mentions by race/ethnicity and area,
1996°
::
A, ea. '> >:
... rt
i4me scans.
,.:
. Wh tes :.
His' ariics »
Atlanta
54
27
2
Baltimore
81
15
< 1
Boston
13
58
10
Chicago
62
16
19
Dallas
24
55
14
Denver
7
26
14
Detroit
70
27
< 1
Los Angeles
21
36
b38
Miami
31
54
14
Minneapolis/
St. Paul
b20
55'
Newark
61
23
7
New Orleans
::'<6f'"..:
b32
4
New York
Cit
41
16
23
Philadelphia
27
61
8
Phoenix
''1 `9!>;.:.:.:;>
b
49
22
St. Louis
6 i:'
b34
4
San Diego
12
39
25
San
Francisco
18
37
7
Seattle'
6
31
2
Washington,
DC
66
28
1
NOTES: "..." Denotes estimate does not rneet
standard of precision. Shaded areas reflect
percentages that have increased by - 5 points since
1994.
8Preliminary estimates
bDenotes percentages that have decreased by -.5
points since 1994.
°Seattle percentages are on the low side because of
an unusually high "race unknown" category.
SOURCE: SAMHSA, Drug Abuse Warning
Network, April 1997 files
Exhibit 22. Percentages of primary
heroin admissions by race in reporting
CEWG areas
.
.:::: .
Ar` a'
e
.............................................................................
Arr 6ei'.::.ns;:`
e a
Wh....':'.
xes:::...:.:...
_..
::H $ 6hi: ."..:
$ I. cs:::
Atlanta
b46
5'` >
< 1
Baltimore
75
24
< 1
Boston
20
54
22
Chicago
81
12
6
Detroit
76
22
1
Hawaii
< 1
60
6
Los Angeles
13
40
41
Minneapolis/
St. Paul
b
43
5
Newark
71
6
22
New Orleans
55
45
New York City
31
26
41
Philadelphia
45
42
4
St. Louis
60
40
San Diego
8
54
33
San Francisco
b21
62
................
3 f..r <«
Seattle
20
72
4
Texas
13
".4$::::..'>
36
NOTE: Shaded areas reflect percentages that have
increased by 5 points since the previous
reporting period.
Reporting periods are January—June 1997, except for
the following: July 1995—June 1996 in San Francisco;
calendar year 1996 in Baltimore, Detroit, Newark, New
York, Philadelphia, and Seattle; July 1996—June 1997
in Boston, Chicago, and Hawaii; April—June 1997 in Los
Angeles; and October 1996—September 1997 in Texas.
bDenotes percentages that have decreased by -5 points
since the previous reporting period.
although an increase of more than 7
percentage points was detected in
Washington, DC. This increase follows a
nearly 6 -percentage -point decline during the
first half of 1996. In New York City,
positive findings declined by 12 percentage
42 CEWG December 1997
points, reversing a 1996 increase of the same
amount. Other sharp declines in positive
findings among females were noted in Dallas,
Detroit, and Phoenix.
Heroin arrests in New York City almost
equaled cocaine arrests (at 37,901 and
38,813, respectively) during 1996. In
Baltimore, heroin -related arrests have
increased from 87 in the first 9 months of
m nod to 1
997
96 139 duringthe same e
19 to
P
During that period, burglaries rose 2.8
percent, and an increased number of burglary
suspects were believed to be heroin addicts.
Heroin cases appear to be declining in
Honolulu (from 31 in the first half of 1996 to
18 in the first half of 1997).
Availability
Higher quality, lower priced heroin appears
to be spreading throughout the country and
is particularly available in eastern and some
midwestern cities. The east coast receives
87 percent of the South American (SA)
(mostly Colombian) heroin entering the
United States, 85 percent of the Southeast
Asian (SEA) heroin, and nearly half (44
percent) of the Southwest Asian (SWA)
heroin shipped to this country (exhibit 23).
Lower quality black tar and brown heroin
from Mexico still predominate in most
western and some midwestern areas.
In Chicago, China white from Southeast Asia
is perceived to dominate the metropolitan
market. The Florida Drug Law Enforcement
Survey ranked availability in Miami at 4.2 on
a 0-5 scale, with 4 representing "readily
available."
Executive Summary: Heroin
BEYOND THE CITY LIMITS...
Boston: "Heroin is now well established in
Boston and Massachusetts as a major alternative
to cocaine. The drug now predominates in
trafficking... and is widely available throughout
the State. "
Exhibit 23. Types of heroin available in
CEWG areas
_>'_.:.,.:.:'>::::;:>:::>`:
«<'r`los
Atlanta
SEA, SWA, SA, Mexican
Baltimore
SEA, SWA, SAb
Boston
SEA, SWA, SAb
Chicago
SEA b, SA, SWA
Black tar & brown
Dallas
SEA, Mexican
Denver
Mexican black tar
Detroit
SA
Hawaii
Mexican black tar
Houston
Mexican
Los Angeles
Miami
Mexican black tar & brown
SA
Minneapolis/
St. Paul
SEA, White powder
Mexican black tar & brown
Newark
SA
New Orleans
SEA", SA, SWA
Mexican brown
New York City
SEA, SA, SWA
Philadelphia
SA
Phoenix
Mexican black tar
St. Louis
Mexican black tar & brown
San Diego
Mexican black tar
San Francisco
Mexican
Seattle
Mexican
Texas
SEA, SWA, SA
Mexican black tar & brown
Washington, DC
SEA b, SA, SWA, Mexican
'SEA denotes Southeast Asian; SWA, Southwest
Asian; and SA, South American.
'Type most available
SOURCES: DEA Domestic Monitor Program,
Intelligence Division, Domestic Unit, unpublished
data for January -June 1997; CEWG city reports,
December 1997
CEWG December 1997 43
Executive Summary., Heroin
Seizures
Heroin seizures have increased substantially
in Newark (from 2,200 seizures in 1996 to
3,200 in the first 10 months of 1997),
Washington, DC (from 1 kilogram in 1996 to
2.2 kilograms in 1997 through November),
and Boston, (where heroin seizures are as
common as cocaine seizures). In Baltimore,
after arresting a suspected dealer and seizing
52 bags of heroin, police took over the
dealer's operation and arrested 60 would-be
buyers. In Minneapolis/St. Paul, however,
seizures declined during 1997.
Price
The Drug Enforcement Administration
(DEA) Domestic Monitor Program (DMP)
conducted two buying operations during the
first half of 1997 (exhibit 24). Compared
with buys in the first half of 1996, the prices
per pure milligram increased in six cities:
Chicago, Detroit, Houston, Los Angeles (by
$1.00 since 1996), Miami, and Phoenix.
Prices remained relatively level in Seattle,
and they declined in Atlanta, Dallas (by
$1.64), Denver (by $1.57), Newark, New
Orleans, New York, Philadelphia, St. Louis,
San Francisco, and Washington, DC.
Exhibit 24. Average heroin price and purity per milligram in CEWG cities,
first half 1997
Price
Philadelphia0.25
--�
Philadelphia
New York City
0.56
Newark
Denver
0.60
Boston
Phoenix
0.61
New York City
San Francisco
0.75
San Diego
Seattle
0.81
Atlanta
Chicago
0.93
Chicago
Newark
0.95
New Orleans
Boston
0.96
Denver
Baltimore
0.99
San Francisco
Washington, DC
1.09
Detroit
Atlanta
1.11
Baltimore
Houston
1.35
Los Angeles
Los Angeles
1.45
Phoenix
Detroit
1.74
Washington, DC
New Orleans
1.98
St. Louis
Miami
2.23
Houston
St. Louis
2.48
Seattle
Dallas
4.90
Dallas
Dollars
Purity
76.40
64.10
63.90
60.30
48.50
41.70
33.00
32.40
29.60
26.90
26.20
26.10
25.20
22.50
21.80
18.00
18.00
17.80
8.90
0 10 20 30 40 50 60 70 80
Percent
Source: DEA Domestic Monitor Program, Intelligence Division, Domestic Unit, preliminary unpublished data
44 CEWG December 1997
5
Executive Summary: Heroin
According to local law enforcement and field price (exhibit 25). In San Francisco, the
sources, the minimum price per bag in standard price for a gram fell to $40 in 1997,
Boston increased from $4 to $7, but no from $60 a year earlier. The price of a gram
change was detected in the maximum price in Washington, DC, increased, while the
per bag ($20), the pound price, or the ounce ounce price declined and kilogram prices
remained stable.
Exhibit 25. Heroin prices and purity in reporting CEWG areas
*SEA denotes Southeast Asian; SWA, Southwest Asian; and SA, South American.
SOURCE: CEWG city reports, December 1997
CEWG December 1997 45
rain
>aun
:>;:::.:.:.:...;:.;:.;»:;:.;:.;:.;:.;:.;
:..;:.;:.;:.;:;:.;:.;:.;;:.;::.;
.....:.::.;:.::.:...Ates ::::::::.::::.:::::.::::::::::.:::::
:;;:::>::>::>::>::>::»:......::.:>::>:::; ;:.>::>::>::>
:.:::::::::::::::
T
>::> .
:.;:.;:.;:..
.;Putty.: lo::::.:::::::..::;.;:.;:.;.::;:.;E::.::....::::::::::::.::::::.:::::::::.::.::::::::::.::...............
ICH ....................................
Atlanta
SEA
50
$6,000-$9,000
Mexican brown
15
--
$6,000-$8,000
SA
60
$180-$200
$3,600-$5,000
SWA
40
--
-Chica
o
Chicago
SEA
$175
Denver
Mexican black tar
32
$120-$140
$1,500-$2,500
Hawaii (Hilo, Kona)
Black tar
67
$200-$500
$3,000410,000
China white
Minneapolis/St. Paul
Mexican black
--
$350-$500
$3,000-$4,000
tar, Mexican
brown, white
powder
New Orleans
SEA
14
$300-$600
$4,000-$9,000
SA
27
Phoenix
Mexican black tar
--
$100-$120
$1,250-$3,000
Mexican brown
St. Louis
Mexican
--
$250-$600
-
San Diego
Mexican black tar
40-60
$50-$200
$1,00043,000
Texas
Mexican black tar
30-80
$250-$400
$1,900-$4,500
SEA
--
SA
40-80
SWA
80-90
Washington, DC
Mexican
--
$90-$400
$3,500-$7,000
SEA
SA
*SEA denotes Southeast Asian; SWA, Southwest Asian; and SA, South American.
SOURCE: CEWG city reports, December 1997
CEWG December 1997 45
C 0
Executive Summary: Heroin
BEYOND THE CITY LIMITS...
Denver: "Outside Denver, prices for heroin
increase. DEA data indicates that a gram of
heroin in Colorado Springs sells for $75-$300.
... These data support anecdotal accounts of
users from other areas of Colorado traveling to
Denver to purchase heroin. "
Purity
Philadelphia: "The autumn (1997)
focus group members reported a
perceived increase in potency, which
they attributed to a change in the
cutting agents. "
San Francisco: "Treatment program
observers report that users view
heroin as significantly stronger and
cheaper. "
According to the DMP, street -level heroin
purity generally remained highest in the
Northeast, where the four highest purity
levels were reported. Philadelphia continued
to record the highest average purity during
the first half of 1997, followed by Newark,
Boston, and New York City (exhibit 24).
High purities notwithstanding, between the
first halves of 1996 and 1997, DMP purity
declined in eight cities, most notably Phoenix
(15 percentage points) and Houston (13
percentage points). It also declined in
Atlanta, Chicago, Detroit, Los Angeles, San
Diego, and Seattle. By contrast, during the
same reporting period, purity rose in nine
cities: Newark (28 percentage points),
Philadelphia (18 points), Denver (16.4
points), and—less dramatically— Boston,
Dallas, New York City, St. Louis, San
Francisco, and Washington, DC.
Local law enforcement sources in both
Atlanta and Denver are noting purity
changes in street -level heroin, attributable to
cutting many times.
Trafficking and Distribution
New York City. "The perceived
opportunities in the heroin street trade
have attracted many individuals who
were previously involved in dealing
cocaine to start selling heroin. "
St. Louis: "The cellular phone
industry has decreased the need to
have a house for users, thus reducing
risk to the seller. "
Arizona, California, South Florida, and
Texas remain primary points of entry for
heroin. In 1996, officials seized significant
amounts of Southeast Asian heroin at
airports in New York City, and in Seattle,
Washington, as well. SEA, SWA, and
Colombian heroin is transshipped from
Mexico through Texas with little spillage;
most of it is destined for the Northeast.
Boston's supply comes from New York, and
Denver's source is Mexico.
Heroin dealers appear to be streamlining
their business. In both New York City and
Atlanta, a majority of traffickers reportedly
sell only heroin. Furthermore, in New York
City, some heroin dealers are specializing in
either injectable heroin or heroin suited for
intranasal use. In St. Louis, heroin is sold by
both large distribution networks and many
small entrepreneurs.
46 CEWG December 1997
In many CEWG areas, particular ethnic
groups control a large part of the heroin
trade. Nigerians remain responsible for a
large portion of heroin distribution in
Atlanta, but they have diversified their
couriers to include all ethnic groups. In
Denver, heroin distribution is still dominated
by Hondurans, Guatemalans, Nicaraguans,
and Mexican nationals. Traffickers in
Boston include Dominican and Colombian
nationals, along with South and Central
Americans, Nigerians, Asians, and local
groups.
"Brand names" were reported in both New
York City and Philadelphia. Atlanta dealers
continue to market their product with stars,
initials, and other symbols, but names are
Executive Summary: Heroin
uncommon. In Boston, however, officials
report almost no brand names or logos on
prepackaged bags of heroin, suggesting an
increase in centralized distribution.
BEYOND THE CITY LIMITS...
Newark: People travel the Garden State Parkway
to Newark or New York, purchase heroin for $10
a bag, and take it back to Ocean County where
they can sell it for 520.
Baltimore: "Three residents of Carroll County
were killed in Baltimore City in apparent drug
disputes this year. This is consistent with police
observations that both suppliers and buyers often
live outside the city and use Baltimore City
dealers to broker their transactions. "
CEWG December 1997 47
MORTALITY AND EMERGENCY
DEPARTMENT DATA
The number of drug overdose deaths
involving opiates other than heroin
increased in Seattle between 1995 and 1996
(from 11 to 25) and appears to be on a
level course in 1997 (18 through September
10). Methadone was the most frequently
reported other opiate. In Minneapolis/St.
Paul, methadone was detected in 4 of the
12 heroin -related deaths reported in 1997.
In Philadelphia, traces of propoxyphene
(Darvon-N and Darvocet-N 100),
oxycodone (Percodan and Percocet), or
hydrocodone (Vicodin, Hycodan, and
Lortab) were reported in 27 deaths in the
Detroit
San Francisco
New Orleans
Boston
Philadelphia
Seattle
first half of 1997. Propoxyphene -related
deaths appear to be increasing in Phoenix
(totaling 4 in the first half of 1997—the
same number as in all of 1996).
Exhibit 26 lists the cities with the highest
ED rates per 100,000 population in 1996
for four selected opiates: codeine,
oxycodone, hydrocodone, and
propoxyphene. For the first three drugs,
only a few ED rates changed significantly
(p < 0.05) between 1995 and 1996: for
example, codeine rates declined 28 percent
in Phoenix (to 3.4 per 100,000 population),
while hydrocodone rates declined 16
percent in Seattle (to 5.8) but increased 65
percent in San Diego (to 7.1). For
Exhibit 26. Cities with the highest rates of ED mentions
per 100,000 population for four selected opiates, 1996*
Codeine
0 2 4 6 8 10
ED Mentions Per 100,000 Population
Oxycodone
0 2 4 6 8 10
ED Mentions Per 100,000 Population
*Preliminary estimates
New Orleans
Detroit
Atlanta
and St. Louis
New Orleans
Dallas
San Francisco
SOURCE: SAMHSA, Drug Abuse Warning Network, April 1997 files
Propoxyphene
0 2 4 6 8 10
ED Mentions Per 100,000 Population
Hydrocodone
9.0
8.7
6.9
0 2 4 6 8 10
ED Mentions Per 100,000 Population
48 CEWG December 1997
propoxyphene, however, ED rates declined
significantly in nine CEWG cities
(Chicago, Dallas, Denver, Los Angeles,
Miami, Minneapolis/St. Paul, San Diego,
San Francisco, and Seattle). The largest
declines occurred in Minneapolis/St. Paul
(down 52 percent, to 1.9 per 100,000
population) and Seattle (down 50 percent,
to 1.7). Only in Detroit did propoxyphene
ED rates increase significantly (up 63
percent, to 4.4 per 100,000 population).
TREATMENT DATA
In New Orleans, the percentage of patients
entering treatment for other opiate use
increased between 1996 and 1997, from 2
percent to 3 percent of admissions. The
percentage of white males in that population
increased sharply between the first halves of
1996 and 1997, from 49 percent to 68
percent. In Baltimore, 3 percent of
treatment admissions for primary heroin use
reported using other opiates as well. Nearly
2 percent of adult treatment admissions in
Texas use other opiates. Their client profiles
differ considerably from those of heroin
addicts.
AVAILABILITY, PRICE, AND USE
PATTERNS
Methadone
Methadone (Dolophine) continues to be an
inexpensive diverted pharmaceutical in some
CEWG cities. It sells for approximately $1
per milligram on the streets of Atlanta,
Chicago, and Seattle.
CEWG December 1997
Executive Summary: Other Opiates
Hydromorphone
Hydromorphone (Dilaudid) remains the
leading heroin substitute in New Orleans. It
remains readily available there, as well as in
Atlanta and Phoenix, where it is frequently
abused. In Chicago, by contrast, decreased
availability has resulted in diminishing use
since 1987. Abuse has also reportedly
declined in Texas. In St. Louis,
hydromorphone remains common among a
small group of chronic addicts, but the drug
is obtained through prescription scams and is
difficult to access.
Reported prices have remained stable in all
of the reporting areas: $10—$80 per dosage
unit in Atlanta; $50 per dosage unit in
Minneapolis/St. Paul, $30—$50 per 4 -
microgram pill in St. Louis, and $25—$35 per
tablet and $50 per unit in New Orleans.
Codeine
On Chicago's South Side, some dealers
specialize in codeine pills, which are used
primarily by heroin addicts to moderate
withdrawal symptoms. Codeine products
also continue to be abused in San Francisco
and Arizona. In Texas, 90 -day supplies are
imported from Mexico.
Hydrocodone
Hydrocodone abuse remains steady in
Phoenix, Pittsburgh, and Seattle. According
to DEA reports, hydrocodone combination
products (Vicodin and others) are the most
commonly diverted narcotic controlled
substances.
Executive Summary: Other Opiates
Opium
In Minneapolis, packages containing opium
are frequently shipped to the Southeast
Asian community from Southeast Asia,
several rugs soaked in opium were
intercepted in Ramsey County. A small
percentage of treatment clients in Texas
consume opium orally.
Other Abused Opiates
Several other opiates are reported in various
cities:
• Oxycodone remains a primary opiate in
Seattle and Phoenix. It was detected in
seven overdose cases in Philadelphia. In
Boston, it continues to be used with
heroin and crack and, sometimes, to
potentiate the effects of methadone. In
Miami, however, use has reportedly
declined.
• Fentanyl is commonly diverted in Texas.
• Propoxyphene napsylate and its
combinations are among the most
frequently abused pharmaceuticals by
narcotic addicts in Chicago, where traces
of the drug were found in 16 overdose
cases. Use has reportedly declined in
Miami.
CEWG December 1997
New York City. "In casual conversation with users and dealers, field researchers find
that widespread use of marijuana may be partially due to a change in attitude and
perception. First, many drug users tend to opt for marijuana in preference to crack,
which is regarded as a low -status drug. Second, increased discussion of legalization
and marijuana's medicinal attributes have contributed to a wider social acceptance.
The substance is especially accepted in inner-city neighborhoods. "
Texas: "The Texas school survey found that... this increase is partially due to more lax
attitudes toward drug use among Texas students, lowered perceptions of parental
disapproval of substance use, and the increased availability of drugs. "
Atlanta: "Ethnographic data indicate prevalent marijuana use among many residents of the
north Georgia mountain area. "
EMERGENCY DEPARTMENT
DATA
During 1996, marijuana accounted for a
relatively substantial proportion (>_ 10
percent) of total drug ED mentions in four
cities: Detroit, Miami, New Orleans, and
Washington, DC (exhibit 1). It accounted
for 5 percent or more in every CEWG city in
DAWN, except for Newark and San
Francisco, which had the lowest proportions
(3 percent in each). New Orleans had the
highest percentage (11.5 percent). Since
1994, these percentages have generally either
remained stable or increased minimally (1-2
percentage points).
New Orleans also had the highest estimated
rate of ED mentions per 100,000 population,
followed by Detroit and Philadelphia;
Denver had the lowest rate (exhibit 27).
Between 1994 and 1996, rates increased in
15 of the 20 CEWG cities in DAWN (9 were
significant at p<0.05)—continuing the
upward trend ongoing in many cities since
1992. The largest increases occurred in
Baltimore (49 percent), Chicago (47
percent), Philadelphia (42 percent), and
Detroit (41 percent) (exhibit 28). Only
CEWG December 1997
two cities had statistically significant rate
declines over the 2 -year period: Washington,
DC (31 percent), and Denver (29 percent).
INFORMATION TO ACTION
San Diego: ",Statistics such as these resulted in
the initiative to provide treatment on demand for
adolescents and the push to set up Juvenile Drug
Courts.....
TREATMENT DATA
Marijuana is the top-ranking illicit primary
drug of abuse among treatment admissions in
Chicago, Denver, and Minneapolis/St. Paul;
it equals heroin as the top-ranking drug in
Seattle; and it also accounts for substantial
proportions (>20 percent) of admissions in
Hawaii and New Orleans (exhibit 29). Over
the past few years, percentages have been
increasing sharply in most areas. Compared
with the previous reporting period, however,
percentages increased only slightly to
moderately in 10 areas: Atlanta, Baltimore,
Boston, Chicago, Minneapolis/St. Paul,
Newark, New York City, Philadelphia, San
Diego, and Seattle. Percentages
51
Executive Summary: Marijuana
Exhibit 27. Estimated rate of marijuana ED mentions per 100,000 population
by metropolitan area, 1996*
New Orleans =107.3
Detroit 98.6
Philadelphia 65.4
Atlanta 60.9
Chicago 57.9
Boston 54.3
Miami 53.0
Baltimore 51.6
Washington, DC 50.8
Seattle 46.8
St. Louis 39.0
New York City 37.7
Newark 34.2
San Francisco 29.8
Phoenix 29.6
Los Angeles 24.9
San Diego 24.8
Dallas 22.9
Minneapolis/St. Paul 22.1
Denver 19.2
All of United States 19.7
0 20 40 60 80 100
ED Mentions per 100,000 Population
*Preliminary estimates
SOURCE: SAMHSA, Drug Abuse Warning Network, April 1997 files
Exhibit 28. Annual trends in marijuana ED mentions
nor 100.000 000ulation in four selected cities, 1991-96*
Year
*Preliminary estimates
SOURCE: SAMHSA, Drug Abuse Warning Network, April 1997 files
52 CEWG December 1997
BEYOND THE CITY LIMITS...
Baltimore: `Primary marijuana use represented
a higher proportion of treatment admissions in
the surrounding counties than in Baltimore
City... "
St. Louis: "In rural treatment programs,
marijuana is the second most frequently
identified drug as the reason for entering
treatment, following alcohol. "
declined slightly in Denver, New Orleans,
and Texas, and they remained stable in
Arizona, Hawaii, and St. Louis.
USE PATTERNS
Youth often consume marijuana with malt
liquor, as reported in Atlanta and Chicago.
Executive Summary.- Marijuana
Among primary marijuana treatment admis-
sions, alcohol is still generally the most
common secondary drug of abuse; either
alcohol or cocaine remains the most common
tertiary drug. However, treatment clients in
some cities report different patterns of
multisubstance use: in Hawaii, for example,
methamphetamine is the most common
tertiary drug; in San Francisco, cocaine is the
foremost secondary drug, while methamphet-
amine is the most common tertiary drug (a
change from 1 year earlier, when alcohol was
secondary and cocaine was tertiary).
BEYOND THE CITY LIMITS...
Baltimore: "Some 17 percent of (surrounding)
county admissions used 'other'substances,
primarily hallucinogens and inhalants, compared
with 7 percent of city admissions. "
Exhibit 29. Marijuana as a proportion of primary drugs of abuse among
treatment admissions (excluding alcohol -only) in six CEWG areas
(320%1o, 25%
37%
Denver Seattle New Orleans
(1/97-4/97) (1/97-7/97) (1/97-4/97)
2 22% 21%
Hawaii Chicago Minneapolis/St. Paul*
(7/96-6/97) (7/96-6/97) (1/97-6/97)
❑ Marijuana D Heroin X Other
■ Cocaine ( Stimulants
*Alcohol -only is not excluded
CEWG December 1997 53
Executive Summary: Marijuana
In many cities, the increasing trend in
marijuana use closely corresponds with the
rise in use of blunts (gutted cigars refilled
with marijuana). Joints or blunts are either
smoked alone or combined with other
substances. They are often dipped in PCP,
as reported in Chicago, St. Louis, Texas, and
Philadelphia (where they are called "love
boats" when prepared by the user and "dust
blunts" when sold already laced). They
sometimes contain crack or cocaine HCl, as
in Chicago ("diablitos," "primos," or
"3750s"). Sometimes they are laced with
heroin, as in one San Francisco neighbor-
hood. In Houston, blunts (also called
"swishers") or joints are sometimes dipped in
codeine cough syrup ("candyblunts") or
embalming fluid ("dip," "fry," "fry sticks,"
"amp," and "water -water").
San Francisco: "Treatment program
staff cite reports, mostly from blacks
in the Western Addition district... of
'canade' (a so-called Canadian
marijuana, possibly cannabis indica),
which is laced with heroin. "
Atlanta: "Ethnographic data indicate
that fewer marijuana users are lacing
blunts with cocaine or methamphet-
amine. Instead, they have apparently
shifted to drinking malt liquor, which
some users refer to as 'liquid crack. "'
Chicago: "These youth tend to mimic
the type of drug use popularized in rap
culture: smoking a blunt and drinking
40 -ounce bottles of malt liquor. In
their integration of marijuana use into
their Lifestyles, they resemble their
predecessors of 30 years ago, except
that they smoke marijuana rolled from
a cigar wrapper rather than the
traditional cigarette paper. "
Age
Philadelphia: 'According to users
new to treatment, the use of PCP -
laced blunts is increasing. "
DEMOGRAPHICS
New York City. 'According to street
observations, however, users were
seen as young as 12 years and as old
as 80 years, and all ages in between.
Younger users, however,... continue to
prefer smoking blunt(s)... "
Atlanta: "Ethnographic data continue
to indicate an increasing number of
youth who become involved with
marijuana. "
Chicago: "... 'blunt' smoking ... is
especially common among black youth
age 14-24. "
Compared with cocaine and heroin, mari-
juana demographics are more sharply youth
dominated. Nevertheless, people of all ages,
including adolescents, continue to be
represented in marijuana ED mentions
(exhibit 30). No one group accounted for a
clear majority in any city in 1996. The
youngest (12-17) age group accounted for
20 percent or more of marijuana ED
mentions in seven of the CEWG cities, and it
was the modal group in Denver and
Minneapolis/St. Paul. Patients age 18-25
were the modal group in nine cities, the
26-34 group was modal in six cities, and the
3 5+ group was modal in three (Atlanta,
Detroit, and New Orleans).
Marijuana treatment demographics are more
sharply youth dominated than are the ED
54 CEWG December 1997
Executive Summary: Marijuana
Exhibit 30. Percentage of marijuana/hashish Exhibit 31. Percentage ofprimary marijuana
ED mentions by male representation, age admissions in reporting CEVVG areas by male
group, and area, 1996" representation and age group*
NOTE Shaded areas reflect percentages that have
increased by _-5percentage points since 1984.
'Preliminary estimates
'Percentage has declined by _-5 percentage points since
1894.
SOURCE: 8AyWHSA'Drug Abuse Warning Network,
April 1987files
CEWG December 1997
Atlanta
71
9
27
32
32
Baltimore
72
15
30
30
14
Boston
661
18
32
2 9
b 221
Chicago
17
27
30
Dallas
78
22
29
26
991
Denver
75
83
Los Angeles
69
15
34
27
23.
Miami
761
51
26
32
321
Minneapolis/
St. Paul
65
_9
"27
23
13
Newark
68
20,
29
33
6
New Orleans
73
8
29
`31
New York
751
8
27
34
31
Philadelphia
70
14
33
28
25
Phoenix
69
23
36
`21
20
St. Louis
68
16
29
"27
281
San Diego
67
32
27
24
241
San
Francisco
74
18
`24
30
29
I
Seattle
73
17
341
27
21
Washington,
DC
73
20
34
`26
19
NOTE Shaded areas reflect percentages that have
increased by _-5percentage points since 1984.
'Preliminary estimates
'Percentage has declined by _-5 percentage points since
1894.
SOURCE: 8AyWHSA'Drug Abuse Warning Network,
April 1987files
CEWG December 1997
NOTE: Shaded areas reflect percentages that have
increased by -5 urmore points since previous
report period.
'Total admissions number excludes alcohol -only but
includes n|onho|'in'oomhination; reporting periods are
January -June 1997' except for the following: July
1995 -Juno 1996 in San Francisco; calendar year 1990
in Baltimore, Nevvod^' and New York City; January -April
1997 in Denver' July 1996-Jono 1997 in Chicago and
Hawaii; July -September 1897 in Los Angeles; and
October 198G-Sopnombor1897inTexas.
'Percentage has declined by _-5 percentage points since
previous report period.
"AUogroups are different: �25; 26-35; and 38+
55
Atlanta
39
27
14
Baltimore
83.
50
30.
12
8.
Chicago
78
38
36
17
991
Denver
75
83
Los Angeles
61
46
Minneapolis/
76
51
24
St. Paul
Newark
`88
b 35
20
6
New
71
Orleans
New York
78
b 30
18
9
Cityc
St. Louis
82
19
44
26
12
San Diego
73:
32
27
24
17
San
77
25
42
16
17
Texas
761
51
24
NOTE: Shaded areas reflect percentages that have
increased by -5 urmore points since previous
report period.
'Total admissions number excludes alcohol -only but
includes n|onho|'in'oomhination; reporting periods are
January -June 1997' except for the following: July
1995 -Juno 1996 in San Francisco; calendar year 1990
in Baltimore, Nevvod^' and New York City; January -April
1997 in Denver' July 1996-Jono 1997 in Chicago and
Hawaii; July -September 1897 in Los Angeles; and
October 198G-Sopnombor1897inTexas.
'Percentage has declined by _-5 percentage points since
previous report period.
"AUogroups are different: �25; 26-35; and 38+
55
Executive Summary: Marijuana
demographics (exhibit 31). The youngest
age group (< 17) now accounts for the
largest percentages of marijuana admissions
in 9 of the 13 areas where age breakdowns
are available (and in 5 of those areas, they
are in the majority). Young adults
(age18-25) represent the largest groups in
the other four areas. In some areas, such as
San Diego, the increase in marijuana
admissions is largely due to increased
availability of programs for adolescents.
Age distributions for marijuana ED mentions
remained relatively stable in most cities
between 1994 and 1996. Interestingly, only
the youngest (12-17) and oldest (35+)
groups showed any marked increases (>_ 5
percentage points). The youngest group
increased in four cities (Denver, Minnea-
polis/St. Paul, Newark, and San Diego),
while the oldest group increased in seven
(Baltimore, Chicago, Dallas, Detroit, New
Orleans, New York City, and St. Louis). By
contrast, the two middle groups showed
declines: the 18-25 group declined in four
cities (Denver, Minneapolis/St. Paul, San
Diego, and San Francisco), as did the 26-34
group (New Orleans, Phoenix, St. Louis, and
Washington, DC). The oldest (35+) group
declined in Boston and Newark.
Similarly, age distributions remained
generally stable among primary marijuana
treatment admissions. Compared with the
previous report period, the youngest group
increased substantially (>_ 5 percentage
points) in only three areas: Atlanta, Hawaii,
and New York City. The only other notable
increases were among the 18-25 group in
Newark and the 26-34 group in Minnea-
polis/St. Paul. The only declines of
comparable magnitude were among the s 17
group in Newark, the 18-25 group in New
York City, and the 35+ group in Atlanta.
St. Louis: "Juvenile offenders primarily choose
marijuana rather than harder drugs, in part
because they participate in the distribution
network -for harder drugs. These runners do not
use their product. "
In each of the seven CEWG cities where
ADAM tests juvenile male arrestees, the
percentage of positive urinalysis was much
higher for juveniles than for adults in the first
half of 1997. Positive findings among
juveniles in those cities ranged from a low of
51 percent in San Diego to a high of 64
percent in Washington, DC. These
percentages increased in six of those seven
cities, particularly in San Diego, Phoenix,
and San Antonio, between the first halves of
1996 and 1997 (exhibit 32). Denver was the
only city with a slight decline.
Local student surveys in many CEWG areas
similarly reflect escalating adolescent
marijuana use. For example, current (past -
month) use rates have increased in several
areas: Massachusetts (to record highs in
1996); Chicago (to 19 percent in 1995);
Miami (to 21 percent of 12th graders and 20
percent of 10th graders in 1995); Newark (to
slightly more than 20 percent in 1995); and
Texas (to 16 percent in 1996).
Gender
Males continue to outnumber females among
marijuana ED mentions and treatment
admissions in all the areas (exhibits 29 and
30). Among ED mentions, the gender gap is
widest in Miami and New York City and
56 CEWG December 1997
Executive Summary. Marijuana
Exhibit 32. Percentage positive for marijuana among juvenile male arrestees
in CEWG cities, first halves of 1996 and 1997
Washington, DC
64
63
San Antonio 59
53
Denver58l
- - - _J 61
St. Louis 57
56
Phoenix 55
� 51
Los Angeles 52 55
First half 1997
San Diego 42 51 ❑ First half 1996
T 11
0 10 20 30 40 50 60 70 80
Percentage Positive
SOURCE: National Institute of Justice, Alcohol and Drug Abuse Monitoring system,
preliminary data, November 1997 files
narrowest in Minneapolis/St. Paul. Among
marijuana admissions, Newark has the widest
gender gap while Los Angeles and Hawaii
have the narrowest. In all reporting areas,
except for New Orleans and Los Angeles,
the percentage of females is lower among
treatment admissions than among ED
mentions—in contrast to the case of cocaine
and heroin.
QUESTIONS THAT WARRANT FURTHER
RESEARCH....
Why are female marijuana users more likely to
seek emergency medical help than drug
treatment services?
Are prevention and treatment services more
targeted to the needs ofmales than females—
particularly in the younger age groups?
CEWG December 1997
Gender distributions among ED mentions
remained relatively stable between 1994 and
1996, with three exceptions: Chicago
(where the percentage of females increased
by approximately 5 percentage points), and
Dallas and Denver (where the percentage of
males increased 10 points and 5 points,
respectively). Among primary marijuana
admissions, too, gender distributions
remained relatively stable since the previous
report period. The exceptions were Newark
(where the percentage of females increased)
and Atlanta and San Diego (where the
percentage of males increased).
Marijuana indicators are even more male
dominated than cocaine indicators: the
percentage of males is generally higher for
marijuana among both ED mentions and
treatment admissions. The only exception
57
Executive Summarv: Mariivana
is Phoenix, where males constitute a higher
Phoenix (Hispanics increased, whites
percentage of cocaine ED mentions than
declined), and San Francisco (whites
marijuana ED mentions.
declined). Among marijuana treatment
admissions, recent shifts included increasing
Male arrestees tested positive for marijuana
African-American representation with
at higher percentages than their female
corresponding declines among whites in five
counterparts in every CEWG city in the
areas: Atlanta, Baltimore, New Orleans, St.
ADAM program, except for Houston—in
Louis, and San Diego.
contrast to the percentages for cocaine and
opiates, which tended to be female
LAW ENFORCEMENT DATA
dominated.
Race/Ethnicity
Marijuana ED patients varied in their
racial/ethnic distributions among the 20 cities
in DAWN (exhibit 33). Whites constituted
the largest group in 6 cities, and African-
Americans were the largest group in 12.
Hispanics were substantially represented
(>_20 percent) in Chicago, Los Angeles, New
York City, and Phoenix. Among primary
marijuana treatment admissions, racial/ethnic
distributions similarly varied across the
country, but in a pattern somewhat different
from ED breakdowns (exhibit 34). Whites
accounted for the largest percentage in 8 of
the 15 reporting areas, and African-
Americans had the greatest representation in
5. Hispanics were substantially represented
(>_20 percent) in Los Angeles, New York
City, San Diego, and Texas.
Several shifts (>_ 5 percentage points)
occurred in marijuana ED racial/ethnic
distributions between 1994 and 1996:
Baltimore (the percentage who were
African-Americans increased, while whites
declined), Chicago (Hispanics increased,
whites declined), Dallas (whites declined);
New Orleans (whites increased, African-
Americans declined), Philadelphia (whites
increased, African-Americans declined),
Arrestee Data
According to preliminary first -half -1997
data, marijuana exceeds cocaine as the most
frequently detected drug among adult male
arrestees in eight of the CEWG cities in
ADAM (exhibit 35): Chicago, Dallas,
Detroit, Philadelphia, St. Louis, San
Antonio, San Diego, and Washington, DC.
Positive urinalysis among that population in
CEWG cities ranged from a low of 19
percent in Houston to a high of 53 percent in
Chicago, among females, positive findings
ranged from 14 percent in New Orleans to
41 percent in Detroit, and, among juveniles,
there was less variation, with a range of 51
percent in San Diego to 64 percent in
Washington, DC.
First -half-year comparisons between 1996
and 1997 show notable increases (>_ 5
percentage points) among ADAM males in
only two cities: Chicago (9 points) and
Philadelphia (5 points). Considerable
declines, however, occurred in New York (9
points), Houston (9 points), St. Louis (7
points), and Denver (5 points). Among
fernales, by contrast, positive findings
increased notably in five cities: Detroit (17
points), New York (6 points), Philadelphia
(6 points), Phoenix (5 points), and Dallas (5
points); Houston was the only city with a
58 CEWG December 1997
"
ExecutivmSmmmarv: /Nmrhiaana
Exhibit 33. Proportions ofmarijuana/hashish Exhibit 34. Race/ethnicity mfprimary marijuana
EDmentions byrace/ethnicity and area, 1996" admissions bypercentage inreporting CEgVG
areas'
NOTE: Shaded areas represent percentages
that have increased by �5ormore points
since the previous report period.
"Tot |admisoionnnumhorexc|udesa|oohu|*n|ybut
includes u|ooho|'in~uomhinution;reporting periods are
----r' --- 1997 -'—,' —for the foll---'": --Iv'
NOTES: Shaded areas percentages that have '
l995-Jvn� 1998 in San Fn"nriorn� calendar year 1996
increased by _>5 percentage points since 1994; in Baltimore, Newark, and Nev, York City;
percentages in several cities are on the low side January -April 1997 in Denver, July 198G -Juno 1397
because o+unusually high "race unknown" category inChicago and Hawaii; July -September 1997 in Los
or missing data. Angeles; and October 1896-Soptombo, 1997 in Texas.
"Percentage has declined by ^5 percentage
'Preliminary estimates points since the previous report period.
^ "Hovvaiianncnnshtote52 percent.
Penmn�agahaodaoUnadby _>5 percentage points
since 1994.
SOURCE: SAMHSA.Drug Abuse Warning Network,
April 1997 files
CEVVG[)ecennber 1997 59
Atlanta
46
22
1
Baltimore
b45
8
Boston
9
78
4
Chicago
45
b 24
17
Dallas
31
b 48
12
Denver
6
32.
12
Detroit
72
25
1
Los Angeles
34
33
29
Miami
46.
43
10
Minneapolis/
St. Paul
12
68
I
Newark
61
19
10
New Orleans
'64
31
2
New York
City
46
17
20
Philadelphia
'53
40.
5
Phoenix
7
b 55
22
St. Louis
57
41
16
San Diego
16
55
17
San
Francisco
20
b 32
17
Seattle
12
33
2
Washington,
DC
41
39
Total U.S. 1
36
46
10
NOTE: Shaded areas represent percentages
that have increased by �5ormore points
since the previous report period.
"Tot |admisoionnnumhorexc|udesa|oohu|*n|ybut
includes u|ooho|'in~uomhinution;reporting periods are
----r' --- 1997 -'—,' —for the foll---'": --Iv'
NOTES: Shaded areas percentages that have '
l995-Jvn� 1998 in San Fn"nriorn� calendar year 1996
increased by _>5 percentage points since 1994; in Baltimore, Newark, and Nev, York City;
percentages in several cities are on the low side January -April 1997 in Denver, July 198G -Juno 1397
because o+unusually high "race unknown" category inChicago and Hawaii; July -September 1997 in Los
or missing data. Angeles; and October 1896-Soptombo, 1997 in Texas.
"Percentage has declined by ^5 percentage
'Preliminary estimates points since the previous report period.
^ "Hovvaiianncnnshtote52 percent.
Penmn�agahaodaoUnadby _>5 percentage points
since 1994.
SOURCE: SAMHSA.Drug Abuse Warning Network,
April 1997 files
CEVVG[)ecennber 1997 59
XX
Baltimore
b
49
2
Boston
33
45
17
Chicago
35
51
6
Denver
57
Los Angeles
23
29
48
Minneapolis/
17
73
St. Paul
Newark
79
4
17
New Orleans
31
New York City
51
16
31,
San Diego
19
b 49
22
San Francisco
51
27
16
Texas
23
41
35
NOTE: Shaded areas represent percentages
that have increased by �5ormore points
since the previous report period.
"Tot |admisoionnnumhorexc|udesa|oohu|*n|ybut
includes u|ooho|'in~uomhinution;reporting periods are
----r' --- 1997 -'—,' —for the foll---'": --Iv'
NOTES: Shaded areas percentages that have '
l995-Jvn� 1998 in San Fn"nriorn� calendar year 1996
increased by _>5 percentage points since 1994; in Baltimore, Newark, and Nev, York City;
percentages in several cities are on the low side January -April 1997 in Denver, July 198G -Juno 1397
because o+unusually high "race unknown" category inChicago and Hawaii; July -September 1997 in Los
or missing data. Angeles; and October 1896-Soptombo, 1997 in Texas.
"Percentage has declined by ^5 percentage
'Preliminary estimates points since the previous report period.
^ "Hovvaiianncnnshtote52 percent.
Penmn�agahaodaoUnadby _>5 percentage points
since 1994.
SOURCE: SAMHSA.Drug Abuse Warning Network,
April 1997 files
CEVVG[)ecennber 1997 59
Executive Summary: Marijuana
60
50
40
30
20
10
0
70
60
50
40
30
20
10
0
Exhibit 35. Percentage positive for cocaine and marijuana among
adult male arrestees in selected cities, 1993-96 annual data, 1997 first -half-year data
Dallas
Marijuana
Cocaine
1993 1994 1995 1996* 1H97*
Year
rose ve _
San Antonio
Marijuana
No
Cocaine
1993 1994 1995 1996* 1H97*
Year
*Preliminary data
60
50
40
30
20
10
0
60
50
40
30
20
10
0
rosiuve
Detroit
Marijuana
Cocaine
1993 1994 1995 1996* 1H97*
Year
San Diego
Marijuana
Cocaine
1993 1994 1995 1996* 1H97*
Year
SOURCE: National Institute of Justice, Alcohol and Drug Abuse Monitoring system annual reports, 1993-96;
November 1997 files for first half 1997
noteworthy decline (6 percentage points).
Among juveniles, positive levels increased in
all the cities except Denver, where they
declined slightly (2 points, down to 58
percent). The most notable increases were in
San Diego (8 points, to 51 percent), Phoenix
(5 points, to 55 percent), and San Antonio (5
points, to 59 percent).
In nearly every area where arrest figures are
available, increases are reported. In New
York City, for example, despite the
decriminalization of possessing small
amounts of marijuana, cannabis -involved
arrests almost quadrupled between 1991 and
1996 (when they totaled nearly 19,000).
Similarly, in Phoenix, marijuana possession
arrests have increased dramatically over the
past few years (totaling nearly 13,000 in
1996-94 percent of all drug possession
arrests, compared with 59 percent in 1990).
In New Orleans, too, marijuana arrests
continued to increase (totaling 844 and 906
in the first halves of 1996 and 1997,
respectively). Marijuana arrests in Denver
(possession, not sales) similarly increased 84
percent between 1994 and 1996. In San
Francisco, after steadily declining from 1992
through 1995, marijuana -related arrests
increased 8 percent in 1996. The proportion
of marijuana arrests in Boston rose from 21
percent of all drug arrests in 1996 to 24
60 CEWG December 1997
percent in the first half of 1997, the highest
recorded level for marijuana, and second
only to cocaine. And, in Washington, DC,
marijuana -related arrests have increased from
34 percent of drug arrests in 1996 to 42
percent in the first 9 months of 1997.
Honolulu is the only reporting city where the
number of marijuana arrests have remained
relatively stable during the last few reporting
periods.
Availability, Seizures, Price, and
Quality
Minneapo/is/St. Paul. "Interviews with
Minneapolis teenagers conducted
earlier this year revealed that
marijuana was both accessible and
affordable. For most, marijuana was
easier to acquire than alcohol "
Denver: "Ethnographic interviews
with marijuana users indicate that
both the price and purity of marijuana
have increased drastically within the
past year... They describe powerful
narcoticlike effects from smoking
small quantities of marijuana. "
Continued wide availability was reported in
nearly every city. In several cities, including
Minneapolis/St. Paul and Phoenix, it is the
most readily available substance. Easy
availability also extends to the rural areas
surrounding some cities, such as Atlanta and
St. Louis.
Marijuana seizures have increased in several
cities. In Washington, DC, where such
seizures account for the largest proportion of
drug seizures, they have increased sharply
between 1995 and 1997. Seizures have also
been increasing in Newark, where marijuana
now accounts for more than 20 percent of
drug seizures. Similarly, in Minnesota, law
CEWG December 1997
Executive Summary: Marijuana
enforcement removals have increased. And,
in Miami, indoor hydroponic marijuana farms
have been seized in private homes on a
weekly basis in 1997.
Exhibit 36 presents available marijuana price
data in CEWG cities. Prices are reported as
stable in New Orleans and Seattle. In
Washington, DC, between 1996 and 1997,
sinsemilla prices declined at the lower end of
the price range. Potency has reportedly
increased in some cities, such as Minnea-
polis/St. Paul, where locally grown marijuana
has increasingly elevated tetrahydrocanna-
binol (THC) levels.
Cultivation and Trafficking
Miami: "Inflated profits from these
often small-scale operations have
fueled a new pot -cottage crime
industry,' which is often more
profitable and less risky than dealing
in cocaine. "
Minneapolis/St. Paul. • "One
sophisticated indoor grower boasted
flavored marijuana plants (chocolate,
vanilla, etc.)."
New York City. "The Street Studies
Unit reports increasing numbers of
marijuana copping areas... "
Some CEWG cities have multiple sources of
marijuana: imports from outside the United
States, local or out -of -State outdoor
growing operations, and local indoor
hydroponics. The latter source, which often
involves manipulation of plant genetics, has
contributed to recent increases in potency; it
involves very short growth -to -harvest times;
and it is impervious to weather conditions.
In Miami, supplies of Caribbean and Latin-
American -produced marijuana continue to be
61
Executive Summary • Marijuana
Exhibit 36. Marijuana prices and purity in reporting CEWG cities, December 1997
reporting period
Atlanta Homegrown/Commercial (1.95% THC) $100-$125 $1,000-$1,400
Sinsemilla (6.5% THC) $200-$250 $1,500-$1,800
Indoor -- $2,500+
Baltimore
"Poor quality"
$95
--
Boston
Commercial grade
$75-$300
$1,000-$2,000
Sinsemilla
$200-$300
$2,500-$3,000
Chicago
Commercial grade
$60-$70
$600-$700
"High quality"
$110-$200
$1,000-$2,500
Dallas
Mexican
$50-$80
$450-$800
Domestic (higher THC)
$50-$80
$700-$3,000
Denver
$100-$600
$700-$5,000
Commercial grade
-
$800-$1,200
Sinsemilla
$1,500-$3,200
Honolulu
"Low quality"
$250-$500
$3,000-$6,000
"High quality"
$350-$700
$6,000-$9,000
Houston
$350-$900
Miami
Imported commercial (3-4% THC)
$65-$180
$800-$1,250
Domestic sinsemilla (8-14% THC)
$250-$600
$2,000-$3,500
Minneapolis/St. Paul
Locally grown (elevated THC)
$200-$300
$900-$1,500
Newark
High -resin seedless
$"several
-
hundred"
New Orleans
$125-$160
$750-$1,100
New York City
$70-$80
--
"Skunk"
--
$800
"Chocolate"
$1,000-$1,200
Phoenix
Premium grade
$75-$100
$650-$800
St. Louis
Imported
$2,000-$4,000
Domestic sinsemilla (20% THC)
-
$1,000-$2,000
San Diego
2-3% THC
$50-$75
$500
Sinsemilla (8-16% THC)
$200-$400
--
San Francisco
Commercial grade
$40-$100
$350-$1,000
Sinsemilla
$200-$600
$1,500-$6,000
Seattle
Imported commercial
-
$350-$2,500
Domestic sinsemilla
$200-$350
$2,000-$8,000
Washington, D.C.
Commercial grade
$150-$250
$800-$2,200
Sinsemilla
$150-$500
$2,000-$3,500
62 CEWG December 1997
reported less than the higher potency
domestic varieties produced by indoor
hydroponics. Similarly, in Atlanta,
trafficking patterns have shifted from coastal
marine and air smuggling to complex indoor
hydroponic growing with domestic interstate
shipments; Mexico, however, remains a
primary source for Atlanta, with Hispanic
couriers and transporters used increasingly.
By contrast, some of Boston's marijuana is
grown in Massachusetts, but most originates
in California, Mexico, Colombia, or Jamaica.
Washington State receives a large monthly
influx of low-grade Mexican marijuana,
Executive Summary- Marijuana
which Mexican crime cartels generally
transport overground; additionally, sizable
indoor growing operations produce high
potency sinsemilla; a third source is a recent
development—U.S. growers are increasingly
setting up indoor growing operations across
the Canadian border, then shipping the
marijuana back to the United States for sale.
Denver's marijuana is either locally grown or
imported from other States and Mexico.
Much of the marijuana grown in Missouri—
which is increasingly shifting from outdoor
to indoor operations—is shipped out of
State. Homegrown marijuana is also
reported in New Orleans.
CEWG December 1997 63
Hawaii. "Crystal methamphetamine remains the drug of choice in the island chain.... For
more than a decade, we have been totally unsuccessful at controlling its spread, preventing
its use, or treating its victims. "
MORTALITY DATA
Stimulant -related mortalities were reported
in six areas, five in the western United
States: Hawaii, Minneapolis/St. Paul,
Phoenix, San Diego, San Francisco, and
Seattle. Only two of these cities had
mortality increases since 1996. In San
Diego, a top-ranked city for methamphet-
amine indicators, methamphetamine -related
accidental overdose deaths are expected to
reach record levels in 1997 (with 30 cases
through June). In nearly half of the 1997
cases, methamphetamine was the only drug
detected. Similarly, in Hawaii, ME mentions
for d methamphetamine hydrochloride
("crystal") increased, totaling 13 in the last
half of 1996 and 20 in the first half of 1997.
By contrast, methamphetamine -only deaths
declined sharply in the Phoenix area (from 50
in 1995 to 5 in the first half of 1997). Three
deaths each were reported in Phoenix for the
"speedball" combination of methamphet-
amine with cocaine and for methamphet-
amine with morphine.
In the Seattle area, mortality figures were
relatively low (two methamphetamine- or
amphetamine -caused deaths in the first three
quarters of 1997)—up from 1994, but down
since peaking (at six) in 1995. In
Washington statewide during 1993-95,
methamphetamine was detected in 52 drug -
caused deaths, in 13 of these cases,
methamphetamine was the only drug
detected.
Eastern and midwestern cities continue to
have few or no stimulant mortalities. In
Minneapolis, methamphetamine overdose
deaths totaled three in 1995, two in 1996,
and one in 1997. Nearby St. Paul had one
methamphetamine -related death in 1997,
compared with two in both 1995 and 1996.
EMERGENCY DEPARTMENT
DATA
Methamphetamine ED mentions in 1996
continued at higher rates in the West than in
the other CEWG areas. San Francisco had
the highest rate per 100,000 population
(66. 1), followed by Phoenix (34.5), San
Diego (26.3), Los Angeles (15. 1), and
Seattle (10.1). Eastern and midwestern
cities consistently had much lower rates than
western cities in 1996. The only cities in
these areas with rates higher than 2.0 per
100,000 population were Dallas (4.6),
Minneapolis/St. Paul (3.9), and Atlanta (4.4).
During 1994-96, methamphetamine ED
mention rates declined (p<0.05) in 11 of the
20 CEWG cities in DAWN. In many cities,
these declines followed an increasing trend
from the early 1990s till a 1994 peak (exhibit
37). Since that peak, the largest declines
(p<0.01) occurred in Seattle (38 percent),
San Diego (34 percent), Dallas (30 percent),
and San Francisco (20 percent). In San
Diego, however, ED mentions were the only
stimulant indicator to decrease— and they
still constituted a larger percentage of ED
64 CEWG December 1997
Executive Summary: Stimulants
Exhibit 37. Annual trends in estimated methamphetamine ED mentions
per 100,000 population in the United States and in three top ranking cities, 1991-96*
ED Mentions per 100,000 Population
100 W- San Francisco San Diego
-X - Phoenix All of United States
80 --__
60
40 --iE- ---__
20 i
1991 1992 1993 1994 1995* 1996*
Year
*Preliminary estimates
SOURCE: SAMHSA, Drug Abuse Warning Network, April 1997 files
mentions than marijuana. Only in
Minneapolis/St. Paul did ED mentions
increase significantly during the same period,
but rates there were much lower than in
western cities. Unlike in previous years,
methamphetamine was not the top-ranked
illicit drug ED mention in any city.
The pattern of amphetamine ED mentions is
similar to that of methamphetamine, though
the rates are much lower. Three western
cities have the country's highest rates per
100,000 population: San Diego (19.3), San
Francisco (16.1), and Phoenix (14.8). The
only eastern and midwestern cities with rates
higher than 3.0 are Detroit (10.0), Dallas
(5.6), Philadelphia (4.9), Atlanta (3.5), and
Chicago (3.1).
During 1994-96, amphetamine ED rates
dropped sharply (p<0.01) in Denver (48
percent), San Francisco (40 percent), and
Phoenix (28 percent). However, rates
increased during this period in 10 cities,
including San Diego (16 percent), where
rates have risen steadily since 1991.
TREATMENT DATA
Hawaii: "... 7ce' abusers maLtokee
king
treatment at rates equivalent lcohol
abusers. The system is not abp with
this demand. "
Primary stimulant abuse accounts for the
highest percentage of treatment admissions
in San Diego and Hawaii (exhibit 38).
Methamphetamine equals heroin as the most
reported primary drug in Arizona.
Stimulants account for smaller but notable
proportions (4-13 percent) of admissions in
Denver, Los Angeles, San Francisco, Seattle,
and Texas. In the East and Midwest,
CEWG December 1997 65
Executive Summary: Stimulants
stimulants generally account for 2 percent or
less of primary treatment admissions (a slight
increase since 1996 for some cities); in
Minneapolis/St. Paul, however, they account
for 3 percent. Stimulants continue to be
reported as secondary drugs in San Diego,
and they are reported as tertiary drugs in
Hawaii and San Francisco.
Unlike mortality and ED indicators,
stimulant admission figures appear to be
increasing. Since the last reporting period,
admission percentages increased (4-5
percentage points) in four western areas:
Denver, San Diego, Seattle, and the State of
Hawaii. In Hawaii, stimulants replaced
marijuana as the most reported primary drug
of abuse. In Arizona, the admission
percentage for stimulants remained
unchanged; and in San Francisco, that figure
leveled off, following a sharp increase since
1990. In Denver, new users continued to
account for a significant portion of stimulant
treatment admissions, although this group's
representation has declined since 1995.
USE PATTERNS
Route of Administration
Denver: "Recent chemical regulations
have made ingredients scarce for
producing high-quality crystal
methamphetamine. The resulting
increase in home produced 'bathtub
crank' has likely affected route of
administration, because this form of
methamphetamine cannot be
injected. "
Methamphetamine can be smoked, snorted,
injected, or ingested orally. The primary
route of administration varies, even within
regions (exhibit 39). For example, injection
predominates in Denver, San Francisco, and
Exhibit 39. Route of administration among
primary stimulant/methamphetamine admissions
in selected CEWG areas, 1996*
100
80
60
40
20
0
Percent
Hawaii San Diego Denver
Area
*State fiscal year in Hawaii; calendar year
in San Diego; January—April 1997 in Denver
66 CEWG December 1997
Texas. However, in two other western
areas—San Diego and Hawaii—smoking
was reported as the primary route of
administration. In Hawaii, almost all
stimulants admissions (97 percent) reported
smoking as the primary route of adminis-
tration. In San Diego, the percentage of
treatment admissions who reported smoking
increased since last year (from 35 to 41
percent), surpassing the figure for sniffing
(37 percent). Smoking has also become
more widespread in Denver in the last 3
years (43 percent of new users, compared
with 20 percent in 1994), as well as in Los
Angeles.
Inhalation is the preferred route of
administration in two midwestern reporting
areas: Minneapolis/St. Paul (63 percent) and
St. Louis (41 percent). In the East, smoking
is the preferred route in Boston, followed
closely by ingestion. Atlanta treatment
admissions report sniffing (the primary route
of administration) and injecting in nearly
equal percentages.
Route of administration often varies based
on sociodemographic characteristics. In
Denver, for instance, smokers are usually
middle-class suburbanites, while a quickly
growing population of noninjecting users are
white, homeless youth.
Route of administration also varies for
stimulants other than methamphetamine. For
example, in Chicago, white intravenous drug
users on the North Side inject phenmetrazine
(Preludin). In Minneapolis/St. Paul, khat (a
flowering evergreen shrub imported from
East Africa and the Middle East) is smoked,
chewed, or made into tea. In Boston,
Michigan, and Washington, DC, adolescents
CEWG December 1997
Executive Summary: Stimulants
reportedly inhale crushed methylphenidate
(Ritalin) tablets.
Multisubstance Abuse
Phoenix mortality data, reported above,
confirm that some users are speedballing
morphine with methamphetamine instead of
with cocaine. ME reports in Phoenix also
show that users combine methamphetamine
with cocaine.
Metharnphetamine treatment admissions in
nearly all reporting cities cited marijuana as
the secondary and alcohol as the tertiary
drug of choice. San Francisco remains an
exception, with cocaine cited as the tertiary
drug. Texas is another exception, with
cocaine cited as the secondary and alcohol as
the tertiary drug of choice for fiscal years
1996 and 1997.
In Chicago, some stimulant users continue to
speedball rnethylpheni date with heroin,
sometimes including cocaine for a more
potent effect.
DEMOGRAPHICS
San Francisco: "Treatment program staff
report a marked increase in.., speed
Prevalence, especially among young,
heterosexual whites. This increase is
confirmed by the Pulse Check informant,
who noted increasing use among blue
collar workers, young professionals, and
college students. "
Gender
Males predominate in mortality data in San
Francisco (87 percent) and San Diego (83
percent). They also continue to outnumber
females among stimulant treatment
67
Executive Summary: Stimulants
Exhibit 40. Gender of primary stimulant/
methamphetamine admissions in selected
CEWG areas during the most recent reporting period*
80
70
60
50
40
30
20
10
Percent
7s ■ Males
❑ Females
56
52 50 50
48
44
24
San Francisco Texas
San Diego Seattle
Area
*Reporting periods are January -June 1997 in San
Diego and Seattle; October 1996 -September 1997 in
Texas; and July 1995—June 1996 in San Francisco.
admissions in most reporting areas. In San
Francisco, for example, more than three-
quarters of stimulant admissions are males
(exhibit 40). In Texas, however, admissions
are evenly split between men and women.
And, in San Diego, females have surpassed
males among stimulant admissions.
Among adult arrestees, by contrast, females
tested methamphetamine -positive at higher
levels than males during the first half of 1997
in several cities, including Los Angeles,
Phoenix, and St. Louis. However, in
Denver, San Diego, and Texas, the
percentages of positive screens were nearly
equal among males and females—a shift
from the previous reporting.period, when
females recorded higher percentages in most
of the western sites.
In Texas, 59 percent of adult methamphet-
amine overdose calls to the Southeast Texas
Poison Control Center concerned females.
Age
Denver: "Homeless white youth are
the fastest growing population of non -
injecting methamphetamine users....
A large segment of young meth-
amphetamine injectors also sell
methamphetamine or marijuana. "
Minneapolis/St. Paul: "Several school-
based chemical health specialists
reported growth in the number of
adolescent girls abusing methamphet-
amine to suppress appetite and
control weight. "
St. Louis: "Speed and its derivatives
are becoming more widespread among
high school and college students, who
do not consider these drugs as
dangerous as cocaine. "
Methamphetamine decedents were in the
older age groups in the two cities where
mortality data were available: in San
Francisco, 70 percent were age 35 or older;
and in San Diego, 70 percent were older than
36. Also in San Diego, 2 of the 30
methamphetamine -related deaths were
younger than 18.
Among primary stimulant admissions,
individuals age 26-34 remain the modal
group in most reporting areas, including
Atlanta, Los Angeles, St. Louis, San Diego,
and the States of Hawaii and Texas (exhibit
41). The 35+ group account for the majority
in Baltimore and Minneapolis/St. Paul.
Persons age 18-25 predominate in Chicago.
68 CEWG December 1997
70
60
50
40
30
20
10
0
Exhibit 41. Age distribution of primary stimulant/
methamphetamine admissions in selected CEWG
areas during the most recent reporting period*
Hawaii San Diego Texas
Area
*Reporting periods are January—lune 1997 in
Hawaii and San Diego; and October 1996—
September 1997 in Texas.
Primary stimulant admissions appear to be
aging in Baltimore, where the percentage of
those age 35 and older increased sharply
(from 26 percent to 39 percent) in 1 year.
Similarly, in Texas, the average age of a
treatment admission for primary stimulant
abuse has been increasing (from 26 in 1985
to 30 in 1997). Conversely, the average age
of ephedrine poison center overdose cases in
southeast Texas was relatively young: 22.4.
Boston: "State police interviews
indicate that MDMA is becoming more
popular, mostly among youth in their
late teens and early twenties. "
According to DEA and outreach sources in
western Massachusetts, methylphenidate use
is increasing among adolescents.
Additionally, according to a 1996 Boston
public school survey, nearly 14 percent of
male and 7 percent of female twelfth graders
120
100
80
60
40
20
0
Executive Summary: Stimulants
Exhibit 42. Race/ethnicity of primary stimulant/
methamphetamine admissions in selected CEWG
areas during the most recent reporting period*
Percent
U. Whites ---�
■ African-Americans
I J Hispanics
92
93
63
f;
21_
6 L 1 51 6
San Diego
Seattle Texas
Area
*Reporting periods are January—June 1997 in
San Diego and Seattle; and October 1996—
September 1997 in Texas.
reported lifetime use of methylenedioxy-
methamphetamine (MDMA).
Race/Ethnicity
Whites predominate in available mortality
data, accounting for the majority of
methamphetamine decedents in San Diego
(70 percent) and San Francisco (87 percent).
They also continue to represent the majority
of stimulant admissions in every reporting
area except Hawaii, where nearly half are of
Hawaiian descent (exhibit 42). In Texas,
whites have continued to increase as a
percentage of stimulant admissions (93
percent in 1997, compared with 80 percent
in 1985). By contrast, in Los Angeles, the
percentage of Hispanics in treatment
continued to increase. Similarly, in San
Diego, the percentage of white admissions
decreased while Hispanic admissions
continued to increase.
CEWG December 1997 69
Executive Summary. Stimulants
Whites also predominate in methamphet-
amine -related arrests. For example, they
constituted the majority of adult arrestees in
San Diego (55 percent) and San Francisco
(78 percent).
In San Francisco, the representation of
Hispanics, Asians, and African-Americans
among methamphetamine users is mostly
among gay males, who continue to constitute
a large minority of users. Some white
stimulant injecting drug users in Chicago
reportedly use phenmetrazine, while African-
American stimulant users prefer
methylphenidate.
Exhibit 43. Percentage positive for
methamphetamine among adult male booked arrestees
in western cities, first half of 1996 versus first half of 1997*
Percent
❑ First half of 1996
40 First half of 1997 37
30-
23
20-
14
10 10
F� 2
Los Angeles Denver Phoenix San Diego
LAW ENFORCEMENT DATA *Preliminary data
Arrestee Data
In the first half of 1997, male adult arrestees
tested positive at 10 percent or higher in only
two of the CEWG cities in the ADAM
program (preliminary data): San Diego (37
percent) and Phoenix (14 percent) (exhibit
43). Positive, but lower level, screens were
also reported in other cities: Denver (5
percent); Dallas and Los Angeles (4 percent
each); San Antonio (3 percent); Philadelphia
(1 percent); and Atlanta and St. Louis (both
<1 percent). San Diego and Phoenix also
had the highest percentages among female
adult arrestees (36 percent and 21 percent,
respectively), followed by Los Angeles (8
percent). Only three cities had notable
positive findings for juvenile arrestees: San
Diego (15 percent), Phoenix (10 percent),
and Los Angeles (6 percent).
Contrary to available mortality and ED data,
but consistent with available treatment data,
preliminary ADAM data suggest increases
between the first halves of 1996 and 1997.
City
SOURCE: National Institute of Justice, Arrestee
Drug Abuse Monitoring system, preliminary data,
November 1997 files
Methamphetamine -positive findings
increased among all three arrestee
populations (males, females, and juveniles) in
nearly every CEWG city in the program.
The only exceptions were among female
adult arrestees in Los Angeles (where the
percentage declined by 4 points) and San
Antonio (where the percentage decreased
slightly). Among both male and female
arrestees, the sharpest increases occurred in
San Diego, Phoenix, and Dallas, while the
sharpest increases among juvenile male
arrestees occurred in San Diego and
Phoenix.
Similarly, methamphetamine -related arrests
increased in several CEWG areas. In
Phoenix, for example, methamphetamine
arrests totaled 547 in 1997, up 141 percent
from 1996. In Honolulu, methamphetamine
cases increased between the second half of
1996 and the first half of 1997 (from 227 to
70 CEWG December 1997
326). In Seattle, too, felony filings for
methamphetamine manufacturing/dealing
have been increasing, totaling 8 in 1995, 43
in 1996, and 31 in 1997 through September.
"Speed" arrests also increased in Denver and
San Francisco.
Arrest figures involving stimulants other than
methamphetamine are relatively much lower.
Nevertheless, several are noteworthy. In
Washington, DC, for example, four junior
high school students were arrested in a
neighboring suburban county for selling
methylphenidate on school property. And in
Minneapolis, numerous prosecutions have
involved khat. All the defendants were
refugees from Somalia.
Availability, Price, and Purity of
Stimulants Other Than
Methamphetamine
San Francisco: "Local attendees of
the Labor Day gathering called
Burning Man, ' in nearby Nevada,
reported the availability and use there
of methylenedioxyamphetamine
(MDA) and dimethyltryptamine
(DMT). "
In many CEWG areas, ephedrine -based
over-the-counter products remain available.
In Texas, for example, the substances are
increasingly marketed as "all natural," or "all
herbs," even though they may contain
50-100 milligrams of ephedrine combined
with caffeine. Ephedrine is available in that
State for $1,200 per pound and $10 per
1,000 tablets. Ephedrine -based products are
also sold in Minneapolis/St. Paul health food
and convenience stores. In Phoenix, bulk
quantities of ephedrine and pseudoephedrine
tablets are sold at numerous retail outlets. In
Atlanta, Minneapolis/St. Paul, and Texas,
CEWG December 1997
Executive Summary: Stimulants
ephedrine products are also marketed as
legal versions of MDMA ("XTC" or
"ecstasy") and are sold as "herbal ecstasy,"
"cloud 9," and "herbal bliss."
MDMA continues to be sold in the Atlanta
suburbs and club scene, at dose prices of
$5—$25 (compared with $15—$20 in 1996)
and milligram prices of $55—$150 (stable).
The MDMA in Texas, which originates in
local areas, California, and Mexico, sells for
$7—$30 per 50 -100 -milligram tablets.
MDMA availability is also reported in
Baltimore, Chicago, Miami, Minneapolis/St.
Paul, New York City, St. Louis, Seattle,
Washington, DC, and throughout New
Jersey and Hawaii.
Methylphenidate is readily available in
Boston, where it is usually snorted. It is also
widely available in Chicago, where it sells for
$3—$4 per pill ($2.00—$2.50 per pill in 5 -10 -
pill quantities). Phenmetrazine (Preludin) is
also abused in Chicago, but its availability
appears to have declined recently. Also in
Chicago, pseudopharmaceuticals containing
caffeine, ephedrine, or phenylpropanolamine
are available for $1—$2 each.
Khat, used throughout eastern Africa for its
stimulant and medicinal properties, continues
to be intercepted in Minneapolis/St. Paul.
Law enforcement officials there seized 600
pounds of khat through October 1997, a
sharp increase from the 73 pounds seized in
1996.
Methamphetamine Availability,
Price, and Purity
Denver: "Ethnographic reports from
various drug users suggest that
dealers use methamphetamine to cut
71
Executive Summary: Stimulants
other drugs. Previous reports have
St. Louis, methamphetamine availability is
revealed that crack is sometimes cut
stable in rural areas, in the city itself, the
with methamphetamine. Recently,
drug appeared in police exhibits for the first
however, users have reported that
heroin is being cut with methamphet-
time in many years. In Denver, "bathtub
amine. The reasons for this are
crank," a less potent form of methamphet-
currently under investigation. "
amine, is increasingly available because of
phi' ' .>: >:`' .:>''`
recent regulations restricting precursor
Philadelphia: "Focus group members
availability. Availability is also reported in
indicated that methamphetamine ... is
Atlanta, Boston, Miami, and at clubs in
still difficult to obtain and requires a
"
Baltimore and New York City.
connection.
Atlanta
Baltimore: "Users reported that quality
ranged from poor' to "terrible.... ..
Minneapolis/St. Paul law enforcement agents
report increased availability of several types
of methamphetamine: light brown, white,
yellow, pink, and green ("grimace"). In
Methamphetamine is also increasingly
available in Hawaii, as reflected in declining
street prices for that area's two types of
methamphetamine: "clear" and "wash"
(exhibit 44). Prices have also declined in
Texas. Stable prices are reported in both
Boston and Seattle. In Atlanta, where pound
Exhibit 44. Methamphetamine prices and purity in reporting CEWG areas, December 1997
reporting period
* The purity of the methamphetamine does not apply to a specific quantity.
SOURCE: CEWG city reports, December 1997
72 CEWG December 1997
Ounce
:.Pou
..........................
Y.:::.:
.......
::..:.:::.::.::::::::
phi' ' .>: >:`' .:>''`
i>.'<>'>[<«< '«> <>.
..................
....
.:>:>::>::>::>:::«<;:>::>::::;;;;::>::>:<::;<:::>::>::>:;:;
Atlanta
90*
$60-$200
$900-$1,500
$10,000-$16,000
Boston
--
$60-$80
$800-$1,500
$12,000-$24,000
Denver
$900-$1,200
--
Hawaii (Big
"wash"
$400-$600
wash
$12,500-$15,000
wash
$55,000-$70,000
Island)
"clear"
$800-$1,000
clear
$18,000-$23,000
clear
$240,000-$250,000
Minneapolis/
$100
$1,000
-
$10,000-$12,000
St. Paul
New Orleans
--
$150-$160
$1,200
$10,000-$12,000
St. Louis
86*
$37-$100
$800-$1,600
--
(rural areas)
San Diego
20-40*
$50-$75
$500-$900
-
--
Seattle
35-90
$80-$120 1
$560-$859
--
Texas
$90-$100 1
-
$1,000-$1,500
-
$10,000-$15,000
* The purity of the methamphetamine does not apply to a specific quantity.
SOURCE: CEWG city reports, December 1997
72 CEWG December 1997
prices have decreased, high purity levels (90
percent) are identifiable by the off -yellow
coloring of chunky methamphetamine rocks.
Dealers there continue to cut the drug with
powdered vitamins, powdered proteins, or
baby laxatives. In Phoenix, dealers are
beginning to cut methamphetamine with
methylsulfonylmethane (MSM), a white
powder sulfur nutrient used as a dietary
supplement for horses.
Methamphetamine Manufacture,
Trafficking, and Distribution
Mexico is reportedly a major source of
methamphetamine for many CEWG areas,
sometimes almost exclusively, sometimes in
addition to local production. In some cases,
Mexican methamphetamine is shipped with
other drugs. In Miami, methamphetamine
shipments from Mexican traffickers often
include cocaine HCl and heroin as well.
Similar shipments are reported in Hawaii, as
Mexican nationals initially involved in the
heroin trade have diversified their product
line to include methamphetamine, amphet-
amine, and cocaine. Regardless of the
source, manufacturers on both sides of the
U.S.-Mexico border have been producing d -
methamphetamine hydrochloride—a pure,
potent form of the drug—via the ephedrine -
reduction method.
In Hawaii, California-based Mexican sources
use the State's cultural diversity to facilitate
smuggling and distribution to and within the
islands; at the same time, local clandestine
Executive Summary: Stimulants
labs, whose chemical supplies come from
California, have been proliferating. In Texas,
too, metharnphetamine is manufactured
locally but is also imported from California
and Mexico.
Phoenix: "With assistance from a
magazine,... or a recipe on the
lnternet,...it is possible for an
inexperienced entrepreneur to turn a
$150 investment into
$1, 000-$1, 200. "
Minneapolis/St. Paul. "Green
methamphetamine ('grimace,' 'the
green monster') is produced by using
a particular solvent ingredient.
Although well known among users for
making them sick, it is still considered
a desirable product. "
In Washington State, law enforcement
agencies continue to respond to an
increasing number of calls concerning
methamphetamine lab sites (117 calls
through September 1997, compared with 96
in 1996). Lab seizures and dismantling also
continue to increase in Arizona (123 in 1996,
136 in 1997), as does the amount of
methamphetamine seized (a 367 -percent
increase to 304 kilograms in 1997).
According to Phoenix DEA sources,
numerous retail outlets are distributing bulk
ephedrine and pseudoephedrine tablets,
knowing they will be used to manufacture
methamphetamine.
In the Midwest, methamphetarnme
production, availability, and trafficking have
reportedly increased in Minneapolis/St. Paul.
CEWG December 1997 73
Executive Summary: Stimulants
BEYOND THE CITY LIMITS
Large shipments of methamphetamine continued
to enter Minnesota from Mexico, but authorities
are equally concerned about the small-scale,
"cold cook " labs operating in remote, rural
areas of the State. Nineteen such labs were
dismantled in Minneapolis through October
1997, compared with 26 in 1996 and 14 in 1995.
Clandestine methamphetamine "box" labs have
also been proliferating in rural St. Louis, where
women are heavily involved as distributors.
In Boston and New Orleans, methamphet-
amine continues to be supplied by northern
California sources. Most of the metham-
phetamine available in Atlanta is produced in
Mexico and is sold primarily outside the city
at truck stops, auto body shops, and mobile
home parks. Methamphetamine remains
scarce in Washington, DC, but seizures did
increase there between 1995 and 1997
(through November 20), from 6 to 95 grams.
74 CEWG December 1997
Boston: "Media reports, confirmed by treatment workers, suggest that indiscriminate
polysubstance use is becoming more prevalent among adolescents. "
MORTALITY AND EMERGENCY
DEPARTMENT DATA
Depressant -related overdose deaths
increased in Honolulu (16 cases through
June 1997, compared with 1 in 1996).
Similarly, in Phoenix, barbiturate -related
deaths increased from 8 in all of 1996 to 15
in the first half of 1997. In Seattle,
depressant -related overdose deaths
remained stable at 23 through September
10, 1997, compared with 31 in 1996.
Nearly one-third (30 percent) of the deaths
in 1997 were suicides, and the majority
involved benzodiazepines. In Philadelphia,
the 296 drug-related deaths in the first half
of 1997 included 66 mentions of
depressants. Diazepam was the leading
psychoactive prescription drug involved in
deaths in New York City.
Diazepam ED rates during 1996 ranged
from a high of 16.1 per 100,000 population
in San Francisco (stable from 16.3 in
1994), to a low of 2.4 in Minneapolis/St.
Paul. Between 1994 and 1996, the rates
declined significantly (p<0.05) in only one
of the five top-ranking cities: Philadelphia
(from 13.0 to 9.7—a 25 -percent decline).
Rates also declined, but not significantly, in
two other top-ranking cities: Boston (from
13.7 to 11.1) and New Orleans (from 14.1
to 12.3). The only rate increase (but not
significant) among the top five cities was in
Phoenix (from 11.5 to 13.0).
Philadelphia continued to have the highest
rate of alprazolam (Xanax) ED mentions
(16.9 per 100,000 population—up from
12.9 in 1994). New Orleans and Newark
were next at 12.8 each (a statistically
significant 41 -percent increase for Newark
since 1994), followed by St. Louis (12.5)
and Phoenix (10.3). The largest
significant rate decrease between 1994 and
1996 occurred in Boston (a 53 -percent
decline to 7.9 mentions per 100,000
population).
Clonazepam (Klonopin) ED rates declined
in all five top-ranking cities except
Philadelphia, where rates increased
slightly. Boston continued to have the
highest rate (19.6, a 35 -percent decline
from 30.3 in 1994), followed by Phoenix
(10.7), San Francisco (10.0), Seattle (8.4,
a 32 -percent decline from 12.4 in 1994),
and Philadelphia (7.7).
According to the Southeast Texas Poison
Control Center, 19 adult overdose cases in
1997 involved flunitrazepam (Rohypnol),
and 28 involved gamma-hydroxybutyrate
(GHB). In Miami, GHB in combination
with alcohol was responsible for a dramatic
increase in medical emergencies associated
with the drug over the past 2 years: from
38 ED mentions in 1996 to 63 in the first 3
quarters of 1997.
TREATMENT DATA
Depressant admissions continue to account
for a relatively small percentage of overall
treatment admissions in most reporting
areas. In New York City, for example,
CEWG December 1997 75
Executive Summary: Depressants
less than 1 percent of treatment admissions
cited depressants as their primary drug of
abuse. Similarly, despite relatively high
depressant ED rates in Boston, only 1
percent of State -funded treatment clients
during FY 1996 reported using barbiturates
or other sedatives in the month prior to
admission. In Hawaii, depressant
admissions declined from 22 in 1996 to 5
in the first half of 1997. Numerically,
however, depressant admissions increased
in Chicago to 732, (a 144 -percent increase
from 1996).
In Texas, the first cohort of flunitrazepam
users entered treatment. Between January
1996 and September 1997, 118 youth and
103 adults were admitted with a primary,
secondary, or tertiary problem with the
drug.
DEMOGRAPHICS
San Francisco: "Treatment program
observers note a continued increase in
reports of GHB, mostly seen among
young white men and women, both
gay and straight. "
Depressant abusers appear to fall into two
distinct groups: adolescents and young
adults who use GHB, ketamine ("Special
K"), or flunitrazepam at nightclubs or
parties; and whites older than 30 who use
pharmaceutical depressants such as
diazepam, clonazepam, and alprazolam.
Anecdotal data and field reports continue to
provide evidence of the first category of
abusers. In Atlanta, flunitrazepam
continues to be mentioned as a drug used
by high school students, and its use is
suspected among adolescents in an urban
county where a syphilis outbreak occurred
among white, middle-class, adolescent
girls. Ketamine use is reported among
youth in the Minneapolis club scene and
among high school and college students in
Boston. In San Francisco, ketamine use is
reportedly increasingly common among gay
men who view it as a party drug.
In Texas, poison control center data also
indicate a younger cohort of "club drug"
users. The average age of the 19
flunitrazepam overdose cases between
January 1996 and September 1997 was
19.7; of the 28 GHB overdose cases, the
average age was 26.4. Similarly, the
average age of adult flunitrazepam
treatment admissions in Texas was 24,
which is much younger than most adult
clients entering treatment (overall average
age is 33.9). Hispanics were overrepre-
sented among both adult admissions (66
percent) and juvenile admissions (74
percent).
BEYOND THE CITY LIMITS ...
Texas: "Of the youth entering treatment for
flunitrazepam abuse, 74 percent entered
programs located on the Texas -Mexico border.
Since flunitrazepam abuse has been a problem
among border youth for a longer period of time,
this represents the first cohort whose use has led
to dependence and the need for treatment. "
Mortality and overall treatment figures,
however, reflect an older, usually white
cohort of depressant abusers. For example,
nearly all (95 percent) of the depressant -
related deaths in Seattle involved whites,
and the mean age was 41.7. Similarly, in
76 CEWG December 1997
Texas, treatment admissions had an average
age of 37 and were primarily white (85
percent) and female (64 percent).
USE PATTERNS
Texas: "Communities on the Texas -
Mexico border report clonazepam
(Rivotril) is 'everywhere' and is being
used by juveniles in combination with
beer, just as flunitrazepam has been
used. "
According to field reports, flunitrazepam,
GHB, and ketamine continue to gain
popularity among dance and nightclub
patrons in several CEWG cities. In
Minneapolis, flunitrazepam is taken alone
orally, dissolved in beverages, or crushed
into a powder and snorted. GHB in
combination with alcohol has replaced
flunitrazepam among club patrons in
Miami. In Atlanta, GHB is commonly
used as a synthetic steroid at fitness centers
and gyms. Reports from both Honolulu
and New York City indicate use of club
drugs as well.
In the Boston area, alprazolam and
clonazepam are often used with heroin,
crack, and methadone, while diazepam
continues to be a common component in
multi -drug ingestion patterns in Chicago.
Also in Chicago, sporadic reports continue
of amitriptyline tablets (Elavil) being
injected on the South Side. Many heroin
addicts in Miami use benzodiazepines in an
attempt at self-medication. Similarly,
clonazepam remains popular among opiate
addicts in Minneapolis/St. Paul, and in
Atlanta it is sold to enhance the effects of
methadone.
Executive Summary: Depressants
LAW ENFORCEMENT DATA
Washington, DC: "Local police, the
DEA, and area colleges have linked
flunitrazepam to several sexual
assaults in the DC area... eight in the
past year involving college students. "
In March 1997, the Florida Legislature
classified flunitrazepam as a Schedule I
drug, and GHB as Schedule II. Addi-
tionally, in New York, ketamine has been
designated as a controlled substance as of
early 1998. The Washington, DC, area's
first conviction involving flunitrazepam as
a "date rape" drug occurred in October
1996.
Law enforcement agencies reported just a
few depressant seizures in 1997. One
seizure of flunitrazepam was reported in the
Boston area, and an early 1997 traffic stop
in Minneapolis yielded 3,500 tablets of the
drug. Also in Minneapolis, sources
reported burglaries of veterinary suppliers
in which ketamine was the only substance
taken. In Miami, ketamine was reported in
several DUI cases, usually in combination
with other drugs. Benzodiazepines were
the most often identified depressants in the
ADAM program in Texas, with positive
findings ranging from 2 percent to 14
percent.
AVAILABILITY, PRICE, AND
QUALITY
Because of the Federal ban on importing
flunitrazepam, several other substances
have been substituted for the drug. The
CEWG December 1997 77
Executive Summary: Depressants
most frequently substituted drug continues
to be Rivotril (the international name for
clonazepam), which has been reported in
Miami, Minnesota, and Texas. Prices for
flunitrazepam ("R2", "rope," and "Mexican
valium") remain steady at $5-$10 per tablet
in Minneapolis/St. Paul. According to
sources in Boston, ketamine and GHB
availability has recently increased.
Besides club drugs, several other
depressants remain available throughout the
reporting CEWG areas. In Honolulu,
barbiturate prices remained stable at
$3-$20 per unit, and secobarbital ("reds")
sells for $2-$3 per pill. Diazepam tablets
remain widely available in Chicago for
$1-$4 per tablet, while the pills cost
$5-$20 in Atlanta and are frequently found
at crack houses there. In New York City,
amitriptyline, alprazolam, and diazepam
remain available but are less accessible
because many storefront "medical offices"
have been closed by law enforcement
officials. Benzodiazepines are available in
Seattle for $1 per 5 -milligram tablet and
$2-$4 per 10 milligrams.
78 CEWG December 1997
San Francisco: "Ethnographic observers note a renewed interest in PCP on the streets,
especially among Hispanics in the Mission District. "
MORTALITY AND EMERGENCY
DEPARTMENT DATA
In St. Louis, phencyclidine (PCP) has been
identified in a few ME cases, primarily
along with marijuana. No other
hallucinogen -related mortality data were
available.
Hallucinogen ED rates remained relatively
low compared with the rates for other
drugs. In 1996, Seattle and San Francisco
led the Nation in lysergic acid diethylamide
(LSD) ED rates (exhibit 45). All other
CEWG cities had rates lower than 5.0.
Seattle
San Francisco
Atlanta
Denver
Washington, DC
Baltimore
New Orleans
Dallas
San Diego
Miami
Los Angeles
Minneapolis/St. Paul
Philadelphia
Phoenix
Chicago
Boston
St. Louis
New York City
Detroit
Newark
All of United States
4.9
4.5
3.9
3.2
3.2
3.1
3.1
2.9
■ 2.5
■ 2.4
■ 2.4
■ 2.2
12.1
12.0
1.5
1.4
1.3
1.2
Between 1994 and 1995, the LSD -related
ED mentions per 100,000 population
generally increased. However, between
1994 and 1996, the ED rates declined or
remained stable in every CEWG area
except for New Orleans and San Diego
(five declines were significant at p < 0.05).
San Francisco led the Nation in PCP -
related ED mentions per 100,000
population; the rates were lower than 10.0
in the other CEWG cities. Like LSD -
related ED rates, PCP -related ED rates
generally declined. In Washington, DC,
the rates declined significantly (p<0.05)
Exhibit 45. Rate of LSD and PCP ED mentions
per 100,000 population by city, 1996*
LSD
7.3
0 2 4 6 8 10 12
ED Mentions per 100,000 Population
*Preliminary estimates
San Francisco
Chicago
Los Angeles
Philadelphia
Washington, DC
Seattle
Baltimore
New Orleans
Phoenix
St. Louis
New York City
Dallas
San Diego
Detroit
Atlanta
Boston
Denver
Miami
Newark
Minneapolis/St. Paul
All of United States
PCP
11.2
I�II� 9.3
8.0
7.0
6.9
5.5
4.3
3.7
3.3
3.0
2.3
1.5
1.4
1.2
1.1
1.0
0.8
0.8
0.7
. 1.5
-_1___
1___T_I _
.
0 2 4 6 8 10 12
ED Mentions per 100,000 Population
NOTE: "..." denotes that estimate does not meet standard of precision or is less than 10.
SOURCE: SAMHSA, Drug Abuse Warning Network, April 1997 files
CEWG December 1997 79
Executive Summary: Hallucinogens
from 35.6 in 1994 to 6.9 in 1996, an 81 -
percent decline. Significant declines also
occurred in New York (79 percent),
Baltimore (70 percent), New Orleans (45
percent), Los Angeles (41 percent), and
Chicago (35 percent). By contrast, during
the same time period, rates increased
significantly in Detroit, Phoenix, and San
Francisco. These figures, however,
remained relatively low.
TREATMENT DATA
Primary hallucinogen users continue to
constitute small percentages of total
treatment admissions in most reporting
CEWG areas: 2 percent of adolescent
admissions in Texas, and less than 1
percent of all admissions in Boston,
Denver, Chicago, Hawaii (only two
admissions in the first half of 1997), and
Seattle. In Baltimore, the treatment
admission rate declined sharply in 1996,
driven primarily by a decline in admissions
in the surrounding counties. The number of
primary PCP admissions declined in
Philadelphia from 93 in the first half of
1996 to 14 in the first half of 1997;
primary admissions for other hallucinogens
also declined (from 14 to 8 during the same
period). In Chicago, the proportion of
treatment admissions for primary
hallucinogen dependence dropped nearly
continuously from FY 1984 to FY 1997 (to
less than 1 percent).
:O
DEMOGRAPHICS
According to field reports and available
treatment data, adolescents and young
adults remain the most frequently cited
users of hallucinogens. In Seattle, DEA
reports and ethnographic data indicate that
LSD and psilocybin mushroom use is
escalating among younger users. Similarly,
in both Atlanta and St. Louis, LSD use is
reportedly most common among high-
school -age suburban students. Qualitative
and quantitative data in both Minneapolis/
St. Paul and New Orleans also indicate use
among young adults. In New Orleans, for
example, hallucinogens remain widely
available and PCP use is increasing among
college students. Treatment data also
indicate young users of hallucinogens. In
Texas, the average age of adult admissions
for primary hallucinogen use was 24 during
the first half of 1997.
BEYOND THE CITY LIMITS ...
Atlanta: "7n addition to ethnographic data, DEA
reports indicate that LSD use is escalating
among suburban, muddle -class teens and young
adults. "
Whites constitute the largest racial/ethnic
group among LSD treatment admissions in
many CEWG areas. In Chicago, for
CEWG December 1997
example, white male users of LSD have
dominated treatment admissions over the
past 10 years.
Available treatment data indicate that PCP
users are not as likely to be white as their
LSD -using counterparts. Among primary
PCP admissions in Los Angeles, 56 percent
were Hispanic, and 59 percent were
female. Similarly, ethnographic reports in
San Francisco indicate a renewed interest in
PCP on the streets, primarily among
Hispanic users in the Mission District. In
Chicago, some data indicate increased PCP
use in the African-American communities
on the South and West Sides.
While ethnographic and treatment data
indicate a young cohort of hallucinogen
users, PCP -positive screens among juvenile
male arrestees were reported in only four
CEWG cities: Washington, DC, (8.8
percent), and Los Angeles, Phoenix, and
San Diego (all <_3 percent).
Information from school surveys offers
further evidence of an increasing young
cohort of hallucinogen users. For example,
according to a survey of Boston public
school students in grades 7-12, LSD and
other hallucinogen use rose substantially
from 1993 to 1996, with lifetime use
increasing from 6 to 11 percent.
USE PATTERNS
PCP -and -marijuana combinations continue
to be reported in many CEWG areas.
According to first-time marijuana treatment
admissions in Philadelphia, the use of PCP -
laced blunts is increasing. Combined use
Executive Summary: Hallucinogens
of the two drugs is also reported in New
Orleans, St. Louis, and Chicago, where the
combination is known as "happy stick" or
"wicky stick." A brand of cigarettes—
More—laced with PCP are called "sherm
sticks" in Chicago, and some indicators in
Philadelphia suggest limited use of PCP -
laced crack.
Minneapolis/St. Paul: "Several school
counselors encountered small bottles
that originally contained food coloring
or breath freshener filled with liquid
LSD. "
Liquid LSD is available in Atlanta, along
with forms known as "blotter acid" and
"window pane," which are microthin
gelatin squares 1/10 the size of an aspirin.
In Minneapolis/St. Paul, the drug is most
commonly found in thin, orange or yellow
tablets known as microdots. In New
Orleans, the most frequently encountered
form of LSD is blotter paper. Treatment
personnel in Boston reported recently
increased multiple -dose usage of LSD.
LAW ENFORCEMENT DATA
Arrestee Data
According to first -half -1997 ADAM data, 8
percent of male arrestees in Chicago tested
positive for PCP, up from 2.5 percent in
the first half of 1996. Positive findings
also increased in Philadelphia (from 2.4 to
7.6 percent) and San Diego (from 0.9 to
2.1 percent). By contrast, PCP -positive
screens declined among male arrestees in
Dallas (from 4.4 to 1.6 percent), Los
Angeles (from 4.2 to 2.9 percent), and St.
Louis (from 5.7 to 0.4 percent).
CEWG December 1997 81
Executive Summary: Hallucinogens
Among female arrestees, PCP -positive
screens were reported in only five CEWG
areas: Houston, Los Angeles, Phila-
delphia, Phoenix, and Washington, DC.
The highest rates were reported in
Philadelphia (4.6 percent—up from 0
positive screens in the first half of 1996)
and Los Angeles (2.17 percent). The
highest percentage of PCP -positive screens
among juvenile male arrestees occurred in
Washington, DC: 8.8 percent (up from 7
percent in the first half of 1996).
Availability and Price
PCP prices were available in only a limited
number of cities (exhibit 46). The Texas
ounce price for liquid PCP represents a
considerable decline during the past 6
months (from $1504600). In Chicago,
"mint leaf" or "love leaf," a moist, loose,
tobaccolike substance sprayed with PCP
and wrapped in tinfoil, is available and can
be purchased in $10 and $20 quantities.
Exhibit 46. PCP prices in reporting CEWG
areas, December 1997 reporting period
SOURCE: CEWG city reports, December 1997
LSD remains readily available in some
CEWG cities, including Miami and New
Orleans; sporadic availability is reported in
Baltimore and St. Louis. LSD dose prices
are somewhat consistent throughout the
country, with the average price falling
around $5 (exhibit 47). Larger amounts
are available in 100 -dose units in many
cities, with prices ranging from $125 to
$400.
In addition to LSD and PCP, a few other
hallucinogenic substances were reported in
various CEWG areas. Continued use of 4-
bromo-2, 5-dimethoxyphenethylamine
("nexus") was reported in Atlanta, where
capsules sell for $20-$30 per unit.
Legislators in Florida recently classified the
drug as a Schedule I controlled substance.
Psilocybin mushrooms have reportedly
been available in Boston, Seattle, and
Minneapolis/St. Paul.
Exhibit 47. LSD prices in reporting CEWG
areas, December 1997 reporting period
SOURCE: CEWG city reports, December 1997
82 CEWG December 1997
Prat flit s: <[::
xltrge::::.:
.� .
Atlanta
$3-$10
$200
Baltimore
$4-$5
$125-$160
Boston
$5
$200
Honolulu
$4-$6
$225-$275
Minneapolis/
$5
up to $125
St. Paul
New Orleans
$1.50-$8
$200-$400
St. Louis
$2-$4
SOURCE: CEWG city reports, December 1997
82 CEWG December 1997
Manufacture, Trafficking, and
Seizures
The west coast remains a major source for
hallucinogens in Boston and several other
CEWG areas. Much of the LSD in St.
Louis is brought in from the Pacific
Northwest.
Hallucinogen seizures are lower than for
other drug categories. In Boston, sporadic
Executive Summary: Hallucinogens
seizures of psilocybin mushrooms were
reported, including 4 pounds in
southeastern Massachusetts. Similarly, law
enforcement agents in Minneapolis seized
more than 19,000 grams of psilocybin
mushrooms in 1996. Washington, DC,
police seized 1,356 dosage units of PCP
through November 1997, an 80 -percent
decline from the seizures in 1995.
CEWG December 1997 83
Anabolic Steroids
A recent seizure in Phoenix involved a wide
variety of steroids. Steroid prices in that city
include $105 for a 10 -milliliter vial of
testosterone cypionate, and $210 for a 30 -
milliliter vial of testosterone suspension.
Inhalants
Inhalant abuse remains a serious problem
among adolescents in Texas, but treatment
admissions are declining. Primary inhalant
abuse accounted for 5 percent of all
adolescent admissions during 1997,
compared with 7 percent during the first 9
months of 1996. The majority of these
admissions were male (65 percent—down
from 76 percent in 1996) and Hispanic (77
percent); 19 percent were white, and only 4
percent were African-American. The
racial/ethnic distribution among Texas
inhalant admissions is heavily influenced by
the location and orientation of the treatment
programs.
According to a San Francisco survey, 12
percent of middle school students and 8
percent of high school students used
inhalants in their lifetime. Commercial STP
or other octane enhancers ("chemo') remain
the most popular inhalants. Frequently, rags
soaked in chemo are sealed in zippered
plastic bags and sold for $1.00. In
Philadelphia, focus groups in fall 1997
continued to identify the use of toluene and
other solvents. White males in their preteens
or young teens are most often identified with
this phenomenon, known as huffing.
84 CEWG December 1997
Mode of Exposure
The Centers for Disease Control and
Prevention (CDC) reports that injecting
drug use remains the second most common
mode of exposure among AIDS cases
nationwide. Through June 1997, injection -
related AIDS cases accounted for 32
percent of total diagnoses: 26 percent
(n=154,664) involved injecting drug use as
the sole mode of exposure, and 6 percent
(n=38,923) involved the dual risk
categories of injecting drug use and male -
to -male sex (exhibit 48). Male -to -male sex
remains the only mode of exposure to
exceed injecting drug use among total U.S.
AIDS cases.
Newark continues to have the highest
percentage of injecting drug use as the sole
mode of exposure among CEWG reporting
areas (58 percent), but that percentage
continues to decline (from 62 percent in
1995 and 61 percent in 1996). New York
City has the second highest percentage (45
percent). Eight CEWG areas had increases
in the percentage of injecting drug use
cases as the sole mode of exposure, but
those increases were relatively small. No
percentage increases were reported in any
CEWG area among cases with the dual
exposure of injecting drug use and male -to -
male sex.
The proportion of IDUs among cumulative
AIDS cases increased in Massachusetts to
34 percent in December 1997, and the
increase among incident AIDS cases was
even greater: 52 percent between May and
October 1997—the highest proportion yet
reported for this category. Similarly, 44.4
percent of AIDS cases diagnosed in
Philadelphia between July 1996 and June
1997 were attributable to injecting drug
use, compared with 35 percent among
cumulative cases. In Washington, DC, 35
percent of adult/adolescent AIDS cases
diagnosed after 1993 and reported through
May 15, 1997, were attributed to injecting
drug use, compared with 32 percent of the
cumulative cases.
Demographics
In many areas of the country, injection -
related AIDS cases remain disproportion-
ately nonwhite. For example, in Boston,
55 percent of injection -related AIDS
patients are African-American and 20
percent are Hispanic. Among the
heterosexual IDU cases in New York City,
African-Americans are the modal group (47
percent), followed by Hispanics (38
percent) and whites (14 percent).
Likewise, African-Americans are the modal
group in San Francisco (47 percent),
followed by whites (37 percent) and
Hispanics (13 percent). Of the recently
diagnosed AIDS cases among IDUs in
Washington, DC, 97 percent of the males
and 96 percent of the females are African-
American.
Males remain the majority among injection -
related AIDS cases in several CEWG areas:
New York City (74 percent), San Francisco
(73 percent), and Boston (73 percent). The
proportion of female AIDS cases related to
injecting drug use, however, is higher than
the male proportion in several CEWG
CEWG December 1997 85
Executive Summary: AIDS Among IDUs
areas. In Atlanta, for example, IDUs
account for 32.5 percent of the cumulative
female cases and 16.8 percent of the
cumulative male cases, and in Los Angeles
27 percent of female cases are injection -
related, compared with 5 percent for males.
Similarly, in Phoenix, 35 percent of female
cases, but only 9 percent of male cases, are
attributable to injecting drug use. Half of
the heterosexual transmissions in
Massachusetts are among sex partners of
IDUs, and 69 percent are females.
Prevention
Massachusetts continues to operate five
needle exchanges, but opposition to
establishing new sites remains strong. State
legislation that would have bypassed the
need for local siting approval has been
tabled, giving the advantage to vocal and
well -organized adversaries of harm
reduction initiatives. A syringe exchange
program has operated in Minneapolis since
1995. It operates at four locations and also
offers "safe site delivery" (individualized
deliveries to safe, publicly accessible
locations).
Researchers in St. Louis are taking a
different approach to AIDS prevention. At
the St. Louis University Medical Center,
researchers continue to test a potential
human immunodeficiency virus (HIV)
vaccine among high-risk populations,
including IDUs, high-risk homosexual
men, and young adults with sexually
transmitted diseases. Phase II trials, started
in late 1997, involve the collaboration of
basic and behavioral scientists.
86 CEWG December 1997
° ' ~
Exhibit 48. Acquired immunodeficiency syndrome among injecting drug users as reported byCENVG representatives, December 1997
"Calculated from adult and adolescent cases only a"����,p�"�ovw" ,mm'*��,m�v-
o
" SOURCE: oo,�omm,Disease onmmiand p,ovonuon'*x<w/ouou,,ox�n,*no*m�7(l):s.1e' 19e5. --
"oounos: Centers for Disease Control and Prevention, /ouIAunuSurveillance Report u(l>:s.1e. 19ee.
dnouncs: Centers for Disease Control and Prevention, +ovIAxnnSurveillance Report a(1):s.1s' 1997.
pone
A rou t.
bti -Y
Xbl4j�
Do
"Calculated from adult and adolescent cases only a"����,p�"�ovw" ,mm'*��,m�v-
o
" SOURCE: oo,�omm,Disease onmmiand p,ovonuon'*x<w/ouou,,ox�n,*no*m�7(l):s.1e' 19e5. --
"oounos: Centers for Disease Control and Prevention, /ouIAunuSurveillance Report u(l>:s.1e. 19ee.
dnouncs: Centers for Disease Control and Prevention, +ovIAxnnSurveillance Report a(1):s.1s' 1997.
NIDA
NATIONAL INSTITUTE
ON DRUG ABUSE
National Institute on Drug Abuse
NIH Publication number 98-4297
Printed 1998