New Perspectives & New Challenges in Substance Abuse

1. New Perspectives & New Challenges in Substance Abuse Jane C. Maxwell, Ph.D. Addiction Research Institute The University of Texas at Austin www.utattc.net

2. Data Sources • Overdose death certificates & Medical Examiner Reports • Poison Control Center cases • Treatment admission records (TEDS) • Emergency room data (DAWN) • Price, purity, supply, trafficking data (DEA) • Surveys (NSDUH, MTF,YRBS) • Community Epidemiology Work Group (NIDA) • Forensic laboratory tests (NFLIS, Police & ME Labs) • AIDS cases (Health Department) • Community Epidemiology Work Group (NIDA)

3. Drug Use Patterns Vary over Time and Space

4. Percentage of Drug Items Identified by Toxicological Labs as Heroin by State, 2006 Source: NFLIS

5. Percentage of Drug Items Analyzed by Tox Labs Identified as Cocaine, by State, 2006 Source: NFLIS

6. Percentage of Drug Items Analyzed by Tox Labs Identified as Methamphetamine, by State, 2006 Source: NFLIS

7. % Texas Treatment Admissions by Primary Substance of Abuse: 1987-2009 Source: DSHS

8. And Our Demand for Drugs Influences Drug Use in Our Neighbors

9. Cocaine 10% Cocaine 10% Cocaine 8% Heroin 15% Heroin 9% Cocaine 24% Heroin 10% Meth 35% Meth 22% Heroin 10% Meth 8% Meth 42% Meth 35% Meth 11% Heroin 33% Heroin 31% Heroin 15% Heroin 31% Cocaine 22% Cocaine 64% Cocaine 32% Cocaine 47% Primary Drug of Abuse at Admission to Treatment: 2007 SISVEA & TEDS

11. British Columbia Prairie Provinces Ontario Quebec Atlantic Canada

12. Canadian Methamphetamine Seizures: 1988-2007 Source: Office of Research and Surveillance, Health Canada

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

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

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

16. Heroin Changes • Increasing use by youth nationally. DAWN ED cases for those ages 18-20 increased by 83% between 2006 and 2008. • Texas heroin treatment admissions for those ages 20-29 increased from 35% in 2005 to 41% in 2009; admission for those 40-49 decreased from 22% to 16% in the same period. • So? Cheese Heroin now Heroin. Watch for more and more young users and ways to prevent transition from inhaling to needles.

17. Texas Heroin Admissions by Age Group: 2005-2009 Source: DSHS data; analysis by JC Maxwell

18. Lag Between First Use of Heroin and Admission to Treatment in Texas 1-2 years 2-4 years 10-12 years

19. Other Opiates OxyContin, Vicodin, Darvocet, hydrocodone, oxycodone, methadone, codeine, etc.

20. Source Where Pain Relievers Were Obtained for Most Recent Nonmedical Use among Past Year Users Aged 12 or Older: NSDUH 2006 Source Where Respondent Obtained Bought on Internet0.1% Drug Dealer/Stranger4% Other 15% Source Where Friend/Relative Obtained More than One Doctor 2% More than One Doctor3% Free from Friend/Relative7% Free from Friend/Relative56% One Doctor 19% Bought/Took fromFriend/Relative5% OneDoctor 81% Bought/Took from Friend/Relative15% Drug Dealer/Stranger2% Other 12% 1 The Other category includes the sources: “Wrote Fake Prescription,” “Stole from Doctor’s Office/Clinic/Hospital/Pharmacy,” and “Some Other Way.”

21. COCAINEStill Around—with New Users

22. Cocaine • Different routes of administration—Crack vs. powder. • Injecting cocaine and heroin either together or sequentially (“Speedball”) • Risky sexual behaviors while smoking crack and trading drugs for sex in crack houses. Impact on HIV/AIDS rates. • Changes in characteristics of crack users.

23. Race-Ethnicity of Texas Cocaine Admissions: 1993 v. 2009 Source: DSHS analysis by JC Maxwell

24. Reefer Sadness Marijuana

25. MARIJUANA • Indicators are fairly stable. • Influence of Blunts and Wraps • Use with Fry, PCP, DANK, crack, cough syrup, honey, etc., continues. • Continuing references to pot and PCP and embalming fluid (formaldehyde). • CJ v. Non-CJ treatment admissions

26. % Texas Secondary Students Who Had Used Marijuana in the Past Month, by Ethnicity: 1990-2008 Source: DSHS

27. Ways Texas Secondary Students Used Marijuana Most or Always: 2008 Source: DSHS

28. Relationship of Use of Tobacco, Marijuana & Blunts: 2008 Texas Secondary School Survey

29. Addiction Severity Index Problems of Texans Treated with Primary Marijuana Problem: 2009 Source: DSHS; analysis by JC Maxwell

30. Cannabis Homologs • Synthetic pot containing compounds that mimic THC • Names include K2, K2 summit, spice, spice gold, spice silver, spice diamond, genie, zohai, space, skunk, yucatan fire, halo, black mamba, damiana, drolle. • Not detected in normal drug screens. • Still legal in most of the U.S. • Side effects include chest pain, tachycardia, skin pain, agitation, confusion, hypervenilation.

31. SPICE

33. Alcohol

34. % of Past Month Alcohol Use Among 12 to 20: 2006 to 2008 24.5-27.4%

35. % of Past Month Drinkers 12 to 20 Who Purchased Their Own Alcohol Last Time they Drank: 2006 to 2008 8.4-10.1% 24.5-27.4%

36. % Past Month Alcohol Users in the U.S. Ages 12 to 20: 2005-2006 SAMHSA, The NSDUH Report: Quantity and Frequency of Alcohol Use Among Underage Drinkers, 4/2008

37. Average # Drinks per Day on the Days Used Alcohol among Past Month U.S. Alcohol Users Ages 12 to 20: 2005-2006 SAMHSA, The NSDUH Report: Quantity and Frequency of Alcohol Use Among Underage Drinkers, 4/2008

38. Relationship Between Age of Onset of Drinking and Prevalence of DSM-IV Alcohol Abuse and Dependence: 1994

39. Percentage of Texas Secondary Students Who Reported They Normally Consumed Five or More Drinks at One Time, by Gender: 2000–2008 Liu, L. Texas School Survey of Substance Use Among Students in Grades 7-12, DSHS.

40. Primary Problem of Texas DUI Clients Under Age 21 at Treatment Admission: 1990-2008

41. Binge Drinking and Women • Women binge drinkers engaged in anal sex more often than women who drank alcohol without binges (33% vs. 16%) and 3 times the rate of women who abstained from alcohol (11%). • Having multiple sex partners was more than twice as common among women binge drinkers than women abstainers (41% vs. 17%). • Gonorrhea was nearly 5 times higher among women binge drinkers compared to women abstainers (11% vs. 2%). • Among men, rates of risky sexual behaviors/STDs were high, but did not differ by alcohol use. • The findings support the need to routinely screen for binge drinking as part of clinical care in STD clinics. • Women binge drinkers may benefit from interventions that jointly address binge drinking and risky sexual behaviors. • Developing gender-specific interventions could improve overall health outcomes in this population. Hutton, H. et al., (2008). The Relationship Between Recent Alcohol Use and Sexual Behaviors: Gender Differences Among Sexually Transmitted Disease Clinic Patients, Alcoholism: Clinical and Experimental Research

42. Texas STD Case Rates: 2009

43. % of Weekend Nighttime Drivers with BACs>0.08g/dL in the Four National Roadside Surveys NHTSA Traffic Safety Facts, 2009

44. % of Weekend Nighttime Drivers with BACs>0.08g/dL or Positive for Drugs in the 2007 National Roadside Survey NHTSA Traffic Safety Facts, 2009

45. Primary Problem Substance of Texas DUI Admissions to Treatment 2008 1996 12% 5% 67% 75% Maxwell, Impaired Drivers at Admission to Substance Abuse Treatment, RSA Poster, 2006.

46. Percentage of Texas Seniors Who Had Driven While Drunk or High from Drugs: 1990–2008 Source: DSHS

47. Sources of Amphetamine-Type Substances Sources of ephedrine Major producers of methamphetamine

48. Methamphetamine Forms: Australia Methamphetamine Powder IDU Description: Beige/yellowy/off-white powder Base / Paste Methamphetamine IDU Description: ‘Oily’, ‘gunky’, ‘gluggy’ gel, moist, waxy Crystalline Methamphetamine IDU Description: White/clear crystals/rocks; ‘crushed glass’ / ‘rock salt’

49. $205 million US

50. # Methamphetamine Clandestine Laboratory Incidents and % of All Substances Identified That Were Methamphetamine in the US: 1999-2008 Source: NFLIS & DEA