Jane Maxwell, UT Addiction Research Institute, Drug Trends: Old Drugs and New Problems - New Drugs and New Problems

Transcription

1 Drug Trends: Old Drugs and New Problems - New Drugs and New Problems Jane Maxwell, Ph.D. Center for Social Work Research The University of Texas at Austin The author has no financial disclosure 2 3

2 4 5 Average Purity of Heroin Samples in the US: % % 3% 2% 1% % Southeast Asian Southwest Asian Mexican South American DEA s Heroin Domestic Monitor Program 6

3 Mexican Black Tar Heroin Mexican Brown Heroin South American Heroin 7 Heroin Almost all heroin in the U.S. is from Mexico or South America. East of the Mississippi, white South American heroin and in the West, Mexican heroin, but seeing Black Tar move eastward and into the South, while South American now seen in Chicago and St Louis. Number of U.S. heroin treatment admissions under age 25 increased from 16,357 in 1992 to 57,6 in 21. Increasing heroin use among suburban youth and young users. Reports of fentanyl mixed with white South American heroin in the NE and Canada. 8 Texas Heroin and Other Opiate Admissions by Age Group: Heroin Other Opiates 1% 1% 9% 9% 8% 8% 7% 7% 6% 5% 4% 3% 2% 5+ 4s 3s 2s U2 6% 5% 4% 3% 2% 5+ 4s 3s 2s U2 1% 1% % % Source: DSHS 9

4 Average Age of Persons Dying with Mention of Heroin in Texas: Age (Years) Source: DSHS Price of an Ounce of Mexican Black Tar Heroin in Texas: h93 1h94 1h95 1h96 1h97 1h98 1h99 1h 1h1 1h2 1h3 1h4 1h5 1h6 1h7 1h8 1h9 2h11 Source: DEA 11 All Heroin Purchases Domestic STRIDE Data January 27 June 212 $1,4 1. $1,2 $1, $1, $1, Price Per Pure Gram $1, $ $ $ $ $ $ $857. $ $83.31 $ $ $ $ $8 $ $644.$ $ $ $ $ Purity in Percent 2. $2 From October 27 through June 212, the price per pure gram of Heroin increased 56%, from $ to $ while the purity decreased 9%, from 41% to 37%. $. Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- Apr - Jul- Oct- Jan- Apr- Jul- Oct- Jan- Apr- Mar Jun Sep Dec Mar Jun Sep Dec Mar Jun Sep Dec Mar1 Jun Sep1 Dec1 Mar1 Jun1 Sep1 Dec1 Mar1 Jun PPG_mean $695.7 $644. $646.7 $564.3 $875.8 $83.3 $873.9 $724.4 $827.9 $741. $857. $1,96 $1,44 $1,161 $1,147 $812.5 $921.7 $875.6 $774.4 $897.9 $ /15/212 Intelligence Division - Indications and Warning Section Purity_mean

5 Other Opiates Shifting back and forth between Rx opiates and heroin. Which came first? Injection drug users report prescription opiate use predates heroin use and tolerance motivates them to try heroin. But also reports of those who became addicted to prescription opiates and when controls were tightened, then shifted to heroin. Cost difference? In Texas, heroin cap is $1-$2 vs. $1/mg for 72 mg OxyContin. Pollini et. Al., Problematic use of prescription-type opioids prior to heroin use among young heroin injectors. Substance Abuse and Rehabilitation 211: , Lankenau SE, et al. (212). Initiation into prescription opioid misuse amongst young injection drug users. Int J Drug Policy. 212 Jan;23(1): Epub 211 Jun Nonmedical Use of Pain Relievers: NSDUH 211 Percent Baby Boomers All Ages or Older 6 Lifetime Past Year Past Month 14 Cocaine Indicators in Texas: # PCC Calls % Treatment % Tox Items # Deaths 15

6 Cocaine: Why the Decline? Poison control, treatment, deaths, & tox lab indicators down in Texas; price up. Amount of coca under cultivation in South America is down 15% 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. Are the shortages of cocaine and increased supply of methamphetamine related? 16 All Cocaine Purchases Domestic STRIDE Data January 27 June 212 $25 1. $2 $197.2 $ $ Price Per Pure Gram $173.97$ $ $ $ $ $181.4 $ $ $ $168.9 $ $ $ $ $122.72$ $ $ $1 4. $97.64 Purity in Percent $5 From January 27 through June 212, the price per pure gram of Cocaine increased 79.%, from $97.64 to $ while the purity decreased 28.3%, from 67.1% to 48.1%. 2. $. Jul- Jul- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- Apr- Oct- Jan- Apr- Oct- Jan- Apr- Sept1 Sept1 Mar7 Jun7 Sep7 Dec7 Mar8 Jun8 Sep8 Dec8 Mar9 Jun9 Sep9 Dec9 Mar1 Jun 1 Dec1 Mar11 Jun11 Dec11 Mar12 Jun12 1 PPG $97.64 $117.6 $128.1 $114.8 $122.7 $123.9 $181. $197. $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 Intelligence Division - Indications and Warning Section 8/15/212 Price of a Kilogram of Cocaine in Texas: Source: DEA 18

7 Main Global Cocaine Flows: 1998 and UNODC, World Drug Report, Drug Trafficking, 1998 & New Problems with Cocaine Levamisole is cancer medication also used in de-worming animals. Can result in agranulocytosis (discoloration of skin, beginning in ears sign of skin cell death) Results in neutropenia (bone marrow does not make enough white blood cells) 2 Marijuana Supply changes Mexican down due to drought & what is coming across is poor quality. Beginning of increased supply of more hydroponic & indoor grows in Texas and less from Mexico? Role of Blunts, Wrappers, Dabs, Vapor Pens in increasing use Increased proportion of treatment admissions (23%) and more impaired. What will happen with medical marijuana and legalization? 21

8 Monitoring the Future Survey: : Marijuana Use by 12 th Graders % Used in Past Year % Great Risk in Using % Strongly Disapprove of Use % Easy or Very Easy to Get 22 Dabs, BHO, Honey, Budder Dabs, shatter wax and vaporizer pens contain hash oil ( wax ). Supposedly 8%-9% 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 ). 24

9 Vapor Pens Advertised for patients Cost $1-$2 Potency varies Higher percentage of THC No odor. Similar to electric cigarettes Pen-style vaporizers contain 1-15 hits Some can be recharged & refilled 25 Medical Marijuana and Drugged Driving in California: 27 v. 21 Using 27 Roadside Survey methodology, marijuana use by drivers increased from 4.% testing positive for THC in 27 to 7.8% in 21. Nearly 1 in 1 weekend nighttime drivers tested positive for THC, and in some jurisdictions, the rate was nearly 1- in-5. 39% of holders of medical marijuana permits tested positive for THC versus 8% without permits. Drivers testing positive for THC did not think it affected their driving. Johnson MB et al., 212. The prevalence of cannabis-involved driving in California. Drug and Alcohol Dependence, 1123, SPICE 27

10 Cannabinoids Identified in U. S. NFLIS Toxicology Labs 19 variations reported in variations reported in variations reported in 212 JWH-25, 461, 14% JWH-81, 182 JWH-73, 33, 9% JWH-18 64% SYNTHETIC CANNABINOI D 7% JWH-21 AM-221 9% 35% JWH % JWH-81 6% JWH-18 16% XLR-11 14% UR-144 AM % 41% MAM-221 4% SYNTHETIC CANNABINO ID 6% SOURCE: National Forensic Laboratory Information System, 21, 211, Cannabis vs. Cannabinoids: Clinical Cases Most symptoms are similar to cannabis intoxication Tachycardia Reddened eyes Anxiousness Mild sedation Hallucinations, acute psychosis Memory deficits Symptoms not typically seen after cannabis intoxication Seizures Hypokalemia (low potassium) Hypertension (high blood pressure) Nausea/vomiting Coma Agitation, violent behavior Early articles on psychosis or schizophrenia with synthetic cannabis or cannabis Association between age at onset of psychosis and age at onset of cannabis use in non-affective psychosis, Galvez-Buccollini, Schizophrenia Research 139 (212) Letter to the Editors, Schizophrenia Research 118 (21) Synthetic cannabinoid JWH-18 and psychosis: An explorative study. Every-Palmer, Drug and Alcohol Dependence 117 (211) Spicing things up. Spaderna et al., Psychopharmacology (213) 228: Miotto et al., Clinical & pharmacological aspects of bath salt use. Drug & Alcohol Dependence (213) in press. 29 U. S. Human Exposure Calls for Synthetic Cannabinoids and Cathinones and Impact of Federal Regulations The Effect of Federal Controls on Synthetic Cannabis Calls to Poison Centers The Effect of Federal Controls on Synthetic Cathinone Calls to Poison Centers Jan Jul 21 Jan 211 Jul Jan July Jan Jan Jul Jan Jul Jan July Jan SOURCE: American Association of Poison Centers 3

11 Who are the users of psychoactive drugs (synthetics, hallucinogens, phenethylamines, tryptamines, MDMA, etc.)? Users of synthetic cannabis: Preliminary analysis of poison center, emergency room, and treatment data show young (under age 2) males with low levels of employment and education and high levels of legal problems. Users of synthetic cathinones and hallucinogens more likely to be slightly older (26-3 years). Users of synthetic cathinones, tryptamines, LSD, and phenethylamines more likely to have more serious consequences when seen in emergency rooms, etc. 31 Amphetamine-Type Stimulants: MDMA, 2C-xx, Khat, Meth, Amphet, Synthetic Cathinones An Emerging Liking for Speedy or Upper Drugs and Examples of Drug Replacement 32 Possible reason for the changes we are seeing? 1. MDMA drought 2. Change in supply of methamphetamine as precursors shift from pseudoephedrine, which is now limited to small number of tablets in US and banned in Mexico, to P2P/Phenylacetone, which is banned in US but available in Mexico. 3. The search for MDMA replacements using other Amphetamine Type Substances (ATS)? 33

12 Glimpses of MDMA Situation in U.S.: Results of Pill Tests Containing MDMA* Any MDMA MDMA Only MDMA Reports: NFLIS Forensic Labs * bstance_by_year.php Source: DEA NFLIS 34 What s Molly? Ecstasy pills with little MDMA and lots of caffeine, meth, assorted drugs? - or - A pure crystalline form of MDMA, most often sold as a powder filled capsule? - or - Methylone? (Bath salts)? Reports of desired effects of euphoria, but also increased paranoia, agitated delirium, hallucinations, psychotic episodes, violent or destructive self-harm, including death Bottom line - Molly is no longer just a pure form of MDMA ecstasy, but may be a drug that is even more harmful than ecstasy itself. 35 From the term Bath Salts to Synthetic Cathinones Mephedrone, methylone, 4- MEC Stimulants related to methcathinone, MDMA, amphetamines 2C Phenethylamine Psychedelics related to datura, mescaline, 25I- NBOMe (micrograms, not milligrams) 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. 36

13 Synthetic Cathinones Identified in US NFLIS Toxicology Labs 17 varieties identified in 21 n= varieties identified in 211 n=6, varieties identified in 212 n=14,239 METHY LONE 11% 4MMC 33% METHYLONE 26% 4-MEC 4% 4-MMC 5% METHYLONE 23% ALPHA-PBP 18% MDPV 52% MDPV 53% MDPV 21% PENTEDRONE 5% 4-MMC 2% SOURCE: National Forensic Laboratory Information System, 21, 211, Clinical effects of synthetic cathinones in patients admitted to ED (N=236) Agitation 82% Combative/Violent behavior 57% Tachycardia/Racing heart 56% Hallucinations 4% Paranoia 36% Confusion 34% Myoclonus/Movement disorders 19% Hypertension 17% Chest pain 17% CPK elevations 9% Source: Spiller et al., New and Old Hallucinogens in the U.S.: NFLIS 21-5/213 Other Psilocybine Psilocybine/Psilocin % of All Hallucinogens Tested Psilocin LSD Hallucinogen DMT 5MEO MDMA 2C-x TFMPP SOURCE: DEA NFLIS

14 All Methamphetamine Purchases Domestic STRIDE Data January 27 June 212 $ $3 $ $36.49 Price Per Pure Gram $ $ $ $ $ $ $ $ $15 $ $14.22 $ $ $126.3 $14.66 $98.29 $93.71 $93.14 $9.39 $1 $ $14.34 $85.24 $81.28 Purity in Percent 2. $5 From July 27 through June 212, the price per pure gram of methamphetamine decreased 72%, from $ to $81.29, while the purity increased 128%, from 41% to 93%. $. Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- Apr- Mar7 Jun7 Sep7 Dec7 Mar8 Jun8 Sep8 Dec8 Mar9 Jun9 Sep9 Dec9 Mar1 Jun1 Sep1 Dec1 Mar11 Jun11 Sep11 Dec11 Mar12 Jun12 PPG_mean $158.9 $226.6 $288.6 $36.4 $244.7 $244.3 $199.4 $179.4 $188.7 $138.7 $14.2 $127.6 $126.3 $111.7 $14.3 $98.29 $14.6 $93.14 $93.71 $86.2 $ Purity_mean Intelligence Division - Intelligence Division - Indications and Warning Section Indications and 8/15/212 Warning Section Methamphetamine & Amphetamine Indicators in Texas: # PCC Calls % Tmt Admits # Deaths % of Tox Items 41 Different Manufacturing Processes I. Ephedrine/Pseudoephedrine Based (d-form): (1% of samples over 6g 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. Still used in rural areas and Midwest and South, but usually produces less than 6 g of methamphetamine. II. P2P/Phenylacetone (Illegal in US-Schedule II, precursors legal in Mexico) (l and d,l-forms): (95% of samples over 6g tested). If drug is 1% potent, it s all d-form. If % potent, is all l-form. Mexican chemists are refining their process to produce more potent P2P meth. 42

15 DEA Methamphetamine Profiling Program: 21-2nd Q 213 1% 8% 6% 4% 2% % Production Routes P2P Phosphorus Iodine Purity and Potency Purity Potency 1% 8% 6% 4% 2% % Source: DEA 43 Local Texas Reports on Meth Use 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 meth, often injecting, and increasing cases of syphilis. Conversion labs in Texas change liquid meth from Mexico to powder or Ice. Increases in meth use also reported by other CEWG members. Increasing need for treatment as this more potent meth spreads

16 Data Sources Monitoring the Future Surveys: SAMHSA s Drug Abuse Warning Network: Texas poison control centers: /1/213 Texas treatment data: Mortality from poison control centers: DEA s National Forensic Laboratory Information System (NFLIS): 25-June 213 DEA s STRIDE system Reports from NIDA s Community Epidemiology Work Group members June 213 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