Substance Abuse Trends: Old and New Drugs

1. Substance Abuse Trends: Old and New Drugs Jane Maxwell, Ph.D. Center for Social Work Research The University of Texas at Austin

6. Cocaine 6% Cocaine 7% Heroin 16% Heroin 13% Meth 9% Meth 8% Meth 27% Meth 17% Heroin 11% Heroin 10% Meth 13% Meth 25% Cocaine 17% Heroin 34% Heroin 9% Heroin 25% Cocaine 29% Cocaine 32% Cocaine 3% Cocaine 13% Cocaine 42% Heroin 3% Primary Drug of Abuse at Admission to Treatment: 2009 Cocaine 8% Cocaine 14% Heroin 8% Meth 4% Meth 1% Meth 2% Meth 1% Heroin 1% SISVEA & TEDS

7. Heroin 1998 Miami DMP Samples Southwest Asian 2.1 % Pure Southeast Asian 2.3 % Pure South American 19.2 % Pure

8. Heroin Sources and Supply Routes SWA Mexican SEA So. Amer

9. Mexican Black Tar Heroin Mexican Brown Heroin South American Heroin

10. Heroin • Almost all in Texas is Black Tar & Mexican brown; continuing occasional mentions of white heroin with no DEA footprint. • Price range has narrowed with ounce dropping from $700-$5000 to $700-$4000. • Houston DEA reports heroin is moderately available but more available than 6 months ago. Increased street level availability. Seizures up. Afghan heroin thru mail to Killeen-Fort Hood. • El Paso DEA reports seizures have increased and more available. • Dallas DEA reports supply is stable. Youths still using “cheese” (heroin powdered using Tylenol PM®). • All CEWG members report increasing heroin use and increasing number of youth and young users.

11. Heroin Indicators in Texas:1998-2011 *Dallas

12. Texas Heroin Admissions by Age Group: 2005-2011 Source: DSHS

13. Age and Race/Ethnicity of Persons Dying with Mention of Heroin: 1992-2010 Source: DSHS

14. Other Opiates OxyContin, Vicodin, hydrocodone, oxycodone, methadone, codeine, etc. Favorites vary by region (oxycodone vs. hydrocodone) Shifts back and forth between Rx opioids and heroin

15. Public Health Impact of Opioid Pain Reliever UseFor every opioid overdose death in 2009 there were Source: Len Paulozzi at 2012 ASAM; data from TEDS, DAWN, NSDUH

16. Drug poisoning death rates by age: United States, 1999-2009 6 5 4 3 2 1 CDC/NCHS, National Vital Statistics System; and Warner M, Chen LH, Makuc DM, Anderson RN, Miniño AM. Drug poisoning deaths in the United States, 1980–2008. NCHS data brief, no 81. Hyattsville, MD: National Center for Health Statistics. 2011. http://www.cdc.gov/nchs/data/databriefs/db81.htm

17. Major “Other Opiates” in TexasHydrocodone 10X Higher Hydrocodone/Vicodin Schedule III Oxycodone Schedule II

18. “Holy Trinity” “Houston Cocktail” Hydrocodone, alprazolam, and carisoprodol (Vicodin, Xanax, Soma) 6 Houston “pain clinic” doctors each wrote between 23,907 and 43,383 scripts in a 15-month period. Real-time on-line Texas prescription monitoring program underway.

19. Nonmedical Use of Tranquilizers: Numbers in Thousands, NSDUH 2010 Source: SAMHSA

20. Benzodiazepines in Texas: 1998-2011

21. Poisoning Deaths with Benzodiazepine and Opioid Analgesics Mentioned: NCHS 1999-2008 Source: NCHS, National Vital Statistics System

22. “SYRUP” in Texas • Codeine cough syrup continues to be abused. • Cut with Karo syrup, jolly ranchers, and soft drink. • Rap music on syrup continues. • Prepackaged to introduce to youths or ready to add the syrup?

23. Codeine Promethazine Cocktail

24. New “Relaxation” Drinks:Drank and Lean Valerian Roots Melatonin Rose Hips “Slow Your Roll” “Slow Motion Potion”

25. SIZZURPCognac, Vodka, and Fruit Flavor

26. Cocaine: What’s going on? • Poison control, treatment, deaths, & tox lab indicators down nationwide; price and purity up. • Amount of coca under cultivation down • Demand in Europe for cocaine. • Use of Levamisole as a filler with serious medical consequences.

27. Cocaine Indicators in Texas: 1998-2011

28. From January 2007 through June 2011, the price per pure gram of cocaine increased 71%, from $98 to $167, while the purity decreased 27%, from 67% to 49%. All Cocaine Purchases Domestic STRIDE DataJanuary 2007 – June 2011

29. 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)

30. Methamphetamine: It’s Back (It never went away)

31. Median Methamphetamine Purity in the Continental United States (1985-2005) Impact of US and Canadian precursor regulation on methamphetamine purity in the United States. (2009) Cunningham JK, Liu L-M, Callaghan R. Addiction; 104, 441-453.

32. From July 2007 through June 2011, the price per pure gram of methamphetamine decreased 69%, from $290 to $90 while the purity increased 127%, from 39% to 88%. All Methamphetamine Purchases Domestic STRIDE DataJanuary 2007 – June 2011

33. Methamphetamine & Amphetamine Indicators in Texas: 1997-2011

34. Comparison of Amphetamine and Methamphetamine Indicators in Texas 2011 Source: DSHS and NFLIS

35. Different Manufacturing Processes I. Methylsulfonylmethane (MSM) being used to cut meth (or sold instead of meth). II. Ephedrine/Pseudoephedrine Based (d-form): 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. III. P2P/Phenylacetone (Illegal in US-Schedule II, precursors legal in Mexico) (l and d,l-forms).

36. DEA Methamphetamine Profiling Program: 2010-2012 Source: DEA

37. Source: DEA

38. Source: DEA

39. Biggest Risks of Meth Use:Mental Source: Maxwell

40. Driving Behavior Reported by Sample of Meth Users in Treatment Source: Maxwell

41. Marijuana

42. Marijuana Indicators in Texas: 1997-2011

43. % Texas Secondary Students Who Had Used Marijuana in the Past Month, by Ethnicity: 1990-2010 Source: DSHS

44. Consequences of Marijuana Abuse Acute (present during intoxication) • Impairs short-term memory • Impairs attention, judgment, and other cognitive functions • Impairs coordination and balance • Increases heart rate • Psychotic episodes Persistent (lasting longer than intoxication, but may not be permanent) • Impairs memory and learning skills • Sleep impairment

45. Long-Term Cumulative Effects of Chronic Abuse • Can lead to addiction • Increases risk of chronic cough, bronchitis • Increases risk of schizophrenia in vulnerable individuals • May increase risk of anxiety, depression, and amotivational syndrome National Institute on Drug Abuse, Research Report Series, Marijuana Abuse, updated 9/2010.

46. www.nida.nih.gov/ResearchReports/Marijuana/default.html

47. Dangerous, Imitation, Emerging Drugs (DIED)

48. Imitation • Mimic Illegal Drugs • Imitate • Fake • Impersonate • Rip Off • Synthetic Cannabinoids “cannabimimetics” • Synthetic Cathinones- Khat- “Cathinimetics” such as 4-MMC, MDPV, Mephedrone • Phenethylamines, Tryptamines, Piperazines • Beat the Drug Test

49. Drugs • Not “spice,” “bath salts,” or “incense” • Psychoactive substances • Change the brain’s functions • Complex chemistry • Constantly changing to “stay legal” • Complicated neuropharmacology

50. Emerging Drugs Items Identified in Texas NFLIS Tox Labs: 2010 and 2011