DRUG ABUSE TRENDS MINNEAPOLIS/ST. PAUL. December Carol Falkowski Director of Research Communications BUTLER CENTER FOR RESEARCH

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1 H A Z E L D E N F O U N D A T I O N DRUG ABUSE TRENDS BUTLER CENTER FOR RESEARCH MINNEAPOLIS/ST. PAUL December 2005 Carol Falkowski Director of Research Communications P.O. BOX 11 CENTER CITY, MN (800) FAX (651) butlerresearch@hazelden.org WEBSITE:

2 ABSTRACT Throughout 2005 the consequences of methamphetamine (meth) abuse in the Twin Cities captured headlines, filled the airwaves, and strained public health, treatment, child welfare, and criminal justice systems. At the same time, other drugs exhibited mixed patterns, including a significant increase in heroin in Minneapolis, a continued prevalence of cocaine in hospital emergency departments, and a sustained decline in club drugs. An unprecedented 12.1 percent of patients entering Twin Cities addiction treatment programs in 2005 (first half) reported meth as the primary substance problem, a level that for the first time closely approached that of cocaine (13.4 percent). While the number of small-time meth labs declined (largely attributed to a new State law limiting retail sales of pseudoephedrine products), the purity level of meth increased significantly. In Minneapolis the overall weight-based purity of meth seized by law enforcement was 73.1 percent in 2005, compared with 13.6 percent in Meth-related deaths appeared stable from 2004 to Heroin appeared in Minneapolis in 2005 in record high amounts -- all of it black tar heroin of Mexican origin. Opiate-related deaths continued at heightened levels, while treatment admissions rose to 5.2 percent of admissions in 2005, up from 3.1 percent in At hospital emergency departments, cocaine-related visits outnumbered those involving any other illicit drug in 2005 (first half), continuing a long-standing trend. At addiction treatment programs more patients reported marijuana as the primary substance problem than any other illicit drug (19 percent) in 2005, also continuing a long-standing trend. Indicators regarding the abuse of club drugs (GHB, MDMA, Ketamine, LSD) showed downward trends in The rate of alcohol consumption and binge drinking in Minnesota was among the highest in the nation in Alcohol abuse exacted a costly toll among young people and on the highways, although alcoholrelated treatment admissions fell to 45.2 percent of total admissions in 2005, down from 54.6 percent in Tobacco use among youth declined in the Twin Cities and statewide in 2004 and 2005, but remained prevalent among patients in addiction treatment programs. INTRODUCTION This report is produced twice annually for participation in the Community Epidemiology Work Group of the National Institute on Drug Abuse, an epidemiological surveillance network comprised of researchers from 21 U.S. areas who monitor emerging patterns and trends in drug abuse. It is available online at: AREA DESCRIPTION The Minneapolis/St. Paul, Twin Cities, metropolitan area includes Minnesota s largest city, Minneapolis and Hennepin County, the capital city of St. Paul and Ramsey County, and the surrounding counties of Anoka, Dakota, and Washington. Recent estimates of the population of each county are as follows: Anoka ,197; Dakota ,462; Hennepin -- 1,239,837; Ramsey ,274; and Washington ,395; for a total of 2,557,165, or roughly half of the Minnesota State population. In the five-county metropolitan area, 84 percent of the population is White. African- Americans constitute the largest minority group in Hennepin County, while Asians are the largest minority group in Ramsey, Anoka, Dakota, and Washington Counties. St. Paul has the largest Hmong population of any U.S. city. Outside of the Twin Cities area, the State is less densely populated and more rural in character. Minnesota shares an international border with Canada, a southern border with Iowa, an eastern border with Wisconsin, and a western border with North Dakota and South Dakota, two of the country s most sparsely populated States. Illicit drugs are sold and distributed within Minnesota by Mexican drug trafficking organizations, street gangs, independent entrepreneurs, and other criminal groups. Drugs are typically shipped or transported into the Minneapolis/St. Paul metropolitan area for further distribution throughout the state. 1

3 DATA SOURCES Data for this report were obtained from the following sources: Treatment data are from addiction treatment programs (residential, outpatient, extended care) in the five-county metropolitan area as reported on the Drug and Alcohol Abuse Normative Evaluation System (DAANES) of the Minnesota Department of Human Services (through June 2005). Hospital emergency department (ED) data are from the Drug Abuse Warning Network (DAWN) Live!, a newly revised system administered by the Office of Applied Studies of the Substance Abuse and Mental Health Services Administration. Data derived from DAWN Live! represent drug reports in drug-related emergency department (ED) visits. A patient may report the use of multiple drugs (up to six) and alcohol. Since its 2003 redesign, DAWN data are no longer weighted, and thus may not be used as population-based estimates for the reporting area. These DAWN Live! data cannot be compared to DAWN data from 2002 and before. A full description of DAWN is online at: Data from participating hospital emergency departments in the Minneapolis and St. Paul Standard Metropolitan Statistical Area are from drug-related visits that occurred between 1/1/2005 and 6/30/2005. There are 28 eligible hospitals in the area, with 26 in the DAWN sample, of which 11 to 13 participate. All but one hospital submitted data that were over 90 percent complete. All DAWN cases are reviewed for quality control and based on this review, may be corrected or deleted, and are therefore subject to change. The Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA) prepared these data on 12/6 and 12/7/2005. Mortality data on drug-related deaths are from the Hennepin County Medical Examiner and the Ramsey County Medical Examiner (through September 2005). Hennepin County cases include those in which drug toxicity was the immediate cause of death and those in which the recent use of a drug was listed as a significant condition contributing to the death. Ramsey County cases include those in which drug toxicity was the immediate cause of death and those in which drugs were present at the time of death. Crime lab data are from: 1) the National Forensic Laboratory Information System (NFLIS), sponsored by the U.S. Drug Enforcement Administration, 2) the St. Paul Police crime lab, and 3) the Minneapolis Department of Health and Family Support crime lab (through October 2005). NFLIS reports solid dosage drug analyses conducted by state and local forensic laboratories across the country on drugs seized by law enforcement. During their present reporting period (10/1/2004 through 9/30/2005) only one Minnesota lab participated, the Bureau of Criminal Apprehension crime lab, which predominantly handles cases from the non-metro areas of the State and is located in St. Paul. Alcohol and tobacco survey data are from the Behavioral Risk Factor Surveillance System (BRFSS), an ongoing data collection program of the Centers for Disease Control and Prevention (CDC) and U.S. states and territories. Supported by CDC's Behavioral Surveillance Branch, it is designed to measure behavioral risk factors in the adult population (18 years of age or older) living in households. BRFSS field operations are managed by state health departments, that transmit the data to the CDC's National Center for Chronic Disease Prevention and Health Promotion's Behavioral Surveillance Branch data for Minnesota are based on 4,460 respondents age 18 and older. Summary reports of state-specific data are prepared by CDC and are online at: Student survey data on selected drugs of abuse are from the 2001 and the 2004 Minnesota Student Survey. Responses concerning drug use in the past year are presented for high school seniors in the metro area, representing 14,140 respondents in 2001 and 16,156 in DWI (driving while intoxicated) and traffic fatality data (2004) are from the Office of Traffic Safety, Minnesota Department of Public Safety, online at: ww.dps.state.mn.us. Youth tobacco data and tobacco-related cost data are from the Minnesota Department of Health, online at: Additional data on the consequences of meth across various public systems in the State are from the Minnesota Bureau of Criminal Apprehension and the Minnesota Department of Public Safety, Human Immunodeficiency Virus (HIV) data for 2004 are from the Minnesota Department of Health, HIV/AIDS in Minnesota: Annual Review, online at: Additional information is from interviews with treatment program staff, health officials, narcotics agents, corrections and law enforcement officials, crime lab specialists, and school-based drug/alcohol abuse counselors (conducted in November and December 2005). 2

4 DRUG ABUSE PATTERNS AND TRENDS COCAINE/CRACK Admissions to addiction treatment programs with cocaine as the primary substance problem were stable in 2005 (first half), accounting for 13.4 percent of total treatment admissions, compared with 13.3 percent in 2004, and 13.5 percent in Most cocaine admissions were for crack cocaine. Regarding race/ethnicity, 48 percent were African- American, 42.8 percent were White, 4.6 percent were Hispanic, 2.4 percent were American Indian, and 0.6 percent were Asian. The vast majority (86.7 percent) were age 26 and older. The average age of first cocaine use was 25.1 years. See Exhibit 1. Cocaine-involved visits dominated drug-related hospital emergency department (ED) data, and outnumbered visits for any other illicit drug in 2005 (first half). See Exhibit 2. Of the 1,532 reports, onethird (34.5 percent) were women (Exhibit 3). Half (52.8 percent) were age 25 through 34, and only 4.2 percent were under age 18 (Exhibit 4). Half (49.7 percent) were African-American, 46.8 percent were White, and 3.5 percent were Hispanic (Exhibit 5). Accidental overdose deaths involving cocaine in both Hennepin and Ramsey County appear stable. Hennepin County reported 36 in 2005 (through September) compared with 39 in 2004 (entire year). This includes a newborn where maternal use of cocaine was listed as a significant contributing condition. Ramsey County reported eight in 2005 (through September) compared with 10 in 2004 (entire year). Cocaine accounted for 27.3 percent of the drug seizures reported to NFLIS (Exhibit 6). Prices were $100 per gram, $800 to $1,200 per ounce, and up to $22,000 per kilogram. The price of a rock of crack was unchanged at $10 to $20. Upward variations in price were attributed to higher purity products. Gangs in both cities were involved in the street-level retail distribution of crack cocaine. According to the Minnesota Student Survey data, past year cocaine use was reported by 6.1 percent of metropolitan area high school seniors in 2004, compared with 5.5 percent in In one Twin Cities suburb, several middle school students were hospitalized in December after drinking a liquid that contained a high concentration of cocaine. HEROIN Heroin-related admissions to addiction treatment programs accounted for 5.2 percent of total admissions in 2005 (first half), compared with 3.3 percent in 2004 and 3.1 in But because the five private, for-profit methadone programs (that serve roughly 1,600 patients in the metro area) do not report to the Drug and Alcohol Abuse Normative Evaluation System (DAANES), these figures do not accurately reflect the total number of patients receiving treatment for heroin/opiate addiction in the Twin Cities. Like those receiving treatment for cocaine, patients treated for heroin addiction tended to be older with almost none (0.2 percent) under age 18, 62.5 percent over age 35, and 22.6 percent age (Exhibit 1). The most common route of administration was injection (61.8 percent), followed by sniffing (35.8 percent) and smoking, also known as foiling (2.6 percent). Most patients had prior treatment experience, with only 12 percent reporting their first treatment episode in Heroin was involved in 376 emergency department incidents in 2005 (first half), ranking sixth behind cocaine, marijuana, methamphetamine, underage drinking and prescription opiates. Of these reports, two-thirds (65.4 percent) were males. Over half (54.8 percent) involved people age 35 and older, and a scant 0.7 percent were under the age of 18. Of those with known race/ethnicity, 59.5 percent were White, 38.9 percent were African-American, and 1.5 percent were Hispanic. Opiate-related deaths, mostly accidental heroin overdoses, continued at heightened levels, and outnumbered cocaine-related deaths in both counties since Hennepin County reported 47 opiaterelated deaths in 2004, and 46 in 2005 (through September). Of these, seven involved fentanyl, seven methadone, and two oxycodone. Ramsey County reported 25 in 2004 and 19 in 2005 (through September). Of these, seven involved methadone and two oxycodone. Law enforcement seizures of black tar heroin increased substantially in Minneapolis from 76 grams of heroin at the Minneapolis lab in 2004, to 1,538 grams in a twenty-fold increase. Purity levels ranged from 19.6 up to 86.8 percent. In 2004 all of the heroin seized in Minneapolis was white, off-white, or tan powder, whereas in 2005, all of it was black tar heroin of Mexican origin. Similar patterns did not occur in Ramsey County. Retail heroin prices remained at $20 to $40 per dosage unit or paper, $300 to $400 per gram, and $2,500 per ounce. OTHER OPIATES/NARCOTICS Prescription narcotic analgesics, used medically in the treatment of pain, are also abused nonmedically for 3

5 the euphoric, heroin-like effects. Of particular concern are prescription medications containing oxycodone: Percodan, Percocet, and the long-acting OxyContin. In 2005 (first half), 420 ED reports involved prescription opiod abuse. In May 2005, a 17-year-old suburban boy died from an apparent accidental overdose of OxyContin. Within the Hmong immigrant population, a small proportion regularly smokes opium. Packages concealing opium continue to be shipped from Asia to residents of the Twin Cities Hmong community. In January 2005, 30 pounds of opium, with a reported street value of $1.3 million, was seized as it was delivered to a suburban Woodbury couple. METHAMPHETAMINE/OTHER STIMULANTS The consequences attributable to methamphetamine (meth) abuse, distribution, and manufacture have been considerable in the Twin Cities and the entire State of Minnesota in recent years (Exhibit 7). The Minnesota Department of Public Safety estimates the annual statewide public cost attributable to methamphetamine in Minnesota in 2004 at $130 million. This includes law enforcement, adult prosecution, adult corrections, environmental cleanup, treatment, and child welfare costs. Excluded in this estimate are the costs of related crime, health care, treatment for insured and private pay patients, and juvenile offenders. According to the Minnesota Department of Corrections, meth offenders accounted for 51.7 percent of all drug offenders in State prisons in 2005, compared with 20 percent in Legislative efforts concerning the sale of over-thecounter cold preparations that contain pseudoephedrine, a nasal decongestant used in the manufacture of methamphetamine, resulted in a new State law effective 7/1/2005, that mandates: 1) pseudoephedrine pills must be sold from behind pharmacy counters, 2) sales are limited to people age 18 and older, who must show identification and sign a log, and 3) sales are limited to six grams (about two packages) every 30 days. There are also new criminal penalties, clean-up and notification requirements, child endangerment and vulnerable adult provisions, treatment grants to counties, and 10 new State law enforcement agents. According to Minnesota Governor Tim Pawlenty, the number of meth labs significantly declined since the law took effect. Comparing the third quarter of 2005 with the third quarter of 2004 he reported: 1) a 78 percent decrease in meth labs seized, 2) a 75 percent reduction in arrests for meth manufacture, and 3) a 66 percent reduction in the amount of meth seized. Meth-related treatment admissions continued to climb to an unprecedented, record-high of 12.1 percent of treatment admissions in 2005 (first half), compared with 10 percent in 2004 and only three percent in Of these slightly more than one-third were women (35.7 percent), and the vast majority (90.1 percent) were White. Smoking was the most common route of administration (67.1 percent) followed by sniffing (14.9 percent) and injecting (13.8 percent). Almost 40 percent were between 18 and 25 years of age, and 11.5 percent were age 17 and younger. The average age of first meth use was 20.5 years. Hospital ED visits involving methamphetamine totaled 673 in 2005 (first half). Women accounted for 42 percent, and of those with known race/ethnicity almost all (93.6 percent) were White, 4.3 percent were African-American, and two percent were Hispanic. Roughly half were patients under age 25 (Exhibit 4). Hennepin County reported six accidental overdose deaths involving methamphetamine in 2005 (through September) compared with 11 in 2004 (entire year). This count excludes eight MDMA cases in 2004 and three in Ramsey County reported four methamphetamine-related deaths in 2005 (through September) compared with 10 in 2004 (entire year). Methamphetamine remained a major focus of law enforcement at all levels in both metropolitan and non-metropolitan areas of the State. Seizures of methamphetamine by law enforcement accounted for 51.5 percent of the total samples reported to NFLIS. See Exhibit 6. The most notable trend in Minneapolis was the dramatic increase in methamphetamine purity levels. Almost all of the samples in 2005 were high purity crystal meth, compared with the lower quality, largely homemade meth of several years ago. The overall weight-based purity level of methamphetamine analyzed at the Minneapolis lab in 2005 was 73.1 percent, which compares with 57.8 percent in 2004, 26.9 percent in 2003, 18.3 percent in 2002, and 13.6 percent in According to law enforcement sources, this heightened purity reflects both an increase in the supply of imported vs. locally manufactured product, and in the capacity of law enforcement to intercept the supply higher up the distribution chain before it is diluted and adulterated for retail sale. Meth prices ranged from $70 to $100 per gram, $900 to $1,000 per ounce, and $10,000 to $14,000 per pound. Past year meth use was reported by five percent of metropolitan area high school seniors in 2004, compared with 5.7 percent in 2001, according to the Minnesota Student Survey. 4

6 Methylphenidate (Ritalin), a prescription drug used in the treatment of attention deficit hyperactive disorder, is also used nonmedically to increase alertness and suppress appetite. The pills, sometimes known as hyper pills, or homework pills, are crushed, snorted, or ingested orally. They sold for $5 per pill or were simply shared with fellow students at middle schools and high schools. MARIJUANA Again in 2005, more people entered addiction treatment programs for marijuana than for any other illicit drug (Exhibit 1). Almost one out of five patients in addiction treatment programs (19.0 percent) reported marijuana as the primary substance problem, compared with 19.9 percent in 2004 and 21.2 percent in Of these, 42.9 percent were age 17 or younger, 33.3 percent were 18-25, and only 10.7 percent were 35 or older. For many (43.2 percent) it was their first treatment episode. The average age of first marijuana use was 13.8 years. There were 1,390 marijuana-involved hospital ED reports in 2005 (first half), ranking second only to cocaine. Most were White (72.9 percent), and over half (55.8 percent) were under the age of 25. In December 2005, Washington County law enforcement arrested four suspects involved with a large-scale indoor marijuana growing operation involving 2,100 plants in three homes in suburban St. Paul Park. Another incident involved a Minneapolis teen who pleaded guilty in December to aiding and abetting second-degree murder of an 18-year-old boy during the trade of an AK-47 rifle for marijuana in Marijuana accounted for 9.9 percent of drugs seized, according to NFLIS data. Marijuana sold for $5 per joint and was readily available. Standard, commercial grade marijuana sold for $50 per quarter ounce, $150 to $175 per ounce, and $1,200 per pound. The more potent BC Bud sold for up to $100 per quarter ounce, $600 per ounce, and $5,000 per pound. Past year marijuana use was reported by 30.2 percent of metropolitan high school seniors in 2004, compared with 33.9 percent in CLUB DRUGS In ,4 methylenedioxymethamphetamine (MDMA), known as ecstasy, X, or e, contributed to the deaths of eight young males in Hennepin County, compared with three in 2005 (through September). In 2005 (first half), 74 hospital ED visits involved MDMA (Exhibit 2). MDMA use declined markedly among metropolitan area students in 2004, according to the Minnesota Student Survey. Past year MDMA use was reported by 4.5 percent of high school seniors in 2004, down from 9.1 percent in It sold for $20 per pill. Gamma hydroxybutyrate (GHB), known as "G, Liquid E, or Liquid X, is a concentrated liquid abused for its stupor-like depressant effects and as a predatory knock-out, drug-facilitated rape drug. There were seven hospital ED reports of GHB in 2005 (first half). It sold for $10 per capful. Ketamine, also known as Special K, is a veterinary anesthetic that first appeared as a drug of abuse among young people in Minnesota in 1997, with two ED reports in 2005 (first half). It is snorted, injected, or put into capsules or pills and produces strong, dissociative effects. HALLUCINOGENS Salvia Divinorum, a sage plant also known as diviner s sage, can be smoked, chewed, or brewed in tea. Some high school students consume it at school by placing the leaves in their lunchtime beverages. Its abuse was last reported locally in 2004 at the University of Minnesota and at some metropolitan area high schools. Effects include intense but very short-lived hallucinations and out-of-body experiences. Over-the-counter cough and cold products that contain dextromethorphan, a cough suppressant, continued to be abused by ingesting doses many times in excess of the recommended amount for hallucinogenic effects. Dextromethorphan (also known as DXM ) is the active ingredient in Coricidin HBP Cough and Cold (known as Triple Cs ) and Robitussin. Excessive dosages produce long-acting hallucinations, altered time perception, slurred speech, profuse sweating, uncoordinated movements, and high blood pressure. Being under the influence of these products is known as Robo-tripping or Skittle-ing. Lysergic acid diethylamide (LSD or acid ) is a strong, synthetically produced hallucinogen, typically sold as saturated, tiny pieces of paper known as blotter acid, for $5 to $10 per dosage unit. There were 12 hospital ED reports of LSD in 2005 (first half) and an additional 16 reports of miscellaneous hallucinogens. See Exhibit 2. Phencyclidine (PCP), a dissociative anesthetic, is most often used in combination with marijuana in joints known as wet sticks, or dipped joints, but can also 5

7 be injected or snorted. In 2005 (first half) there were 21 ED reports of PCP. OTHER DRUGS Khat, a plant with stimulant effects that is chewed or brewed in tea in East Africa and Middle Eastern cultures, is used within the Somali immigrant communities of the Twin Cities and Rochester, Minnesota. Its active ingredients, cathinone and catheine, are controlled substances in the United States. The Ramsey County Sheriff seized 124 pounds of khat in the third quarter of Prescription drug abuse, a category that includes the nonmedical abuse of a wide range of prescription drugs, increased in 2004 among students in the Twin Cities area, according to the Minnesota Student Survey. Past year prescription drug abuse was reported by 11 percent of high school seniors in 2004, compared with 9.4 percent in Incidents of middle school-aged and high school-aged children bringing various pills to school to share with classmates continued throughout the area. In 2005 (first half) there were 119 ED reports involving the nonmedical abuse benzodiazepines, which are prescribed medically to treat anxiety disorders. ALCOHOL Alcohol remained the most widely used mood-altering substance in Minnesota. In 2004 current (past month) alcohol use was reported by 66.2 percent of Minnesotans age 18 and older in 2004, compared with 56.8 percent nationally. See Exhibit 8. The only states with higher rates were Wisconsin (67.8 percent), Massachusetts (67.4 percent) and Rhode Island (66.3 percent). States with the lowest rates were Utah (28.7 percent), West Virginia (30.2 percent) and Kentucky (31.7 percent). Binge drinking (consuming five or more drinks on one occasion) in the past month was reported by 19.8 percent of Minnesotans age 18 and older in 2004, compared with 14.9 percent nationally. See Exhibit 9. The only states with higher rates were the neighboring states of Wisconsin (21.8 percent) and North Dakota (20.4 percent). States with the lowest rates were Tennessee (8.2 percent), Utah (9.2 percent) and Kentucky (9.6 percent). DWI (driving while intoxicated) offenses are one of the most visible consequences of alcohol abuse. In 2003 there were 32,193 DWIs in Minnesota, half of which were in the Twin Cities area. Of those arrested, 41 percent were repeat offenders, and 51 percent were between the age of 21 and 34. Minnesota was one of the last states to adopt.08 BAC (blood alcohol concentration) as the legal per se level for impaired driving, effective August 1, In 2004 there were 51 alcohol-related fatalities in the five-county metropolitan area (Exhibit 10). Statewide, of the 4,841 motor vehicle crashes that involved alcohol in 2004, 177 people died and 3,622 were injured, at an estimated economic cost of $280 million. In one recent case (December 2005) a 41-year-old man, who had been released from prison less than five months earlier for killing a woman while driving drunk, led police on a high-speed, wrong-way chase for nine miles through the western metropolitan area before being arrested for DWI, fleeing a police officer, receiving stolen property, and refusing to submit to a chemical test. Extreme college drinking remains a problem of significant magnitude and growing concern. The body of a 19-year-old boy from local Stillwater was discovered in the Red River near Minnesota State University at Moorhead, five days after he was last seen leaving a fraternity party. His autopsy revealed a BAC of 0.17 and THC metabolites indicating marijuana. Nine men were charged in the case, six of them with the felony of selling liquor to a minor resulting in death. In 2004 at the same fraternity, a young man died of alcohol poisoning after drinking at a bar on his 21 st birthday. The national fraternity has since suspended that chapter. Admissions to addiction treatment programs with alcohol as the primary substance problem accounted for 45.2 percent of total admissions in 2005 (first half), down from 54.6 percent in Of these patients, one-quarter were women, 77.2 percent were White, 12.2 percent were African-American, 5.9 percent were Hispanic, and 3.2 percent were American Indian. The average age of first alcohol use was 15.8 years. There were 434 hospital ED reports of underage drinking in 2005 (first half). See Exhibit 2. Past year alcohol use was reported by 60.4 percent of metropolitan area high school seniors in 2004, compared with 65 percent in TOBACCO Tobacco use is the leading cause of preventable disease and death in Minnesota, producing $1.6 billion in direct health care costs annually, and an additional $1 billion in lost productivity costs. Each 6

8 year 5,600 Minnesotans die from tobacco-related disease, one of every seven deaths. Current smoking was reported by 20.7 percent of people age 18 and older in Minnesota in 2004, compared with 20.8 percent nationally. States with the highest rates were Kentucky (27.5 percent), West Virginia (26.8 percent) and Tennessee (26.1 percent). States with the lowest rates were Utah (10.4 percent), California (14.7 percent) and Idaho (17.4 percent). See Exhibit 11. Tobacco use declined among metropolitan area youth significantly in 2004, according to the Minnesota Student Survey. Past year use of tobacco products was reported by 41.8 percent of high school seniors in 2004, compared with 48.4 percent in A newly released statewide survey of youth smoking by the Minnesota Department of Health found that from 2000 to 2005, current (past month) tobacco use among Minnesota middle school students (grades 6-8) fell from 12.6 to 9.5 percent, and among high school students (grades 9-12) from 40 to 29.3 percent. Environmental tobacco smoke (ETS) is smoke from lit cigarettes that is not intentionally inhaled (also known as second-hand smoke). Exposure to ETS increases the risk of cancer and heart disease, and exacerbates other respiratory conditions such as asthma. Exposure to ETS causes 3,000 deaths from lung cancer and 35,000 deaths from heart disease annually, among nonsmokers in the U.S. Two of three Minnesotans (65 percent) are exposed to ETS in a typical week - at home, at work, in a car or another location. Even among nonsmoking Minnesotans, 59 percent reported ETS exposure in the past week, according to 2003 Minnesota Adult Tobacco Survey. Children raised in smoking homes who are exposed to ETS are more prone to colds, bronchitis, pneumonia, ear infections, reduced lung function, and allergies than children living in smokefree environments. An estimated 280,000 Minnesota children are exposed to ETS in the home annually. As more cities and states enact indoor smoking bans in bars and restaurants, Hennepin County relaxed its countywide ordinance less than a year after it was first passed. Pursuant to recent action by the Hennepin County Board of Commissioners, bar owners in some parts of Hennepin County can apply for exemptions from the current county-wide smoking ban if half of their gross sales come from liquor, not food (effective 1/3/2006). Bars located in areas with more restrictive smoking bans cannot apply -- Minneapolis, Bloomington, and Golden Valley. Ramsey County currently has a restaurant-only smoking ban. Daily nicotine use (mostly tobacco) remained prevalent among patients in addiction treatment programs ranging from 79.2 percent among heroin addicts to 61.4 percent among alcoholics (Exhibit 1). DRUG ABUSE-RELATED INFECTIOUS DISEASES As of 12/31/2004 a cumulative total of 7,547 people were diagnosed and reported with HIV/AIDS in Minnesota: 3,213 with HIV infection (non AIDS) and 4,334 diagnosed with AIDS. Of these, 2,697 were known to be deceased. In Minnesota in 2004, of the 2,493 white males living with AIDS (the largest single demographic group), the exposure categories were as follows: men who have sex with men (85 percent); injection drug use (three percent); men who have sex with men and injection drug use (eight percent); heterosexual contact (two percent); other (two percent). Comparable figures for other groups are available from the Minnesota Department of Health. Of the 311 new HIV infections diagnosed in 2004, 39 percent were in Minneapolis, 14 percent in St. Paul, 35 percent in Twin Cities suburbs, and 12 percent in out-state Minnesota. In Minnesota in 2003, the Minnesota Department of Health reported 2,400 newly identified cases of hepatitis C virus (HCV), most of whom were chronically infected. Of the 23 acute cases, 57 percent reported past injection drug abuse. The level of HCV, a blood-borne liver disease, among injection drug abusers remained high, with estimated rates as high as 90 percent among patients in methadone treatment programs. 7

9 Exhibit 1 Characteristics of patients admitted to Twin Cities area addiction treatment programs by primary substance problem: 2005 (January through June) TOTAL admissions = 9,720 ALCOHOL = 4,396 (45.2%) MARIJUANA = 1,848 (19.0%) COCAINE = 1,302 (13.4%) METH = 1,178 (12.1%) HEROIN = 510 (5.2) GENDER % male % female RACE/ETHNICITY % White % African Am % Hispanic % Am Indian % Asian AGE % 17 and under % % % ROUTE of ADMINISTRATION % smoking % sniffing % injecting % oral 4.2 SECONDARY DRUG % marijuana alcohol alcohol marijuana cocaine TERTIARY DRUG % cocaine alcohol alcohol alcohol alcohol % 1st TREATMENT EPISODE AVERAGE AGE 1st USE (in years) % DAILY NICOTINE USE SOURCE: Drug and Alcohol Abuse Normative Evaluation System (DAANES), Minnesota Department of Human Services, 2005.

10 Exhibit 2 Reports on drug-related hospital emergency department (ED) visits in Minneapolis/St. Paul by drug category (unweighted) January - June 2005 cocaine 1532 marijuana 1390 methamphetamine 673 underage drinking Rx opiates heroin Rx benzodiazepines amphetamines MDMA inhalants PCP LSD GHB misc hallucinogens # of reports SOURCE: Drug Abuse Warning Network (DAWN) LIVE! - Cases from 11 to 13 metro area hospital emergency departments from 1/1/2005 through 6/30/2005. All DAWN cases are reviewed for quality control and based on this review, may be corrected or deleted. They are therefore, subject to change. These data were prepared by the Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA) on 12/6 and 12/7/2005.

11 Exhibit 3 % of cases Reports on drug-related hospital ED visits in Minneapolis/St. Paul by drug and patient gender (unweighted) January - June 2005 male female cocaine marijuana meth heroin SOURCE: Drug Abuse Warning Network (DAWN) LIVE! - Cases from 11 to 13 metro area hospital emergency departments from 1/1/2005 through 6/30/2005. All DAWN cases are reviewed for quality control and based on this review, may be corrected or deleted. They are therefore, subject to change. These data were prepared by the Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA) on 12/6 and 12/7/2005.

12 Exhibit 4 % of cases Reports on drug-related hospital ED visits in Minneapolis/St. Paul by drug and patient age (unweighted) January - June & under and above cocaine marijuana meth heroin 0.7 SOURCE: Drug Abuse Warning Network (DAWN) LIVE! - Cases from 11 to 13 metro area hospital emergency departments from 1/1/2005 through 6/30/2005. All DAWN cases are reviewed for quality control and based on this review, may be corrected or deleted. They are therefore, subject to change. These data were prepared by the Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA) on 12/6 and 12/7/2005.

13 Exhibit 5 % of cases 100 Reports on drug-related hospital ED visits in Minneapolis/St. Paul by drug and patient race/ethnicity (unweighted) January - June White African American Hispanic cocaine marijuana meth heroin SOURCE: Drug Abuse Warning Network (DAWN) LIVE! - Cases from 11 to 13 metro area hospital emergency departments from 1/1/2005 through 6/30/2005. All DAWN cases are reviewed for quality control and based on this review, may be corrected or deleted. They are therefore, subject to change. These data were prepared by the Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA) on 12/6 and 12/7/2005.

14 Exhibit 6 Drug seizures - St. Paul, Minnesota (10/1/2004 through 9/30/2005) drug type (count) methamphetamine (3,333) cocaine (1,771) cannabis (643) MDMA (103) heroin (69) psilocin (67) acetaminophen (62) oxycodone (57) hydrocodone (34) amphetamine (27) all other (311) percent of total items analyzed SOURCE: National Forensic Laboratory Information System (NFLIS), US Drug Enforcement Administration, 2005.

15 Exhibit 7 Increased impact of methamphetamine abuse in Minnesota % increase % % % % 185 % meth arrests meth labs meth treatment admissions meth prison population meth court case filings (adult) Drug Task Forces MN Dept of Public Safety Drug Task Forces MN Dept of Public Safety MN Dept of Human Services MN Dept of Corrections MN Supreme Court SOURCE: Minnesota Bureau of Criminal Apprehension, Minnesota Department of Public Safety, February 2005.

16 Exhibit 8 Current alcohol use 2004 (any alcohol use in past 30 days) Percent SOURCE: Percent of respondents age 18 and older who reported having at least one drink of alcohol in past 30 days. National Center for Chronic Disease Prevention and Health Promotion, 2004 Behavioral Risk Factor Surveillance System, online at:

17 Exhibit 9 Binge drinking (having five or more alcoholic drinks on one occasion) Percent SOURCE: All respondents 18 and older who reported having five or more drinks on an occasion, one or more times in the past 30 days. National Center for Chronic Disease Prevention and Health Promotion, 2004 Behavioral Risk Factor Surveillance System, online at:

18 Exhibit 10 Alcohol-related motor vehicle fatalities County # of alcohol-related motor vehicle fatalities % that were alcohol-related Anoka Dakota Hennepin Ramsey Washington SOURCE: 2005 Minnesota County Health Tables, Minnesota Center for Health Statistics, Minnesota Department of Health, using data from the Minnesota Department of Public Safety, Office of Traffic Safety.

19 Exhibit 11 Current Smoking Percent SOURCE: All respondents 18 and older who reported that they now smoke cigarettes every day or some days. National Center for Chronic Disease Prevention and Health Promotion, 2004 Behavioral Risk Factor Surveillance System, online at: