National Drug Early Warning System (NDEWS) Sentinel Community Site (SCS) Drug Use Patterns and Trends: SCE Narrative

Transcription

1 National Drug Early Warning System (NDEWS) Sentinel Community Site (SCS) Drug Use Patterns and Trends: SCE Narrative The SCE Narrative is written by the Sentinel Community Epidemiologist (SCE) and provides their interpretation of important findings and trends based on available national data as well as sources specific to their area, such as data from local medical examiners or poison control centers. As a local expert, the SCE is able to provide context to the national and local data presented. This SCE Narrative contains the following sections: SCS Highlights Changes in Legislation Substance Use Patterns and Trends Local Research Highlights (if available) Infectious Diseases Related to Substance Use (if available) The SCE Narratives for each of the 12 Sentinel Community Sites and detailed information about NDEWS can be found on the NDEWS website at NDEWS Maine SCS Drug Use Patterns and Trends,

2 National Drug Early Warning System (NDEWS) Maine Sentinel Community Site (SCS) Drug Use Patterns and Trends, 2016: SCE Narrative Marcella Sorg, Ph.D. Rural Drug and Alcohol Research Program University of Maine Highlights Benzodiazepines remain a key drug category involved in drug use and abuse. Although the proportion of deaths involving benzodiazepines as a cause of death declined from 34% to 29% in 2015, the percentage of impaired drivers testing positive for benzodiazepines in 2015 (38%) was similar to 2014 (39%). Cocaine/crack abuse indicators have risen sharply after a multiyear trough. The number of deaths involving cocaine rose from 24 in 2014 to 35 in 2015, a 46% increase, and the number of impaired drivers testing positive for cocaine rose from 22 to 51, a 132% increase. All of the heroin abuse indicators, including deaths, impaired driver toxicology tests, arrests, seizures, and treatment admissions, are very high and increasing dramatically, continuing an upward trend that began in Heroin was involved in 39% of 2015 deaths, 26% of impaired drivers, 39% of Maine State Drug Enforcement Agency (MDEA) arrests, 42% of law enforcement seizures, and 26% of primary admissions. Although arrests and primary admissions for marijuana are at fairly low levels, 4% and 7%, respectively, general use remains very high. The percentage of drug-impaired drivers with cannabis positive urine is 55% and has continued to rise. MDMA indicators are very low and appear to be stable. Methamphetamine indicators continue to show mixed trends at mostly low levels. There were 3 deaths in 2015, only 3% of impaired drivers with methamphetamine-positive urine, and the treatment admissions numbered only 47. Yet, the incidence of methamphetamine small lab incidents has been rising sharply over the last several years, going from 28 in 2014 to 56 in Early 2016 indicators suggest this number may double. NDEWS Maine SCS Drug Use Patterns and Trends,

3 Indicators of illicitly produced fentanyl and its analogues, remain very high and increased in 2015, contributing to 87 (32%) deaths, up dramatically from 38 (18%) deaths in 2014 and 10 (3%) in Illicitly produced fentanyl and its analogs were present in 22% of forensic laboratory items received in Pharmaceutical opioid indicators, primarily oxycodone and methadone, are stable or declining and constituted less than half of the total deaths, 41%, in The percentage of pharmaceutical opioid-positive urinalyses among impaired drivers declined substantially to 48% in 2015 for the first time since 2009 from a multiyear plateau of about 60%. The percentage of primary treatment admissions for pharmaceutical opioids continued a multiyear decline from 37% in 2012 to 24% in Synthetic cathinone abuse is at low levels and declining trends since 2011 and There was one death in Among law enforcement seizures, both the number and variety have decreased. For example, in 2014, there were 63 law enforcement items received representing 12 substances, but in 2015, there were 40 items representing 6 substances. Changes in Legislation In response to the new surge in drug overdoses and influx of heroin and fentanyl trafficking, funding was provided by the legislature for ten new agents, which was an increase of 33%. Participation in the Maine Prescription Monitoring Program, already mandatory in Maine, was tightened by automatically registering physicians in the program. Attention and collaborative work on the overdose epidemic was highlighted by the creation of the Statewide Opiate Collaborative, organized by the U.S. Attorney s office. This group completed its work with an interdisciplinary set of recommendations covering treatment, law enforcement, and harm reduction. Substance Use Patterns and Trends BENZODIAZEPINES Benzodiazepines remain a key drug category involved in drug use and abuse. Although the proportion of deaths involving benzodiazepines as a cause of death declined from 34% to 29% in 2015, the percentage of impaired drivers testing positive for benzodiazepines in 2015 (38%) was similar to 2014 (39%). NDEWS Maine SCS Drug Use Patterns and Trends,

4 Benzodiazepines were named as a cause of death, generally in combination with other drugs and/or alcohol, in 79 (29%) of drug-induced deaths in 2015, which was down from 70 (34%) in 2014 and 63 (36%) in The proportion of benzodiazepine-induced deaths likely had increased from 20% in 2012 in part because of the changing practice standards of medical examiners, who are now encouraged to name all potentially involved drugs on the death certificate. In 2015, benzodiazepines were found in (38%) of impaired driver toxicology tests, which is similar to the 2014 percentage (39%). In 2015, benzodiazepines were found in only 1% of law enforcement items, 1 and in 1% of Maine State Drug Enforcement Agency (MDEA) arrests, the latter a substantial decrease compared with the multiyear period when the percentage was approximately 17%. The number of primary benzodiazepine treatment admissions peaked at 121 in 2011, but they declined to 91 in In 2014, they declined further to 68 in 2014, representing less than 1% of all admissions. After a change in data systems, the number of admissions in 2015 was 57, again less than 1% of admissions. COCAINE Cocaine/crack abuse indicators have risen sharply after a multiyear trough. The number of deaths involving cocaine rose from 24 in 2014 to 35 in 2015, a 46% increase, and the number of impaired drivers testing positive for cocaine rose from 22 to 51, a 132% increase. Cocaine/crack abuse indicators have risen after a multiyear trough. Deaths from cocaine have risen from only 10 statewide in 2013, to 24 in 2014, and to 35 in 2015, the latter an increase of 46%. Nine percent of impaired drivers tested positive for cocaine in both 2013 and in 2014, more than doubling to 17% in Cocaine was found in 26% of law enforcement items received for testing at the State lab in 2015, which was an increase from 21% in The National Forensic Laboratory Information System (NFLIS) correspondingly reported that cocaine was identified in 24.9% of items in After rising sharply in 2013 along with heroin, the number of arrests remained stable in 2014, at 113, but increased sharply again in 2015 to 151. Proportions of primary treatment admissions for cocaine stayed stable at 3% from 2013 to The proportion of primary admissions citing a smoking route of administration decreased to 31% in 2015 from 62% in 2014, whereas inhalation increased from 20% in 2014 to 26% in 2015, and injection remained stable at 15% in both 2014 and MARIJUANA Although arrests and primary admissions for marijuana are at fairly low levels, 4% and 7%, respectively, general use remains very high. The percentage of drug-impaired drivers with cannabis positive urine is 55% and has continued to rise. Marijuana indicators continue to show mixed levels and trends. Arrests continued to decline reaching 6% in 2014 and 4% in The percentage of drug-impaired drivers with cannabinoid-positive urine has increased since 1 Beginning with the 2015 NDEWS report, we are reporting items tested in the year they were received, rather than in the year they were tested, if those years are different. All annual lab results going back to 2010 have been recalculated for the purpose of this report to represent the year received. This provides a more current picture of drug trafficking patterns. NDEWS Maine SCS Drug Use Patterns and Trends,

5 2010, reaching 52% in 2014 and 55% in NFLIS reported that 1.7% of 1,327 items tested in 2015 were positive for cannabis, ranking 10th among drug frequencies; the percentage of items received in 2015 in this analysis was the same. Primary marijuana treatment admissions declined slightly from 8% in 2014 to 7% in The age and gender distribution of primary treatment admissions for marijuana has also remained fairly stable; in 2015, it was 73% male, 24% younger than 18, and 35% 18 to 25 years of age. METHAMPHETAMINE Methamphetamine indicators continue to show mixed trends at mostly low levels. There were 3 deaths in 2015, only 3% of impaired drivers with methamphetamine-positive urine, and the treatment admissions numbered only 47. Yet, the incidence of methamphetamine small lab incidents has been rising sharply over the last several years, going from 28 in 2014 to 56 in Early 2016 indicators suggest this number may double. Methamphetamine indicators continue at low levels and show mixed trends. Three methamphetamine deaths were identified in Among 308 drug-impaired drivers tested in 2015, 8 (3%) had a methamphetaminepositive urinalyses. The MDEA responded to 56 clandestine, small lab incidents in 2015, up from 28 in 2014, 20 in 2013 and 12 in Law enforcement indicators show a continual increase since 2012 in items received, peaking at 73 (6%) in 2014, and declining to 50 (4%) in NFLIS similarly reported 5.5% of items tested as methamphetamine in MDEA arrests for methamphetamine manufacture, trafficking or possession have risen since There were a total of 85 (12%) in 2015, up from 28 (9%) in Treatment admissions have remained stable at low levels. The number of primary methamphetamine treatment admissions plateaued in the 40s from 2010 to In 2014, the number of primary methamphetamine admissions increased to 68 but dropped to 47 in MDMA NEW PYSCHOACTIVE SUBSTANCES (OTHER THAN OPIOIDS) MDMA indicators are very low and appear to be stable. Synthetic cathinone abuse is at low levels and declining trends since 2011 and There was one death in Among law enforcement seizures, both the number and variety have decreased. For example, in 2014, there were 63 law enforcement items received representing 12 substances, but in 2015, there were 40 items representing 6 substances. MDMA indicators are very low in number. There were no MDMA or MDA deaths in Two impaired drivers out of 308 had an MDMA/MDA-positive toxicology in NFLIS reported only 3 law enforcement items tested positive for MDMA in 2015, 0.2%. There were only 18 primary MDMA treatment admissions in 2015, up slightly from 5 the year before. Synthetic Cathinones Synthetic cathinone abuse is now at low levels and shows mixed trends, having declined somewhat since 2011 and Cathinones were involved in 9% of drug arrests in 2013, 8% in 2014, and 5% in Among law enforcement seizures received for testing, the number and variety of different compounds has NDEWS Maine SCS Drug Use Patterns and Trends,

6 decreased from 63 items representing 12 substances in 2014 to 40 items representing 6 substances in 2015: Alpha-PVP (alpha-pyrrolidinopentiophenone) was the most frequently found (n = 23), followed by bk-mdea (n = 8), alpha-php (n = 4), PV8 (n = 3), and 4-fluoro-alpha-PVP and TH-PVP (each n = 1). Among 2015 treatment admissions, 26 were for a primary problem of bath salts, also described as other stimulants and other amphetamines. One death was attributed to alpha-pvp. Heroin OPIOIDS All of the heroin abuse indicators, including deaths, impaired driver toxicology tests, arrests, seizures, and treatment admissions, are very high and increasing dramatically, continuing an upward trend that began in Heroin was involved in 39% of 2015 deaths, 26% of impaired drivers, 39% of Maine State Drug Enforcement Agency (MDEA) arrests, 42% of law enforcement seizures, and 26% of primary admissions. Indicators of illicitly produced fentanyl and its analogues, remain very high and increased in 2015, contributing to 87 (32%) deaths, up dramatically from 38 (18%) deaths in 2014 and 10 (3%) in Illicitly produced fentanyl and its analogs were present in 22% of forensic laboratory items received in Pharmaceutical opioid indicators, primarily oxycodone and methadone, are stable or declining and constituted less than half of the total deaths, 41%, in The percentage of pharmaceutical opioidpositive urinalyses among impaired drivers declined substantially to 48% in 2015 for the first time since 2009 from a multiyear plateau of about 60%. The percentage of primary treatment admissions for pharmaceutical opioids continued a multiyear decline from 37% in 2012 to 24% in Heroin/morphine abuse indicators increased rather dramatically beginning in 2012 and Deaths from heroin/morphine, alone or in combination with other drugs or alcohol, decreased to 4% during 2010 and 2011 but then rose sharply starting in 2012, and doubled in 2015, now constituting 39% of deaths. Approximately one year after the upsurge in heroin deaths, an associated outbreak of deaths from non-pharmaceutical fentanyl occurred. Presumed heroin deaths are identified methodologically, including cases with literal mentions of heroin or heroin/morphine on the death certificate along with an evaluation of data from the scene and the prescription monitoring program that rules out known pharmaceuticals. Non-pharmaceutical fentanyl deaths are identified using the same approach; fentanyl analogs are combined with the overall total of non-pharmaceutical fentanyl deaths and subtotaled. Heroin/morphine-positive impaired driver urinalysis toxicology tests rose sharply from 8% in 2009 to 21% (n = 247) during 2014 and then to 26% (n = 308) in Of the 80 drivers who tested positive for heroin/morphine, 12 (15%) also tested positive for fentanyl and 18 (23%) for cocaine; 7 (9%) tested positive for both. Heroin arrests by the MDEA began increasing in 2011, and during 2015, they constituted 39% of arrests, compared with the 5% low in Arrestees are frequently from New York City and are often connected to street gangs. NFLIS reported that 32.8% of law enforcement 1,327 items tested in 2015 were positive for heroin, making it number one among all drug frequencies. We examined the percentage of law enforcement items NDEWS Maine SCS Drug Use Patterns and Trends,

7 received in , but were tested in 2015 or 2016, which was 29.6%. Of the 1,172 items received, 3.1% were positive for both heroin and fentanyl and 1.6% for heroin and acetyl fentanyl. A total of 1.5% of items were positive for both heroin and cocaine. Primary heroin admissions rose from 6% in 2010 to 22% in 2014 and to 27% in Males (56%) outnumbered females (44%) in 2015 heroin admissions, with the age group comprising 72%, which was up slightly from 67% in Other Opioids Indicators for illicitly produced fentanyl and its analogues remain very high in 2015, contributing to 87 (32%) of Maine s drug-induced deaths, up dramatically from 38 (18%) deaths in 2014 and 10 (3%) deaths in Fentanyl was known to be pharmaceutical in 6 cases in 2015, which were excluded from the number presumed to be non-pharmaceutical. Pharmaceutical opioid-induced deaths totaled 112 (41% of drug overdoses), excluding those presumed to be from non-pharmaceutical fentanyl. Among the pharmaceutical opioid deaths, the most frequent remain from oxycodone, 37 (14%), and methadone, 38 (also 14%). The WONDER data adapted for NDEWS, which extended from 2010 to 2014, differ from the data reported here in several ways. First, the medical examiner-based data include all occurrent deaths, that is, those deaths that occur in the state, whether or not the decedent was a resident; the WONDER data include all resident deaths only. Second, the medical examiner data as reported in this profile expand on the literal death certificate methodologically. In this analysis, pharmaceutical is segregated from non-pharmaceutical drugs, which affected the subtotals for fentanyl and heroin. For example, in cases where the literal cause of death is heroin/morphine, known pharmaceutical morphine has been segregated out and scene investigation data have been used to allow a presumption of heroin. In addition, although Maine medical examiners infrequently use the terms polydrug or multiple drug toxicity as a cause, without mentioning a specific drug, toxicology and autopsy data have been used here to specify the presumptive drugs involved. Thus, the data in this profile extend the literal death certificate data methodologically to enable a finer grained report of drug abuse trends. The percentage of pharmaceutical opioid-positive urinalyses among impaired drivers declined substantially in 2015 for the first time since They had been plateaued at 57% to 60% during the period and dropped to 48% in Heroin/morphine, by contrast, continued a steady increase, rising from 8% in 2009 to 26% in Pharmaceutical and illicitly produced opioids, including all forms of fentanyl, were present in 274 (22%) of forensic laboratory items received in A total of 84 (10%) were positive for fentanyl, 43 (5%) positive for acetyl fentanyl, and 14 (2%) positive for both fentanyl and acetyl fentanyl. No other fentanyl analogs were identified in 2015, and no fentanyl patches were included. Other opioids received in 2015 included 4 (0.5%) hydrocodone, 6 (0.7%) methadone, 32 (4%) buprenorphine, and 36 oxycodone. NFLIS reported that 6.9% of items received in 2015 were fentanyl, 3.9% were acetyl fentanyl, 0.4% were methadone, 0.3% hydrocodone, 2 Fentanyl patches were excluded. All items in which no drugs were found, or in which they were not ultimately tested, were removed from the denominator. NDEWS Maine SCS Drug Use Patterns and Trends,

8 0.2% hydromorphone, and 0.2% morphine. As some of these items may have contained more than one drug, they cannot be summed. The percentage of primary treatment admissions for pharmaceutical opioids rose every year for more than a decade to a peak of 37% in 2012, and they subsequently declined to 29% in 2014 and 24% in During this same time, heroin admissions remained rather stable at about 7% to 9% through 2011 and then rose to 15% in 2013, 22% in 2014, and 27% in The most common route of administration for admissions with a primary problem of pharmaceutical opioids was inhalation (41% in 2015); 19% were injecting, which was the same percentage as in Analysis of the age structure for opioid treatment admissions demonstrates that the year-old cohort has declined slightly from 22% in 2013 to 19% in 2014 and to 14% in Primary oxycodone treatment admissions constituted the most frequent single drug of the non-heroin opiate/opioid admissions, representing 48% in 2015, which was down slightly from 52% in Infectious Diseases Related to Substance Use There were 48 new HIV infections reported in 2015, which was a decrease from 58 in This represents a rate of 3.6 per 100,000 for From 2010 to 2015, 49% of new infections were attributable to male-to-male sexual contact, 4% to intravenous drug use, and 1% to male-to-male sexual contact and intravenous drug use. From 2011 to 2014, the age group made up the largest percentage of new infections; however, that fell from a high of 50% in 2011 to 33% in 2014, with a compensatory rise observed in the age group, which increased from 4% in 2011 to 16% in In 2015, though, the and age groups both made up the largest percentage of new infections at 27% each, with the age group declining slightly to 15%. There were 9 cases of acute hepatitis B in Maine during 2015, with a rate of 0.7 cases per 100,000, compared with 12 cases in There were 107 cases of probable and confirmed cases of chronic hepatitis B in 2015, with a rate of 8.1 cases per 100,000, compared with 108 cases in In 2015, the most reported risk factor for acute infection was drug use (injection 44%; noninjection 56%). There were 30 cases of acute hepatitis C in Maine during 2015, with a rate of 2.3 per 100,000. This represents a tripling of the rate from 2013 when there were 0.7 cases per 100,000. Maine has the fifth highest rate of acute hepatitis C nationwide. In 2015, there were 91 confirmed cases of chronic hepatitis C. A large spike in the number new infections in individuals younger than 30 years of age was also observed. Of 20 cases that were contacted for detailed follow-up, 15 reported use of street drugs and 11 reported intravenous drug use. NDEWS Maine SCS Drug Use Patterns and Trends,

9 Exhibits Exhibit 1. Number of Primary Admissions for Key Drugs, CY Cocaine Heroin/Morphine 1, ,058 1,386 2,035 2,691 2,780 Other Opiates 4,185 4,372 4,409 4,698 4,509 3,468 2,555 Marijuana 1,303 1,275 1,179 1,113 1, Methamphetamine Alcohol 6,481 5,904 4,726 4,473 4,453 4,068 3,583 Benzodiazepines n/a n/a n/a n/a n/a n/a 57 MDMA n/a n/a n/a n/a n/a n/a 18 Synthetic Stimulants n/a n/a n/a n/a n/a n/a 26 Synthetic Cannabinoids n/a n/a n/a n/a n/a n/a 6 Other Total Admissions 14,498 13,576 12,510 12,868 13,290 11,615 10,500 Source: Maine Office Substance Abuse and Mental Health Services NDEWS Maine SCS Drug Use Patterns and Trends,

10 Exhibit 2. Number of Arrests by the Maine Drug Enforcement Agency for Key Drug Categories, CY Cocaine/Crack Heroin Methamphetamine Marijuana Pharmaceuticals Benzodiazepines Total Arrests Source: Maine Drug Enforcement Agency NOTE: Individual drug category totals do not sum to the total number arrests because not all drug categories are included in this table. NDEWS Maine SCS Drug Use Patterns and Trends,

11 Exhibit 3. Percent of Items Seized by Law Enforcement Statewide Testing for Key Drug Categories Identified by the Maine State Health and Environmental Testing Laboratory, CY (n = 811) (n = 995) (n = 999) (n = 1,128) (n = 974) (n = 826) Cocaine Pharmaceutical Opiates* Heroin Fentanyl Powder and residues & Acetyl Fentanyl (excludes fentanyl patches) Marijuana Benzodiazepines Source: Maine Health and Environmental Testing Laboratory *Includes items with fentanyl patches, powder, or residue but not acetyl fentanyl. NDEWS Maine SCS Drug Use Patterns and Trends,

12 Exhibit 4. Number of Deaths Caused by Key Illicit Drugs Alone or in Combination with Other Drugs, CY * Heroin/Morphine Fentanyl Cocaine Methamphetamine *Deaths from known pharmaceutical products of morphine, and fentanyl have been removed from these totals. Deaths attributed to amphetamine, a possible methamphetamine metabolite, have been excluded from the methamphetamine totals, pending a reanalysis to rule out a pharmaceutical source in those cases. Source: Maine Office of Chief Medical Examiner NDEWS Maine SCS Drug Use Patterns and Trends,

13 Exhibit 5. Number of Deaths Caused by Key Pharmaceutical Opioids Alone or in Combination with Other Drugs, CY Pharmaceutical Morphine* Pharmaceutical Fentanyl** Oxycodone Methadone **Only known prescription sources are included. Source: Maine Office of Chief Medical Examiner NDEWS Maine SCS Drug Use Patterns and Trends,

14 Exhibit 6. Pharmaceutical Status of Fentanyl in CY Fentanyl-induced Deaths Fentanyl: no patch or known Rx Fentanyl: patch or Rx was identified Source: Maine Office of Chief Medical Examiner NDEWS Maine SCS Drug Use Patterns and Trends,

15 Exhibit 7. Percentage of Urine Tests of Impaired Drivers Testing Positive for Key Drugs, CY % 60% 50% 40% 30% 20% 10% 0% THC Cocaine Heroin/Morph ine One or more BZD One or more Rx Opioid % 7% 8% 40% 59% % 8% 9% 40% 59% % 9% 12% 45% 59% % 12% 11% 60% 60% % 9% 15% 40% 58% % 9% 21% 39% 57% % 17% 26% 38% 48% Source: Maine State Health and Environmental Testing Laboratory NDEWS Maine SCS Drug Use Patterns and Trends,

16 Exhibit 8. Percentage of Primary Treatment Admissions for Heroin/Morphine and for Pharmaceutical Opiates, CY % 35% 30% 25% 20% 15% 10% 5% 0% Heroin/Morphine 4% 6% 8% 7% 8% 8% 8% 7% 8% 9% 7% 8% 11% 15% 23% 27% Opiates 6% 9% 10% 11% 13% 18% 19% 22% 27% 29% 32% 35% 37% 34% 29% 24% Source: Maine Office Substance Abuse and Mental Health Services NDEWS Maine SCS Drug Use Patterns and Trends,

17 Data Sources Data for this report were drawn from the following sources: Treatment admissions data were provided by the Maine Center for Disease Control and include all admissions to programs receiving State funding. This report includes all 2015 treatment admissions, including admissions for methadone clinics, and makes comparisons with prior calendar years. In March of 2015, data were migrated to a new information system; the migrated data are still being validated, and caution is urged comparing 2015 with prior years. Totals include alcohol admissions (Exhibits 1 and 8). Mortality data were generated by analysis of State of Maine Office of Chief Medical Examiner case files for all drug-induced cases through December That office investigates all drug-related cases statewide (Exhibits 4, 5, and 6). Arrest data were provided by the Maine State Drug Enforcement Agency (MDEA), which directs eight multijurisdictional task forces covering the entire State, generating approximately 60% of all Uniform Crime Report (UCR) drug arrests statewide. Data totals include arrests for possession or trafficking, extending through the end of 2015 (Exhibit 2). Forensic laboratory data on drug seizures were provided by the Maine State Health and Environmental Testing Laboratory, which tests all samples of drugs seized by the MDEA, as well as by other police and sheriff departments. Data were updated for 2010 to 2015 changing from date tested to date received. Data were provided for 2015 (Exhibit 3). Forensic laboratory data on urinalyses of drug-impaired drivers were provided by the Maine State Health and Environmental Testing Laboratory, which tests urine samples of drivers suspected of driving under the influence of drugs. Data were provided for 2015 (Exhibit 7). Infections Disease Related to Drug Abuse. Data were provided by the MAINE Center for Disease Control for HIV/AIDS, Hepatitis B and Hepatitis C. For additional information about the drugs and drug use patterns discussed in this report, please contact Marcella H. Sorg, Ph.D., R.N., D-ABFA, Director, Rural Drug and Alcohol Research Program, Margaret Chase Smith Policy Center, University of Maine, Building 4, 5784 York Complex, Orono, ME 04469, Phone: , mhsorg@maine.edu. NDEWS Maine SCS Drug Use Patterns and Trends,