nationwide trends about drugs

This fact sheet highlights information from the latest meeting (December 2000) of NIDA's Community Epidemiology Work Group (CEWG).* These highlights cover current and emerging trends in drug abuse for 21 major U.S. metropolitan areas. The findings are intended to alert the general public, policy makers, and authorities at the local, State, regional, and national levels to the latest trends in drug abuse.
The CEWG network of researchers are from Atlanta, Baltimore, Boston, Chicago, Denver, Detroit, Honolulu, Los Angeles, Miami, Minneapolis/St. Paul, Newark, New Orleans, New York, Philadelphia, Phoenix, St. Louis, San Diego, San Francisco, Seattle, Texas, and Washington, D.C.

CEWG members assess drug abuse patterns and trends from a variety of health and other drug abuse indicator sources, including the Treatment Episode Data Set (data from treatment facilities) and the Drug Abuse Warning Network (emergency room mentions and medical examiner deaths involving illicit drugs), both of which are funded by the Substance Abuse and Mental Health Services Administration; the Arrestee Drug Abuse Monitoring program, funded by the National Institute of Justice; information on drug seizures, price, and purity, from the Drug Enforcement Administration; the Uniform Crime Reports, maintained by the Federal Bureau of Investigation; and poison control centers. These data are enhanced with qualitative information from ethnographic research, focus groups, and other community-based sources.
Findings presented at the December 2000 CEWG meeting are based on 1999 and 1998 data and on comparisons of these data with those from earlier time periods.

Extent of Use

In 1999, about 14.8 million Americans were current users of illicit drugs, meaning they used an illicit drug at least once during the month prior to being interviewed for the latest National Household Survey on Drug Abuse,1 an annual nationwide survey among Americans age 12 and older. About 3.5 million were dependent on illicit drugs; an additional 8.2 million were dependent on alcohol.

Cocaine/Crack

Trend indicators for cocaine/crack use continued to show a downward trend in 18 of the 21 CEWG metropolitan areas in 1999. The downward trend was striking in areas of the northeast, mid-Atlantic, and northern Midwest region of the U.S.
For example, emergency room mentions involving cocaine/crack dropped 24.3 percent between 1998 and 1999 in New York. Other cities seeing statistically significant decreases were Boston, Dallas, Newark, Washington, D.C., and New Orleans.
Cocaine/crack indicators still remain elevated in most areas, however, and emergency room mentions were at their highest levels in 4 years in Denver, Los Angeles, Miami, Minneapolis/St. Paul, and Phoenix. Data show that cocaine is frequently used with other drugs.
Decreases from 1998 to 1999 for adult male arrestees testing positive for cocaine/crack occurred in Chicago, Los Angeles, New Orleans, New York, Philadelphia, San Diego, and Seattle. Increases were seen in Dallas, Minneapolis/St. Paul, Philadelphia, and Washington, D.C. Increases in cocaine-positive tests for adult female arrestees occurred in Dallas, Chicago, Phoenix, Minneapolis, New Orleans, and Seattle. Notable decreases in cocaine-positive female arrestees occurred in Los Angeles and New York.
An increase in availability and use of cocaine was reported in Denver, Detroit, New York, New Orleans, Philadelphia, Seattle, and Los Angeles. Regionally, arrestee and school survey data indicate cocaine emerging as a significant problem at the Texas-Mexico border. Also, crack use in Atlanta is moving to rural areas outside the city.

Heroin/Morphine

CEWG indicators for heroin/morphine abuse increased in 1999 in 15 CEWG sites, located in all regions of the country. Heroin/morphine ranked first in drug-related emergency room mentions in eight CEWG areas.
CEWG members continued to report increases in heroin indicators among young populations. For example, emergency room mentions of heroin among the 18-25 year old category increased 51.4 percent from 1997 to 1999.
Emergency room mentions of heroin decreased from 1998 to 1999 in Dallas, Honolulu, and San Diego, and were stable in Los Angeles, Newark, New York, and San Francisco. Emergency room data show that heroin is often used in combination with cocaine.
From 1998 to 1999, opiate-positive rates for adult male arrestees increased in four cities and decreased in three. The increases were seen in two cities where they had previously been very low (Atlanta and Dallas). Comparable adult female arrestee data showed increases in eight cities, with the largest observed in Dallas.
The purity of heroin was highest in Newark, Philadelphia, Boston, and New York in 1999, ranging from 60.2 percent to 76.7 percent purity.

Marijuana

There are indications that marijuana abuse is stabilizing in some CEWG areas, after an upsurge in use from 1990-1998. Emergency room mentions of marijuana decreased in 1999 in 10 CEWG areas (Boston, New Orleans, and San Diego in particular) and stabilized in Newark. The lowest rates were in San Diego, Minneapolis/St. Paul, and San Francisco. The highest rates of marijuana emergency room mentions in 10 years, however, occurred in Denver, Los Angeles, Miami, and Washington, D.C. Statistically significant increases occurred in Baltimore, Minneapolis/St. Paul, and Phoenix from 1998 to 1999.
While indicators such as emergency room admissions remained stable or decreased in 1999, CEWG members reported increases in treatment admissions where marijuana was the primary drug of abuse. Data also showed that marijuana was the most likely illicit drug to be used in combination with other substances, including hydrocodone (Lorcet®, Lortab®, Vicodin®) and Ecstasy. In Dallas, there were reports of young marijuana users dipping joints in embalming fluid containing phencyclidine (PCP) or in codeine cough syrup.
Among juvenile arrestees in 1999, marijuana was the most commonly used drug by both males and females. More than half the juvenile males and nearly 40 percent of the females tested positive for marijuana.

Methamphetamine

Indicators for methamphetamine use appeared to trend downward from 1997 through the first half of 1999, but showed indications of increasing again during the last half of 1999. Use of the drug continued to spread to areas outside the west coast and southeast, where abuse has been most concentrated. There were reports of considerable abuse in the Seattle area, increasing use in Atlanta, and a growing demand for smoked methamphetamine ("ice") in Honolulu.
Reports from 11 CEWG areas indicate that methamphetamine was used along with other drugs at raves, and there were indications that methamphetamine activity was increasing in areas where it had not been a major problem in the past.
Emergency room mentions of methamphetamine increased 26.5 percent between the first and second 6-month periods of 1999. Significant increases occurred in San Diego, San Francisco, Los Angeles, Seattle, Denver, and Phoenix. Some CEWG areas reported abuse of methamphetamine with Viagra.
San Diego reported the highest percentage of adult male and female arrestees testing positive for methamphetamine in 1999. Also testing positive in San Diego in 1999 were 15.8 percent of juvenile male and 18.2 percent of juvenile female arrestees, and 22 percent of Hispanic juvenile male and 16.7 percent of Hispanic adult female arrestees.

Ecstasy (MDMA)

Abuse of Ecstasy, or MDMA (methylenedioxymethamphetamine), in 1999 became more widespread in 17 CEWG areas: Atlanta, Baltimore, Boston, Chicago, Denver, Detroit, Miami, Minneapolis/St. Paul, New Orleans, New York, Philadelphia, San Diego, San Francisco, Seattle, St. Louis, Texas, and Washington, D.C. In Boston, MDMA was the most frequently mentioned drug in telephone calls to the Poison Control Center during the first three quarters of 2000.
CEWG members reported that MDMA was being used in a variety of normal recreational and social settings in addition to raves, by a wide variety of age groups. Emergency room data showed that marijuana/hashish abuse in combination with MDMA increased from 8 mentions in 1990 to 796 in 1999.

Emerging Drugs

CEWG members identified several legal, prescription drugs as emerging drugs of abuse in 1999. These include clonazepam (a benzodiazepine) and the controlled substances hydrocodone (Lorcet®, Lortab®, Vicodin®), hydromorphone (Dilaudid®), and oxycodone (Percodan®, Percocet®). Abuse of one or more of these drugs was reported in New Orleans, Phoenix, St. Louis, Texas, and Washington, D.C.
Hydrocodone appeared to be the most widely abused of these drugs. From 1993 to 1999, hydrocodone emergency room mentions increased from 6,115 to 14,639. Among marijuana/hashish emergency room mentions, combined use with hydrocodone increased from 8 in 1990 to 840 in 1999. In some areas, hydromorphone and oxycodone pills are substituted for heroin by heroin abusers.