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 Jane Maxwell, UT Addiction Research Institute, 512 232-0610
4 5 Average Purity of Heroin Samples in the US: 2003-2011 2003 2004 2005 2006 2007 2008 2009 2010 2011 50% 40% 30% 20% 10% 0% Southeast Asian Southwest Asian Mexican South American 6 DEA’s Heroin Domestic Monitor Program Jane Maxwell, UT Addiction Research Institute, 512 232-0610
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 57,060 in 2010. • 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: 2005-2012 Heroin Other Opiates 100% 100% 90% 90% 80% 80% 70% 70% 60% 50+ 60% 50+ 40s 40s 50% 50% 30s 30s 40% 40% 20s 20s 30% 30% U20 U20 20% 20% 10% 10% 0% 0% Source: DSHS 9 Jane Maxwell, UT Addiction Research Institute, 512 232-0610
Average Age of Persons Dying with Mention of Heroin in Texas: 1992-2012 41 40 39 40 39 39 39 39 40 39 40 39 38 38 38 38 Age (Years) 38 38 37 37 37 37 36 36 36 35 35 34 34 33 32 31 Source: DSHS 10 Price of an Ounce of Mexican Black Tar Heroin in Texas: 1987-2012 9000 8000 7000 6000 5000 4000 3000 2000 1000 0 1987 1989 1991 1h93 1h94 1h95 1h96 1h97 1h98 1h99 1h00 1h01 1h02 1h03 1h04 1h05 1h06 1h07 1h08 1h09 2h11 11 Source: DEA All Heroin Purchases Domestic STRIDE Data January 2007 – June 2012 $1,400 100.00 $1,200 $1,161.32 $1,147.37 $1,096.10 80.00 Price Per Pure Gram $1,000 $897.91 $921.71 Purity in Percent $875.89 $873.98 $875.67 $877.84 $857.00 $827.95 $812.52 $817.11 $803.31 $741.01 60.00 $774.49 $800 $695.76 $644.00$646.77 $724.43 $564.36 40.5 $600 37.7 38.4 36.8 40.00 35.7 36.5 34.2 40.5 33.7 34.2 32.4 32.5 32.6 30.4 30.6 28.5 27.4 26.2 $400 25.8 24.1 24.5 24.7 20.00 From October 2007 through June 2012, the price per pure gram of Heroin increased 56%, from $200 $564.36 to $877.85 while the purity decreased 9%, from 41% to 37%. $0 0.00 Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- Apr - Jul- Oct- Jan- Apr- Jul- Oct- Jan- Apr- Mar0 Jun0 Sep0 Dec0 Mar0 Jun0 Sep0 Dec0 Mar0 Jun0 Sep0 Dec0 Mar1 Jun Sep1 Dec1 Mar1 Jun1 Sep1 Dec1 Mar1 Jun1 7 7 7 7 8 8 8 8 9 9 9 9 0 10 0 0 1 1 1 1 2 2 PPG_mean $695.7 $644.0 $646.7 $564.3 $875.8 $803.3 $873.9 $724.4 $827.9 $741.0 $857.0 $1,096 $1,404 $1,161 $1,147 $812.5 $921.7 $875.6 $774.4 $897.9 $817.1 877.85 Purity_mean 32.41 34.21 37.69 40.50 40.53 35.66 38.38 36.45 33.69 32.47 08/15/2012 32.55 27.36 24.07 24.51 24.70 25.84 26.17 28.52 34.17 30.35 30.61 36.79 Intelligence Division - Indications and Warning Section Jane Maxwell, UT Addiction Research Institute, 512 232-0610
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 $10-$20 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 2011: 2 173-180, Lankenau SE, et al. (2012). Initiation into prescription opioid misuse amongst young injection drug users. Int J Drug Policy. 2012 Jan;23(1):37-44. Epub 2011 Jun 20. 13 Nonmedical Use of Pain Relievers: NSDUH 2011 Baby Boomers—1946-1964 16 14 14 13 12 12 10 Percent Lifetime 8 Past Year 6 6 Past Month 4 4 3 3 2 2 2 1 1 1 1 1 0 0 All Ages 50-54 55-59 60-64 65 or Older 14 Cocaine Indicators in Texas: 1998-2012 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 10000 1000 100 10 1 # PCC Calls % Treatment % Tox Items # Deaths 15 Jane Maxwell, UT Addiction Research Institute, 512 232-0610
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 2007 – June 2012 $250 100.00 $197.02 $194.45 $200 $191.95 80.00 Price Per Pure Gram $173.97 $174.49 $174.71 $191.35 67.1 $185.57 $166.24 $181.04 Purity in Percent $173.87 $175.87 $175.16 60.9 $172.66 $168.90 59.2 $164.86 56.8 57.3 57.2 $150 60.00 49.9 49.1 49.6 47.9 48.3 48.3 48.4 48.5 48.1 46.2 45.4 45.6 45.9 44.5 44.6 44.8 $128.10 $122.72 $123.91 $117.63 $114.87 $100 40.00 $97.64 From January 2007 through June 2012, the price per pure gram of Cocaine increased 79.%, from $97.64 to $50 20.00 $175.16 while the purity decreased 28.3%, from 67.1% to 48.1%. $0 0.00 Jul- Jul- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- Apr- Jul- Oct- Jan- Apr- Oct- Jan- Apr- Oct- Jan- Apr- Sept1 Sept1 Mar07 Jun07 Sep07 Dec07 Mar08 Jun08 Sep08 Dec08 Mar09 Jun09 Sep09 Dec09 Mar10 Jun 10 Dec10 Mar11 Jun11 Dec11 Mar12 Jun12 0 1 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 67.13 59.17 56.84 60.89 57.29 57.19 46.16 44.47 47.90 48.28 45.45 45.59 44.56 44.82 45.91 48.34 48.43 49.12 48.48 49.94 49.59 48.11 Intelligence Division - Indications and Warning Section 8/15/2012 Price of a Kilogram of Cocaine in Texas: 1987-2013 50000 45000 40000 35000 30000 25000 20000 15000 10000 5000 0 Source: DEA 18 Jane Maxwell, UT Addiction Research Institute, 512 232-0610
Main Global Cocaine Flows: 1998 and 2008 2008 124 165 19 UNODC, World Drug Report , Drug Trafficking, 1998 & 2010 • Levamisole is cancer New Problems medication also used with Cocaine 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) 20 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 Jane Maxwell, UT Addiction Research Institute, 512 232-0610
Monitoring the Future Survey: 1991- 2012: Marijuana Use by 12 th Graders 100 90 80 70 % Used in Past Year 60 % Great Risk in Using 50 % Strongly Disapprove of 40 Use 30 % Easy or Very Easy to Get 20 10 0 1991 1994 1997 2000 2003 2006 2009 2012 22 Dabs, BHO, Honey, Bud der • 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”). 24 Jane Maxwell, UT Addiction Research Institute, 512 232-0610
Vapor Pens • Advertised for “patients” • Cost $100-$200 • Potency varies • Higher percentage of THC • No odor. Similar to electric cigarettes • Pen-style vaporizers contain 100-150 hits • Some can be recharged & refilled • http://potappetit.com/the-pen-is-mightier-than- the-bong-or-mini-vaporizers-got-the-right-stuff/ 25 Medical Marijuana and Drugged Driving in California: 2007 v. 2010 • Using 2007 Roadside Survey methodology, marijuana use by drivers increased from 4.0% testing positive for THC in 2007 to 7.8% in 2010. • Nearly 1 in 10 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., 2012. The prevalence of cannabis-involved driving in California. Drug and Alcohol Dependence, 1123, 105-109. SPICE 27 Jane Maxwell, UT Addiction Research Institute, 512 232-0610
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