An Overview of Drug Trends in the U.S. Jane Maxwell, Ph.D. Center for Social Work Research The University of Texas at Austin

Transcription

1 An Overview of Drug Trends in the U.S. Jane Maxwell, Ph.D. Center for Social Work Research The University of Texas at Austin

2 This presentation contains information presented by members of NIDA s Community Epidemiology Work Group on June 5-6, Special thanks to Dan Dooley, Boston Public Health Commission; Marcella Sorg, Univ of Maine; and Bruce Mendelson, Denver Drug Strategy Office. 2

3 Percentage Drugs Most Commonly Identified by U.S. Tox Labs Reporting to NFLIS: 2003 vs vs Marijuana Cocaine Methamphetamine Heroin

4 Percentage of Drug Items Identified as Heroin by Tox Labs: NFLIS 2010 <1% 1-2% 3-6% 7-10% 11-14% 15-16%

5 Percentage of Drug Items Identified as Cocaine by Tox Labs: NFLIS 2010 <5% 5-9% 11-15% % 20-29% 30-44%

6 Percentage of Drug Items Identified as Methamphetamine by Tox Labs: NFLIS % 1-3% 5-8% 11-14% 17-24% 25-34%

7 Mexican Black Tar Heroin Mexican Brown Heroin South American Heroin 7

8 Average Purity of Heroin Samples in the US: % % 30% 20% 10% 0% Southeast Asian Southwest Asian Mexican South American DEA s Heroin Domestic Monitor Program

9 Heroin Almost all heroin in the U.S. is from Mexico or South America. East of the Mississippi, white S. American heroin and in the West, Mexican Black Tar, but seeing Tar move eastward into the South, while S. American now seen in Chicago and St Louis. Fentanyl being added to white heroin to increase its potency. June 2014 CEWG meeting all correspondents reported heroin indicators increasing, and especially in suburban areas and among young users. Recent report of white Mexican heroin in NYC is incorrect. Most of it is S. American trafficked by Mexican cartels. Role of Naloxone and NEED FOR MEDICATION-ASSISTED THERAPY FOR YOUNG USERS.

10 Reports from the Northeast Heroin indicators in Northeast at high levels and increasing. 66% of heroin admissions in Boston were age 30+. In Maine, 47% were 25 and under. Other opioids mixed at moderate levels in Mass and Maine.

11 U.S. Heroin Treatment Admissions by Age Group: % 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% s 30s 20s U20

12 Age (Years) Average Age of Persons Dying with Mention of Heroin in Texas: Source: DSHS 12

13 Opioid Items Identified in DEA s NFLIS Laboratory System US Heroin Oxycodone Hydrocodone Source: NFLIS

14 Other Opiates Shifting back and forth between Rx opiates and heroin. Which came first? Still problem with pain pill mills. Houston Cocktail Holy Trinity : oxycodone, soma, alprazolam (Xanax). Evidence in Florida of decreasing problems due to Prescription Monitoring Programs. Reports of difficulty in using hardened extended release pills. Cost difference? Heroin cap in Texas is $10-$20 vs. $1/mg for 72 mg OxyContin. 14

15 New Relaxation Drinks: Drank and Lean Valerian Roots Melatonin Rose Hips Slow Your Roll Slow Motion Potion Google for Cannabist

16 Price Per Pure Gram Purity in Percent January 2007 June 2012 All Cocaine Purchases STRIDE $ $200 $197 $192 $ $ $ $173 $174$174 $191 $175 $166 $174$186 $176 $165 $169 $ $ $128 $118 $115 $123 $ $98 $50 From January 2007 through June 2012, the price per pure gram of Cocaine increased 79.4%, from $97.64 to $ while the purity decreased 28.3%, from 67.1% to 48.1% $0 Jan- Mar07 Apr- Jun07 Jul- Sep07 Oct- Dec07 Jan- Mar08 Apr- Jun08 Jul- Sep08 Oct- Dec08 Jan- Mar09 Apr- Jun09 Jul- Sep09 PPG $97.64 $117.6 $128.1 $114.8 $122.7 $123.9 $181.0 $197.0 $172.6 $173.9 $174.4 $191.9 $191.3 $194.4 $174.7 $173.8 $185.5 $175.8 $164.8 $166.2 $168.9 $175.1 Potency Oct- Dec09 Jan- Mar10 Apr- Jun 10 Jul- Sept1 0 Oct- Dec10 Jan- Mar11 Apr- Jun11 Jul- Sept1 1 Oct- Dec11 Jan- Mar12 Apr- Jun *During 2 nd Qtr. 2012, the number of cocaine samples analyzed for the STRIDE dataset decreased significantly as compared to 1 st Qtr due to resource limitations. 16

17 Cocaine: Why the Decline? Poison control, treatment, deaths, & tox lab indicators down; price up across the US. Amount of coca under cultivation in South America is down 15% and demand in Europe for cocaine. Use of Levamisole as a filler with serious medical consequences. Users in Austin report it is so weak not worth paying for and mixing coke with synthetic cathinones to increase effect. In 2012, DEA reports price per pure gram increased from $98 to $255 while purity decreased from 67% to 44%. Now seeing more cocaine than cannabis at tox labs on the Texas border in 2013 than in Return of cocaine?

18 Monitoring the Future Survey: : Marijuana Use by 12 th Graders % Used in Past Year % Great Risk in Using Regularly % Strongly Disapprove of Use % Easy or Very Easy to Get

19 Vapor Pens Advertised for patients Cost $100-$200 Potency varies Higher percentage of THC No odor. Similar to electric cigarettes Pen-style vaporizers contain hits Some can be recharged & refilled

20 Dabs, BHO, Honey, Budder Dabs, shatter wax and vaporizer pens contain hash oil ( wax ). Supposedly 80%-90% THC. Different methods on the web. Butane Honey Oil or Butane Hash Oil is a golden resin created by placing dried and ground marijuana into a special pvc filter. Butane gas is shot in through one end of the filter while the other end is placed in a bowl full of water. The filter spews out the fresh oil in to the cold water where it sinks to the bottom. The bottom is scraped and the oil is ready to use. Touch the heated knife point or the pin to the Budder on the end of a pin and inhale fumes (and sit down).

21 Wax, Budder, Shatter

22 Marijuana in Colorado Medical use legal since ,000 on registry In 2013, 111,000 patients with valid registry ID and 248,000 patient applications. In 3 months, Colorado has earned $12.6 million in taxes and fees. 148 retail stores, 520 medical marijuana centers and 751 Optimal Premises Cultivation Licenses, Fewer treatment admissions (fewer cj referrals); fewer pot arrests, fewer marijuana positives in fatal crashes, but increases in hospital discharge rates & calls to poison center. Need to regulate/require potency and label candy & cookies that contain THC.

23 Synthetic Drugs Not really Spice, Bath Salts, Incense, or Plant Food Chemically-based; not plant derived Complex chemistry Constantly changing to stay legal Need to prove intended to use to convict in some areas 23

24 The Synthetics: Calls to US Poison Control Centers: US Syn Cannabinoids US Syn Cathinones

25 WH-200 2% JWH-018 Cannabinoids Identified in U.S. NFLIS: JWH-073 OTHER AM-2201 JWH-073 9% JWH-019 1% SYNTHETICS JWH OTHER JWH % AM-2201 Varieties # Items , , , ,884 XLR-11 UR-144 AM-2201 OTHER PB JWH-122 MAM F-PB- 22AB- FUBINACA UR-144 JWH-210 JWH-122 JWH-081 JWH-018 SOURCE: DEA National Forensic Laboratory Information System, 2010, 2011, 2012, 2013 XLR-11 25

26 Comparison of Texas Poison Control and Treatment Cases: PCC-Syn. Cannabis Treatment- Syn Cannabis2013 PCC-Syn. Cathinone 2012*2013 % Male 76% 74% 74% Under Age 20 46% Age 23 14% Intended to Abuse 89% 88% Moderate Effect (returns to preexposure state) Major Effect (life threatening) 42% 47% 6% 12% Deaths 4 4 # Exposures

27 Characteristics of Synthetic Cannabis Users in Texas Drug Treatment 412 admitted to publicly-funded treatment in Texas in Average age 23; had been using the drug 2.5 years prior to treatment admission. 75% male; 52% white, 38% Hispanic, 6% black. Only 38% had no legal problem. 33% lived with family; 6% homeless. 8% employed full time; 45% unemployed. SOURCE: Texas DSHS monthly reports,

28 From the term Bath Salts to Synthetic Cathinones Mephedrone, methylone, 4- MEC, MDPV, Alpha-PVP Stimulants related to methcathinone, MDMA, amphetamines 2C Phenethylamine Psychedelics related to mescaline Some were created in the past to imitate MDMA Tryptamines 5-MeO-DMT & 4-AcO-DMT Psychedelics related to psilocin & bufotenin Piperazines BZP & TFMPP Stimulants And Dissociatives related to ketamine and PCP and Opioids related to morphine, fentanyl, and heroin. 28

29 Synthetic Cathinones Identified in U.S. METHYL ONE 10% MDPV. 53% OTHER 6% MEPHED RONE 32% NFLIS: Varieties # Items , , ,454 MDPV, 25% OTHER, 10% MEC, 8% METHYL ONE, 29% 2013 ALPHA- PVP, 22% PENTED RONE, 6% OTHER 24% METHY LONE 26%.MDPV 50% SOURCE: National Forensic Laboratory Information System, 2010, 2011, 2012, 2013 OTHER 13% ALPHA -PVP, 15% MDPV 7% METHYLONE, 65% 29

30 Phencyclidine PCP, Angel Dust, Killer Weed Dissolved in embalming fluid ( Fry, Amp, Water, Water ). Swallowed, sniffed, smoked on joints dipped in Fry. Out-of-body strength. Dissociative drug like DXM and ketamine; effects are similar to cathinones.

31 Glimpses of MDMA Situation in U.S.: Results of Pill Tests Containing MDMA* Any MDMA MDMA Only MDMA Items Identified in DEA s NFLIS Tox Labs: Mephedrone and methylone act on the brain like MDMA 0 MDMA Synthetic cathinones * bstance_by_year.php Baumann, M.H., et al. The designer methcathinone ana monoamine transporters in brain tissue. Neuron-psycho 31

32 New MDMA Warning Watch out for Molly! Molly initially referred to ecstasy pills with high quality MDMA powder. With MDAM shortage, now have more caffeine, meth, & methylone with little MDMA in them. European Monitoring Centre for Drugs and Drug Addiction issued warning in February 2014 that dangerously high levels of MDMA are appearing in Europe. MDMA tablets in the EU in 2012 contained mg of MDMA, but tablets containing 150 and 200 mg of MDMA are currently available and can contain even higher amounts, e.g. 240 mg.

33 2C Phenethylamines Phenethylamines (stimulant and hallucinogenic effects Bees, Nexus, etc.). Almost all of the 2C phenethylamines are produced in Asia, but some small labs in the US are capable of producing 2C (usually 2C-B). NFLIS Labs nationwide identified 193 reports of phenethylamines in 2010, 340 in 2011, 1097 in 2012, and 1876 in An analogue of 2C-B, 25I-NBOMe first became available online in 2010 with dosage units in micrograms rather than milligrams. SUPER DRUG! NFLIS Labs nationwide identified 10 reports of 2-C- NBOMe variations in 2011, 480 in 2012, and 1563 in 2013.

34 2C-C-NBOMe, 2C-I-NBOMe, Mescaline-NBOMe Analogs of the 2C-X family of phenethylamines Strongly active at the sub-milligram dose (a Super Potent drug) Most 25I and 25C is sold as pure powder, liquid, or blotter. Risk of confusing one white powder for another or simply misunderstanding the difference between one psychedelic or stimulant drug and another Obtained from China. NFLIS Labs nationwide identified 10 reports of 2-C-Nbome variations in 2011, 480 in 2012, and 1563 in Weighing and handling pure high-potency chemicals such as LSD or 25I-NBOMe should be performed wearing eye protection, gloves, and a filter mask SOURCES: Erowid, DEA s National Forensic Laboratory Information System, 2013 and EMCDDA s Joint Report

35 Changes in Psychoactive Substances Identified in Forensic Laboratories in US: Psilocin/Psilocybin Tryptamines Phenethylamines MDMA Synthetic cathinones SOURCE: National Forensic Laboratory Information System, 2010, 2011, 2012, 2013

36 Changes in Psychoactive Substances Identified in Forensic Laboratories in US: Psilocin/Psilocybin Phenethylamines Tryptamines Synthetic cathinones SOURCE: National Forensic Laboratory Information System, 2010, 2011, 2012, 2013

37 METHAMPHETAMINE Different Manufacturing Processes I. Ephedrine/Pseudoephedrine Based (d-form): (1% of samples tested) A. Nazi Method -lithium, anhydrous ammonia B. Cold method-red phosphorus, iodine crystals C. One Pot and Shake and Bake cooking using dry ammonia nitrite and cough syrup rather than liquid anhydrous ammonia. II. P2P/Phenylacetone (Illegal in US-Schedule II, precursors legal in Mexico) (l and d,l-forms): (95% of samples tested). If drug is 100% potent, it s all d-form. If 0% potent, is all l-form. Mexican chemists are refining their process to produce more potent P2P meth.

38 2004 3&4Q Q-10 3Q-10 1Q-11 3Q-11 1Q-12 3Q-12 1Q-13 3Q-13 1Q-14 DEA Methamphetamine Profiling Program: National Data stQ 2014 Production Routes P2P Phosphorus Iodine Purity and Potency Purity Potency 100% 80% 60% 40% 20% 0% 100% 80% 60% 40% 20% 0% Source: DEA 38 *

39 Price Per Pure Gram Purity in Percent All Methamphetamine Purchases Domestic STRIDE Data January 2007 June 2012 $350 $300 $250 $200 $150 $ $159 $ $289 $ $ $ $ $179 $189 $139$ $128$126 $112 $104 $98 $105 $93 $94 $86 $90 $ $50 $0 Jan- Mar07 Apr- Jun07 From July 2007 through June 2012, the price per pure gram of Methamphetamine decreased 72%, from $ to $81.29, while the purity increased 128%, from 41% to 93%. Jul- Sep07 Oct- Dec07 Jan- Mar08 Apr- Jun08 Jul- Sep08 Oct- Dec08 Jan- Mar09 Apr- Jun09 PPG_mean $158.9 $226.6 $288.6 $306.4 $244.7 $244.3 $199.4 $179.4 $188.7 $138.7 $140.2 $127.6 $126.3 $111.7 $104.3 $98.29 $104.6 $93.14 $93.71 $86.20 $ Purity_mean Potency_MPP Jul- Sep09 Oct- Dec09 Jan- Mar10 Apr- Jun10 Jul- Sep10 Oct- Dec10 Jan- Mar11 Apr- Jun11 Jul- Sep11 Oct- Dec11 Jan- Mar12 Apr- Jun

40 Local Reports on Meth Use Meth increasing in Maine one pot used to make meth and pills are back. Methamphetamine remains at very low levels in Boston, Chicago, Philadelphia, Boston, New York City and Baltimore. Street outreach workers in Corpus Christi, which has always been a heroin town, report for every story on local TV on heroin, there are 10 on meth and street outreach workers in Austin report more psychosis with the P2P meth, better highs, and some moving back to smoking Ice since it is available. Other outreach workers reported closed groups of MSM using GRINDR or Craig s List to meet sexual partners to use meth, which will increase the cases of syphilis as well as HIV. Conversion labs in Texas change liquid meth from Mexico to powder or Ice.

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42 Jane C. Maxwell, Ph.D. Senior Research Scientist Addiction Research Institute Center for Social Work Research The University of Texas at Austin 1717 West 6th, Suite 335 Austin, Texas